Aseptic meningitis in a large MMR vaccine campaign (590,609 people) in Curitiba, Paraná, Brazil, 1998  <span class="so-article-trans-title" dir="auto"> Translated title: Meningite asséptica na campanha de vacinação pública tríplice viral (590.609 indivíduos) em Curitiba, Paraná, Brasil, 1998 </span>

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

The aseptic meningitis after Measles-Mumps-Rubella vaccine (MMR) is a well recognized complication, and different incidences have been observed in several studies. We retrospectively analyzed forty cases of aseptic meningitis, during a large public immunization campaign (1998) in Curitiba, Southern Brazil (590,609 people), admitted in our Service. The vaccine utilized was Leningrad-3-Zagreb mumps strain, Edmonston-Zagreb measles strain, and RA 27#3 rubella strain. In all county, a total number of 87 cases were reported, resulting in a incidence of 1.7 cases per 10,000 given doses . The mean age was 23.7 ± 12.8 years. The female:male ratio was 1.35:1. Severe headache with meningismus (92.5%), fever (87.5%), nausea/vomiting (82.5%) were the most common clinical findings. Three cases (7.5%) developed mild mumps. All patients underwent cerebrospinal fluid (CSF) tap with the following findings: mononuclear pleocytosis from 100 to 500 cells/mm³ in 17 cases (42.5%; 257.5 ± 260.6 cells/mm³); increased protein 28 cases (67.5%; 92.1 ± 76.9 mg/dL); glucose was normal in all cases (56.8 ± 11.2 mg/dL) except in 4 (10%) cases, which presented less than 44 mg/dL. All serological tests (latex to bacterial meningitis, Cryptococcus, cysticercosis, VDRL) and bacteriological cultures were negative. Virus identification were also negative in 8 samples. None of the patients had neurological deficits or related symptoms after one year of onset. We believe the benefit of vaccination clearly outweights the incidence of benign vaccine-associated meningitis.

Translated abstract

A incidência de meningite asséptica após vacina tríplice viral (MMR) é diferente em diversos estudos. Analisamos retrospectivamente quarenta casos de meningite asséptica, relacionados a uma campanha de vacinação pública para cobertura tríplice viral em Curitiba, PR, Brasil, ano de 1998. A vacina utilizada foi a Leningrado-3-Zagreb para caxumba, Edmonston-Zagreb para sarampo e RA27#3 para rubéola. Um total de 87 casos foram relatados, resultando em uma incidência de 1,7 casos por 10.000 doses. A idade média dos pacientes foi 23,7 ± 12,8 anos. A relação feminino/masculino foi 1,35:1. Cefaléia intensa com sinais meningorradiculares (92,5%), febre (87,5%), náuseas e vômitos (82,5%) foram os achados clínicos mais comuns. Três casos (7,5%) desenvolveram caxumba branda. Todos os pacientes foram submetidos a punção lombar para obtenção de líquor, com os seguintes achados: pleocitose mononuclear de 100 a 500 células em 17 casos (42,4%; 257 ± 260,6 células/mm³); proteínas aumentadas em 28 casos (67,5%; 92,1 ± 76,9 mg/dL) e glicose (56,8 ± 11,2 mg/dL). Os testes sorológicos (látex para meningites, Cryptococcus, cisticercose, sífilis) e culturas bacteriológicas foram negativas. Identificação viral também foi negativa em 8 casos. Nenhum dos pacientes desenvolveu déficits neurológicos ou sintomas relacionados após um ano do início do quadro. Acreditamos que o benefício da vacinação claramente supera os eventuais efeitos da meningite asséptica após vacinação MMR devido ao seu caráter e evolução benignos.

Related collections

Most cited references 11

Record: found
Abstract: found
Article: not found

Risk of aseptic meningitis after measles, mumps, and rubella vaccine in UK children.

Lee E Miller, M. Goldacre, S Pugh … (1993)

Cases of aseptic meningitis associated with measles/mumps/rubella vaccine were sought in thirteen UK health districts following a reported cluster in Nottingham which suggested a risk of 1 in 4000 doses, substantially higher than previous estimates based on cases reported by paediatricians (4 per million). Cases were ascertained by obtaining vaccination records of children with aseptic meningitis diagnosed from cerebrospinal fluid samples submitted to Public Health Laboratories or discharged from hospital with a diagnosis of viral meningitis. Both methods identified vaccination 15-35 days before onset as a significant risk factor and therefore indicative of a causal association. With both, half the aseptic meningitis cases identified in children aged 12-24 months were vaccine-associated with onset 15-35 days after vaccine. The study confirmed that the true risk was substantially higher than suggested by case reports from paediatricians, probably about 1 in 11,000 doses. However, the possibility that the aseptic meningitis induced by vaccination was largely asymptomatic and a chance laboratory finding in children investigated for other clinical conditions, particularly febrile convulsions, could not be excluded. Comparison of national reports of virus-positive mumps meningitis cases before and after the introduction of this vaccine indicated that the risk from wild mumps was about 4-fold higher than from vaccine. Altogether, 28 vaccine-associated cases were identified, all in recipients of vaccines containing the Urabe mumps strain. The absence of cases in recipients of vaccine containing the Jeryl Lynn strain, despite its 14% market share, suggested a higher risk from Urabe vaccine. A prospective adverse event surveillance system using the study methods is currently being established to assess the risk, if any, from the Jeryl Lynn strain which is now the only mumps vaccine used in the UK.

0 comments Cited 23 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Aseptic meningitis as a complication of mumps vaccination.

A Sugiura, A. L.M. Yamada (1991)

In 1989 a nationwide surveillance of neurologic complications after the administration of mumps vaccine was conducted in Japan, based on the notification of cases and the testing of mumps viruses isolated from cerebrospinal fluid for their relatedness to the vaccine by nucleotide sequence analysis. Among 630,157 recipients of measles-mumps-rubella trivalent (MMR) vaccine containing the Urabe Am9 mumps vaccine, there were at least 311 meningitis cases suspected to be vaccine-related. In 96 of these 311 cases, mumps virus related to the vaccine was isolated from cerebrospinal fluid. The unusually high incidence may have been partly a result of the adverse media publicity of the problem at the time of surveillance. We analyzed clinical features of 165 and 27 laboratory-confirmed mumps vaccine-related meningitis cases that occurred among the recipients of MMR and monovalent mumps vaccines, respectively, during a 1-year period after the introduction of MMR vaccine. The incidence of vaccine-related meningitis was similar among the recipients of MMR and monovalent Urabe Am9 mumps vaccines. Meningitis was generally mild and there were no sequelae from the illness. The complication was more frequent among male than among female children.