Tags

Type your tag names separated by a space and hit enter

A clinician's perspective on yellow fever vaccine-associated neurotropic disease.
J Travel Med. 2020 11 09; 27(7)JT

Abstract

Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. YF vaccination results in long-lasting protective immunity. Serious adverse events (SAEs), such as YF vaccine-associated neurotropic disease (YEL-AND) are rare. We present a case of a 56-year-old Caucasian man with fever, headache, cognitive problems at the emergency department. He received a primary YF vaccination 4 weeks prior to symptom onset. Cerebrospinal fluid tested positive (POS) for YF virus by reverse transcriptase polymerase chain reaction and confirmed diagnosis of YEL-AND. The patient recovered with symptomatic treatment. We reviewed published clinical reports on YEL-AND indexed for MEDLINE. We identified and analyzed 53 case reports. Forty-five patients were male and eight were female. Twenty-nine cases met criteria for definite YEL-AND and twenty-four for suspected YEL-AND according to YF Vaccine Safety Working Group. We applied the Brighton Collaboration diagnostic criteria to assess the diagnostic accuracy of the clinical diagnoses and found meningoencephalitis in 38 reported YEL-AND cases, Guillain Barré Syndrome (GBS) in seven, Acute Disseminated Encephalomyelitis (ADEM) in six and myelitis in five. Thirty-five patients recovered or improved; however, not all cases had a complete follow-up. The prognosis of YEL-AND presenting with GBS, ADEM or myelitis was poor. Fourteen patients received therapy (corticosteroids, intravenous immunoglobulins and/or plasmapheresis). In conclusion, YF vaccine-associated neurotropic disease is a very rare but SAE after YF vaccination. We described a case of YEL-AND and propose a standardized clinical workup of this condition based on a review of the literature. Centralized registration of complications of YF vaccination is encouraged.

Authors+Show Affiliations

Department of Neurology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.Department of Neurology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.Department of Clinical Biology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses- ZBS-1, Robert Koch Institute, Seestraβe 10, 13353, Berlin, Germany.Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium.Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

32965473

Citation

Lecomte, Elien, et al. "A Clinician's Perspective On Yellow Fever Vaccine-associated Neurotropic Disease." Journal of Travel Medicine, vol. 27, no. 7, 2020.
Lecomte E, Laureys G, Verbeke F, et al. A clinician's perspective on yellow fever vaccine-associated neurotropic disease. J Travel Med. 2020;27(7).
Lecomte, E., Laureys, G., Verbeke, F., Domingo Carrasco, C., Van Esbroeck, M., & Huits, R. (2020). A clinician's perspective on yellow fever vaccine-associated neurotropic disease. Journal of Travel Medicine, 27(7). https://doi.org/10.1093/jtm/taaa172
Lecomte E, et al. A Clinician's Perspective On Yellow Fever Vaccine-associated Neurotropic Disease. J Travel Med. 2020 11 9;27(7) PubMed PMID: 32965473.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A clinician's perspective on yellow fever vaccine-associated neurotropic disease. AU - Lecomte,Elien, AU - Laureys,Guy, AU - Verbeke,Frederick, AU - Domingo Carrasco,Cristina, AU - Van Esbroeck,Marjan, AU - Huits,Ralph, PY - 2020/07/15/received PY - 2020/09/09/revised PY - 2020/09/10/accepted PY - 2020/9/24/pubmed PY - 2021/7/29/medline PY - 2020/9/23/entrez KW - ADEM KW - GBS KW - Yellow fever vaccination KW - encephalitis KW - meningitis KW - myelitis KW - serious adverse events JF - Journal of travel medicine JO - J Travel Med VL - 27 IS - 7 N2 - Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. YF vaccination results in long-lasting protective immunity. Serious adverse events (SAEs), such as YF vaccine-associated neurotropic disease (YEL-AND) are rare. We present a case of a 56-year-old Caucasian man with fever, headache, cognitive problems at the emergency department. He received a primary YF vaccination 4 weeks prior to symptom onset. Cerebrospinal fluid tested positive (POS) for YF virus by reverse transcriptase polymerase chain reaction and confirmed diagnosis of YEL-AND. The patient recovered with symptomatic treatment. We reviewed published clinical reports on YEL-AND indexed for MEDLINE. We identified and analyzed 53 case reports. Forty-five patients were male and eight were female. Twenty-nine cases met criteria for definite YEL-AND and twenty-four for suspected YEL-AND according to YF Vaccine Safety Working Group. We applied the Brighton Collaboration diagnostic criteria to assess the diagnostic accuracy of the clinical diagnoses and found meningoencephalitis in 38 reported YEL-AND cases, Guillain Barré Syndrome (GBS) in seven, Acute Disseminated Encephalomyelitis (ADEM) in six and myelitis in five. Thirty-five patients recovered or improved; however, not all cases had a complete follow-up. The prognosis of YEL-AND presenting with GBS, ADEM or myelitis was poor. Fourteen patients received therapy (corticosteroids, intravenous immunoglobulins and/or plasmapheresis). In conclusion, YF vaccine-associated neurotropic disease is a very rare but SAE after YF vaccination. We described a case of YEL-AND and propose a standardized clinical workup of this condition based on a review of the literature. Centralized registration of complications of YF vaccination is encouraged. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/32965473/A_clinician's_perspective_on_yellow_fever_vaccine_associated_neurotropic_disease_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/taaa172 DB - PRIME DP - Unbound Medicine ER -