A clinician's perspective on yellow fever vaccine-associated neurotropic disease

Elien Lecomte, Guy Laureys, Frederick Verbeke, Cristina Domingo Carrasco, Marjan Van Esbroeck, Ralph Huits

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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 Barre 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.

Original languageEnglish
Article number172
JournalJournal of Travel Medicine
Volume27
Issue number7
Number of pages8
ISSN1195-1982
DOIs
Publication statusPublished - 2020

Keywords

  • Yellow fever vaccination
  • serious adverse events
  • meningitis
  • encephalitis
  • GBS
  • ADEM
  • myelitis
  • SERIOUS ADVERSE EVENTS
  • OUTCOME MEASURES
  • CASE DEFINITIONS
  • IMMUNIZATION
  • 17D
  • VIRUS
  • MENINGOENCEPHALITIS
  • SURVEILLANCE
  • ENCEPHALITIS
  • COLLECTION

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