Serious adverse event: late neurotropic disease associated with yellow fever vaccine

Abstract

The yellow fever is a systemic disease that was under control due to the effective campaigns against the vector and promotion of vaccines programs. However, since 1999, outbreaks appeared because of inefficient control of the vector, and led to the need of amplifying the immunization in large scale against the yellow fever virus, and consequently, raising the risk of adverse reactions to the vaccine. We report a case of previously healthy infant, who was referred to our care service, after 3 days with fever, chills, nausea and vomits, he received support therapy and was discharged from the hospital. After 24 hours of supportive measures, he was discharge. The patient returned to our service with general condition decline, strabismus, inability to control of cervical musculature and reduced force of the legs. The patient vaccine had received all vaccines from the calendar, and he was vaccinated for yellow fever 20 days before symptoms. During the hospitalization, liquor was collected, and ceftriaxone and aciclovir were administered. After negative cultures from the liquor, the antibiotics were suspended. The computed tomography of patient's brain showed no alterations. Research for antibodies against yellow fever was requested, being positive for IgM in the liquor, and confirming the neurotropic disease associated with the yellow fever vaccine. On the fifth day of hospitalization, the patient showed improvement on the strabismus, cervical tonus, and musculature force. On the tenth day of hospitalization, patient showed complete improvement, and his laboratory exams no alterations. Subsequently, patient was discharged. The vaccine against yellow fever is safe, efficient and highly recommended, however it is not completely free from serious adverse reactions, including death.

Yellow Fever Vaccine-Related Neurotropic Disease in Brazil Following Immunization with 17DD

“…The administered 17DD vaccine is manufactured in Brazil by Bio-Manguinhos/Fiocruz, and it has been routinely used in several South American countries, while the 17D-204 vaccine is used outside Brazil and manufactured by Sanofi-Pasteur (France), Pasteur Institute Dakar (Senegal) and Federal State Budgetary Scientific Institution (Russia) [ 6 , 10 ]. Both are considered safe and effective, despite very rare cases of serious adverse events (SAEs) [ 8 ] commonly manifested as disorders affecting the immune response and the nervous system [ 11 , 12 , 13 , 14 , 15 ]. The risk of SAEs following immunization is higher in pregnant woman, thymus disorders, infants (6–8 months of age), or persons over 60 years of age [ 11 , 12 , 13 , 14 , 15 ].…”

“…Both are considered safe and effective, despite very rare cases of serious adverse events (SAEs) [ 8 ] commonly manifested as disorders affecting the immune response and the nervous system [ 11 , 12 , 13 , 14 , 15 ]. The risk of SAEs following immunization is higher in pregnant woman, thymus disorders, infants (6–8 months of age), or persons over 60 years of age [ 11 , 12 , 13 , 14 , 15 ]. Due to these risks, the Brazilian National Immunization Program applies the first dose of 17DD in infants at nine months of age, with a booster at four years of age.…”

“…The Brazilian Ministry of Health defines as a confirmed case of YEL-AND the presence of the following criteria: (a) symptom onset between one and 30 days after YF vaccination; (b) clinical presentation compatible with neurotropic disease; (c) CSF indicative of viral meningoencephalitis; (d) the exclusion of other causes; and (e) laboratory detection in CSF of the YFV vaccine by viral isolation, amplification, or by the presence of the anti-YFV IgM antibody [ 7 ]. Considering that the YFV IgM antibody does not cross the blood–brain barrier due to its high molecular weight, its presence in CSF may be considered as locally produced and indicative of CNS infection [ 14 , 16 ]. Beyond these criteria, the diagnosis of YF vaccine-related meningoencephalitis may be corroborated by complementary exams, such as neuroimaging.…”

“…We also carried out a short review using the main databases (PubMed, Lilacs, and Medline) using the keywords “YELLOW FEVER” AND “NEUROTROPIC” or “YELLOW FEVER VACCINE” AND ”NEUROLOGICAL” AND ” ADVERSE EVENT”, resulting in 24 articles reporting several cases of YEL-AND summarized in Table A1 [ 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The data showed that adults and the elderly had a higher risk for development of SAEs, and the highest occurrence of SAEs were associated with the 17D-204 vaccine and presented after administration of the first dose [ 11 , 15 , 16 ].…”

Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil

“…There is no specific treatment for adverse events associated with the yellow fever vaccine [ 138 ]. Because the lethality of YFV infections is significantly higher than the incidence of side effects that may be triggered by the vaccination, vaccination against yellow fever is strongly recommended in areas at risk [ 139 ].…”