Transverse myelitis associated with yellow fever vaccination

Abstract

Yellow fever is a mosquito-borne viral hemorrhagic fever endemic to sub-Saharan Africa and South America associated with significant morbidity and mortality. The use of a live attenuated vaccine can prevent yellow fever, but vaccine-associated neurologic disease has been reported and is a safety concern. We present the case of a previously healthy 35-year-old active-duty man who received the yellow fever vaccine prior to deployment and subsequently developed progressive neurologic dysfunction consistent with transverse myelitis. KEYWORDS Transverse myelitis; yellow fever; yellow fever vaccine-associated neurologic disease Y ellow fever (YF) is a mosquito-borne viral hemorrhagic fever endemic to sub-Saharan Africa and South America with significant morbidity and mortality. The World Health Organization estimates that 200,000 cases occur each year. 1,2 YF can result in severe illness with hepatic dysfunction, renal failure, coagulopathy, and shock. 3 Supportive care is the mainstay of therapy, because there is no specific treatment for YF. Primary prevention with the YF vaccine is pivotal in reducing its incidence. The Centers for Disease Control and Prevention recommends YF vaccination for travelers to and residents of endemic areas aged 9 months and older. The YF vaccine was developed in 1937, with over 600 million doses administered to date, and has been described as a safe vaccine with rare cases of serious adverse reactions. 4 YF vaccine-associated neurologic disease has been reported by the Yellow Fever Working Group. Encephalitis, meningoencephalitis, Guillain-Barre syndrome, and acute disseminated encephalomyelitis are among the most frequently described neurologic complications. These complications account for 0.4 to 0.8 cases per 100,000 doses, as reported to the Vaccine Adverse Event Reporting System. 5 We present the case of a 35-yearold active-duty man who received the YF vaccine prior to deployment and subsequently developed progressive neurologic dysfunction consistent with transverse myelitis.

Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature

“…The most common reported vaccine-related myelitis was due to influenza vaccine (H1N1) (7 out of 20 cases) [ 19 – 25 ] followed by myelitis due to hepatitis B vaccine (3 of the 20 cases) [ 12 – 14 ]. Other causes of vaccine-related transverse myelitis included COVID-19 (SARS-CoV-2) vaccine [ 42 ], Japanese B encephalitis [ 11 ], Measles, Mumps and Rubella (MMR), inactivated Rabies vaccine [ 18 ], Diphtheria, tetanus and acellular pertussis (DTaP) vaccine [ 7 ], typhoid Vi capsular polysaccharide vaccine [ 17 ], oral Polio vaccine (OPV) [ 10 ], Yellow fever [ 15 , 16 ].…”

“…Transverse myelitis (TM) is a very uncommon condition, and rarer is the vaccine-associated TM. However, some studies have reported its occurrence following administration of other vaccines, including diphtheria, tetanus toxoids and pertussis vaccine [ 7 ], measles, mumps, and rubella (MMR) virus vaccine [ 8 , 9 ], oral poliovirus vaccine [ 10 ], Japanese encephalitis virus vaccine [ 11 ], hepatitis B vaccine [ 12 – 14 ], yellow fever vaccine [ 15 , 16 ], typhoid vaccine [ 17 ], rabies vaccine [ 18 ], and seasonal influenza virus vaccine [ 19 – 25 ]. In addition, only oral polio vaccine was found to have a pathogenic causal relationship while other vaccines showed a temporal relationship to TM due to a common denominator such as an adjuvant [ 26 ].…”

Infection-Related Myelopathies

“…Postinfectious TM accounts for approximately 30-60% of cases of idiopathic TM (14, 85, 86) and is more common in children than adults (87). It is often monophasic with neurologic symptom onset 2-6 weeks after a minor infectious episode, such as a viral upper respiratory tract infection, or vaccination (85,86,(88)(89)(90). Although the exact pathophysiology is not completely understood, postinfectious TM is thought to involve an autoimmune inflammatory response triggered by cross-reactivity of pathogen and host antigens (91).…”

Disease Resurgence, Production Capability Issues and Safety Concerns in the Context of an Aging Population: Is There a Need for a New Yellow Fever Vaccine?

“…YEL-AND tends to affect young infants, immunocompromised individuals, and the elderly. The incidence of YEL-AND is 2.2 cases per 100,000 vaccine doses among vaccine recipients ≥60 years old [110][111][112]. In 2009, the first case of encephalitis in an infant was confirmed to be caused by YF vaccine virus transmitted via breastmilk [113][114][115].…”