Incidence of Yellow Fever Vaccine-Associated Neurotropic Disease

Abstract

Abstract. Although the yellow fever 17D strain live-attenuated vaccine has been widely used over the past seven decades with a long history of safe records, recent reports of serious, sometimes fatal, adverse events, raised concerns about its tolerance. We extracted all cases of serious neurologic adverse events that occurred within 30 days of yellow fever vaccination in our institution during [2000][2001][2002][2003][2004][2005][2006][2007][2008]. Four cases (meningitis, n = 2 and meningo-encephalitis, n = 2) were identified. The male:female ratio was 3:1, and ages ranged from 21 to 55 years. Cerebrospinal fluid examination showed pleocytosis (10-82 cells/mm 3 , 64-84% lymphocytes), with slightly elevated protein levels (0.4-0.68 g/L). All symptoms resolved in three patients, but attention disorder and cerebellar syndrome persisted in one patient (at six months followup). The incidence of yellow fever vaccine-associated serious neurologic events was estimated to be 9.9/100,000 vaccine doses (95% confidence interval = 2.7-25.4/100,000) in this study, which was 10 times higher than previous estimates that did not include acute meningitis.

Review of the risks and benefits of yellow fever vaccination including some new analyses

“…A tenfold higher incidence (9.9 per 100,000 doses) of neurological disease in adults based on temporal association with 17D vaccine was reported from a hospital in France between 2000 and 2008 [29]. Although cerebrospinal fluid (CSF) pleocytosis was present in all of the four cases detected in this interval, YF IgM antibodies were demonstrated in the CSF of only one case of aseptic meningitis.…”

Infant meningoencephalitis probably caused by yellow fever vaccine virus transmitted via breastmilk

“…A maior parte das reações adversas descritas é leve, como mialgia, febre, cefaleia, dor no local da injeção e reações alérgicas 2 . Vários relatos de eventos adversos potencialmente fatais ou fatais associados a essa vacina têm sido descritos, sendo que a maioria ocorre após a primeira dose [2][3][4]6 . Os eventos adversos neurológicos incluem: meningoencefalite (doença neurotrópica, causada diretamente pela ação do vírus vacinal), encefalomielite disseminada aguda, Síndro-me de Guillain-Barré e paralisia bulbar, que caracterizam manifestações autoimunes relacionadas à vacinação 2 .…”

“…Essa doença é endêmica em 12 estados do Brasil, manifestando-se de forma epidêmica em outras regiões 1 , e não existe, até o momento, tratamento específico para ela 2,3 . A vacina é a principal estratégia de saúde pública no controle da enfermidade.…”

“…São descritos vários eventos adversos leves pós-vacinais, como cefaleia, mialgia e dor no local da aplicação. Entre os eventos adversos graves destacam-se: anafilaxia, doenças neurológicas e doença viscerotrópica, quadros potencialmente fatais [1][2][3][4] . Entre outubro de 2008 e julho de 2009, no estado do Rio Grande do Sul, foram notificadas mortes de primatas em várias regiões, sendo diagnosticada febre amarela como causa da morte da maioria dos animais.…”

Evaluation of Safety Profile of Yellow Fever Vaccine in Healthy Indian Travellers: A Prospective Observational Study

“…None of these had required any intervention or treatment [7][8][9][10][11]. There are reports of the neurotropic adverse event cases after YFV; however, these cases have good prognosis, which should not contraindicate the use of YFV in risk of yellow fever virus infection [12][13][14][15][16][17].…”