Yellow Fever Vaccination and Kawasaki Disease

Schmoeller, Deonilson Ghizoni; Keiserman, Mauro Waldemar; Staub, Henrique Luiz; Velho, Flávio Petersen; Grohe, Marily de Fátima

doi:10.1097/inf.0b013e3181bbc571

Cited by 24 publications

(9 citation statements)

References 6 publications

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“…A case of multiple evanescent white dot syndrome, an inflammatory disorder of the retina, was reported in a 50-yearold woman who developed rapidly progressive but subsequently reversible visual loss starting 10 days after 17D and hepatitis A vaccination [116]. A case of Kawasaki disease in a 12-year-old male with onset 20 days after 17D vaccination is described [117]. Another unusual case involved autoimmune hepatitis 11 days after 17D and hepatitis A vaccines [118].…”

Section: Other Rare Adverse Events Temporally Related To 17d Vaccinementioning

confidence: 96%

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

Monath

2012

Expert Review of Vaccines

126

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The live, attenuated yellow fever (YF) 17D vaccine provides highly effective and durable immunity and is widely used for travelers to and residents of endemic areas of South America and Africa. Neurotropic and viscerotropic serious adverse events associated with these vaccines occur rarely, but YF 17D vaccine-associated viscerotropic disease (YEL-AVD) is notable for its lethality. There appear to be two distinct patterns of risk for YEL-AVD: the first in younger persons, particularly women, with defects in innate immunity, in whom the case-fatality rate is higher; and the second in elderly persons, particularly men with age-related immune senescence and a lower case-fatality rate. From 1990 to the present, the number of cases (n = 31) and deaths (n = 12) from YEL-AVD in travelers has exceeded the reports of YF (n = 6) acquired by natural infection, raising the question whether the risk of vaccination exceeds the benefit in travelers. To provide some guidance on this point, the rate of vaccine-related injury is compared with the rate of naturally acquired disease in a new analysis that estimates the immunologically susceptible denominator population in YF endemic and epidemic areas. For many years, the risk of vaccine-related illness and death was similar to the risk of illness and death from natural infection with YF in South America. Africa posed a substantially higher estimated risk of wild-type YF than vaccine-related injury. Multiple factors should be considered in making decisions about YF vaccination, including specific destination, season of the year, local evidence for YF transmission, likelihood of exposure to vector mosquitoes and individual risk factors for YEL-AVD, with the goal of increasing vaccine coverage for travel to high-risk areas and reducing unnecessary vaccination. Prospects for future, safer vaccines are also described.

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Section: Other Rare Adverse Events Temporally Related To 17d Vaccinementioning

confidence: 96%

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

Monath

2012

Expert Review of Vaccines

126

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“…Although there are no evidences relating that viral infections can modulate the expression of AIRE in human or murine thymus, we hypothesize that the inhibition of this gene during the YFV17D immunization could contribute to the onset of autoimmune manifestations associated with vaccination. We raised this hypothesis due to several evidences suggesting the onset of autoimmune diseases as a result of viral infections and immunizations [ 44 , 46 ] and, more particularly, due to the important role of AIRE in the TRA expression regulation during thymic selection [ 2 , 7 ]. Decreased levels of AIRE may imply a defective negative selection, therefore releasing autoreactive clones of T cells to peripheral tissues [ 2 , 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, it has been reported that live virus attenuated vaccines are associated with autoimmune diseases [ 42 – 44 ]. Particularly, immunization with YFV17D has been related to several cases of longitudinal myelitis and Kawasaki disease [ 45 , 46 ].…”

Section: Introductionmentioning

confidence: 99%

The Attenuated Live Yellow Fever Virus 17D Infects the Thymus and Induces Thymic Transcriptional Modifications of Immunomodulatory Genes in C57BL/6 and BALB/C Mice

Melo-Lima

Espósito

Fonseca

et al. 2015

Autoimmune Diseases

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Thymus is involved in induction of self-tolerance in T lymphocytes, particularly due to Aire activity. In peripheral tissues, Treg cells and immunomodulatory molecules, like the major histocompatibility complex (MHC) class Ib molecules, are essential for maintenance of autotolerance during immune responses. Viral infections can trigger autoimmunity and modify thymic function, and YFV17D immunization has been associated with the onset of autoimmunity, being contraindicated in patients with thymic disorders. Aiming to study the influence of YFV17D immunization on the transcriptional profiles of immunomodulatory genes in thymus, we evaluated the gene expression of AIRE, FOXP3, H2-Q7 (Qa-2/HLA-G), H2-T23 (Qa-1/HLA-E), H2-Q10, and H2-K1 following immunization with 10,000 LD50 of YFV17D in C57BL/6 and BALB/c mice. The YFV17D virus replicated in thymus and induced the expression of H2-Q7 (Qa-2/HLA-G) and H2-T23 (Qa-1/HLA-E) transcripts and repressed the expression of AIRE and FOXP3. Transcriptional expression varied according to tissue and mouse strain analyzed. Expression of H2-T23 (Qa-1/HLA-E) and FOXP3 was induced in thymus and liver of C57BL/6 mice, which exhibited defective control of viral load, suggesting a higher susceptibility to YFV17D infection. Since the immunization with YFV17D modulated thymus gene expression in genetically predisposed individuals, the vaccine may be related to the onset of autoimmunity disorders.

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“…One month later, the child exhibited improved echocardiographic parameters and good recovery. The child remained asymptomatic and continued low-dose-aspirin therapy according to the authors of the publication [17]. …”

Section: Resultsmentioning

confidence: 99%

Occurrence of Autoimmune Diseases Related to the Vaccine against Yellow Fever

Oliveira

Mota

Santos-Neto

et al. 2014

Autoimmune Diseases

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Yellow fever is an infectious disease, endemic in South America and Africa. This is a potentially serious illness, with lethality between 5 and 40% of cases. The most effective preventive vaccine is constituted by the attenuated virus strain 17D, developed in 1937. It is considered safe and effective, conferring protection in more than 90% in 10 years. Adverse effects are known as mild reactions (allergies, transaminases transient elevation, fever, headache) and severe (visceral and neurotropic disease related to vaccine). However, little is known about its potential to induce autoimmune responses. This systematic review aims to identify the occurrence of autoinflammatory diseases related to 17D vaccine administration. Six studies were identified describing 13 possible cases. The diseases were Guillain-Barré syndrome, multiple sclerosis, multiple points evanescent syndrome, acute disseminated encephalomyelitis, autoimmune hepatitis, and Kawasaki disease. The data suggest that 17D vaccination may play a role in the mechanism of loss of self-tolerance.

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Yellow Fever Vaccination and Kawasaki Disease

Cited by 24 publications

References 6 publications

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

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

The Attenuated Live Yellow Fever Virus 17D Infects the Thymus and Induces Thymic Transcriptional Modifications of Immunomodulatory Genes in C57BL/6 and BALB/C Mice

Occurrence of Autoimmune Diseases Related to the Vaccine against Yellow Fever

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