Transient bulging fontanelle after vaccination: case report and review of the vaccine adverse event reporting system

OBJECTIVE: To describe the features of transient bulging fontanelle (TBF) after vaccination. STUDY DESIGN: We searched the Vaccine Adverse Event Reporting System database for reports describing bulging fontanelle. We defined a definite TBF case as a patient with a bulging fontanelle, normal neuroimaging and cerebrospinal fluid analysis, and absence of a depressed level of consciousness, focal neurologic findings, or identified cause. Follow-up had to reveal normal development. Probable cases lacked either lumbar puncture or neuroimaging or both but met all other criteria. RESULTS: We identified 18 patients with definite or probable TBF. The median age at presentation was 4.5 months, interval from vaccination to symptom onset was 18 hours, and time to resolution was 3 days. Fifteen children were febrile. CONCLUSIONS: We cannot conclude that vaccines cause TBF. Further controlled studies are necessary. Even if further research verifies TBF as a rare side effect, immunization benefits would still vastly outweigh this hypothetical risk. However, confirmation of a vaccine association could modify the management of infants who develop TBF after immunizations.     

Immunosuppression after measles vaccination

The influence of conventional live attenuated measles vaccine on cellular immune responsiveness was investigated in Sweden and Guinea-Bissau. Sixteen children in a residential area in Bissau and 16 living in southern Stockholm were examined before and 8–10 days after vaccination. Lymphoproliferation was measured to concanavalin A (con-A), PPD and tetanus toxoid (TT) using a whole-blood ³H-thymidine incorporation assay. Stimulation indices were significantly lower after vaccination than before, in the case of con-A ( p = 0.03) and TT ( p = 0.01) in the Guinean children and in the case of PPD ( p = 0.009) and TT ( p = 0.03) in the Swedish children. Stimulation of lymphocytes from measles-immune children with measles antigens resulted in weak lymphoproliferative responses. These observations may be relevant to the increased mortality found in children immunized with high-titre measles vaccines, as compared to controls, in recent studies. The study confirms the applicability and usefulness under field conditions of the whole blood version of the thymidine incorporation assay.     

Arthritis after mumps and measles vaccination.

Measles, mumps, and rubella vaccine carries a risk of joint symptoms particularly in children under 5 years. A boy who presented with an inflamed knee after measles and mumps vaccination is reported; synovial fluid aspirated from the joint contained 4.3 x 10(9)/l leucocytes. It is thought that the mumps component is the aetiological cause of acute monoarthritis.     

Transverse myelitis after measles and rubella vaccination

The incidence of severe neurological complications associated with measles or rubella vaccination is low. A 9-year-old girl developed urinary retention and lower limb paralysis 16 days after measles and rubella vaccination. Her illness was diagnosed as transverse myelitis. Clinical, laboratory and magnetic resonance image findings were consistent with her diagnosis. She was treated with steroids and discharged with only mild lower limb weakness.     

Measles vaccination after exposure to natural measles

When an extensive measles epidemic broke out in Turku in late 1975, the availability of a previous study on measles vaccination reactions in 442 children permitted a comparative evaluation to be made on reactions to and the efficacy of measles vaccine (Schwartz strain) administered after exposure to natural measles. In a preliminary study, nine children were vaccinated one to 14 days after exposure to natural measles but before prodromal symptoms appeared. Only one of these nine children developed symptoms and signs comparable to those of the natural disease. In five day-care centers the children were vaccinated when five or more children out of 30 to 40 at each center had measles. In only five of 74 exposed children were the signs and symptoms comparable to those of natural measles. No marked differences in signs and symptoms after the vaccinations were observed between the exposed and nonexposed children. It is concluded that vaccination is safe, can usually prevent measles, even when administered after a prolonged interval following exposure to natural disease, and can usually control an epidemic in progress.     

Seroconversion in different age groups after measles vaccination

Seroconversion following measles immunisation was studied in 439 children aged below 9 to 25 months. The anlaysis of age specific seroconversion rate revealed that only 78 · 9 per cent children in the age group below 9 months was seroconversion rate was not observed with further increase in the age of immunisation. The finding supports the recommendation that 9–12 months is the earliest age for satisfactory active immunisation against measles in India. The use of potent measles vaccine in the immunisation programme was monitored by potency testing of samples recalled from the field.     

Aseptic meningitis after vaccination against measles and mumps

This retrospective study (1979 to 1986) investigated the possible etiologic relationship between vaccination and aseptic meningitis in 115 hospitalized children who became ill within 30 days of vaccination with the Leningrad 3 strain of mumps virus and the Edmonston-Zagreb strain of measles virus. The etiologic viral diagnosis was based on serologic tests and the isolation of virus from cell cultures which distinguished between attenuated and "virulent" mumps virus. The incidence of mumps vaccine-associated meningitis was 1/1000 vaccine recipients. In 92% of children the incubation period was 11 to 25 days and 28% had associated swelling of the salivary glands. Sixteen cases (13.9%) had a positive cerebrospinal fluid culture (attenuated mumps virus, 6 cases; "virulent" mumps virus, 7 cases; echoviruses, 3 cases). Clustering of cases, seasonal occurrence and age of the patients suggested causal relationship with the vaccination in the majority of children. In 4 patients with attenuated virus isolation from cerebrospinal fluid the incubation period ranged from 17 to 20 days. Clinical findings did not differ from natural mumps meningitis. The course was uncomplicated and at discharge the patients had no sequelae. Measles virus was never found as a cause of the meningitis. The mumps vaccine virus should be recognized as one of the causative agents of aseptic meningitis in countries where less attenuated mumps vaccine is used.     

Seroconversion after measles vaccination at nine and fifteen months of age

BACKGROUND: Despite high vaccination coverage, single dose measles immunization programs have been unsuccessful in eliminating the disease. Because seroconversion rates are lower in infants vaccinated before 12 months of age, a second dose of measles vaccine is recommended at 15 months. The aim of this study was to determine the seroconversion rates in children after the first and second doses of measles vaccinations at 9 and 15 months of age. METHODS: Study population comprised 116 infants attending the Well Baby Clinic of Istanbul University, Faculty of Medicine. Serum specimens were obtained from children before and 1 month after the first measles (Rouvax, Schwarz strain 1000 TCID(50)) vaccine given at 9 months. A second dose was given to 72 children at 15 months of age as measles-mumps-rubella (Trimovax, Schwarz measles strain, 1000 TCID(50); Urabe Am 9 mumps strain, 5000 TCID(50); Wister RA 27/3 rubella strain, 1000 TCID(50)). Third blood samples were collected 20 months after the second vaccine. RESULTS: Passive antibody positivity rate was 5.2% at the age of 9 months. Seroconversion rate was 77.6% after the first dose and 81.9% after the second dose of measles vaccine. Of 15 children who were seronegative, 13 (86.7%) became seropositive after the immunization at 15 months. Eleven children (19.2%) seroconverted from positive to negative after the second vaccine. CONCLUSION: The two dose schedule seems to increase the seropositivity rate. Our findings also indicate that increasing vaccination coverage and revaccination at 6 years of age are important even with the early two dose schedule.     

Haemophagocytic lymphohistiocytosis following measles vaccination

A 19-month-old girl developed haemophagocytic lymphohistiocytosis following a measles vaccination. She developed persistent high fever 1 week after vaccination, and then showed pancytopenia, liver dysfunction and hepatosplenomegaly with marked haemophagocytosis. Based on the clinical and laboratory findings, she was diagnosed as having haemophagocytic lymphohistiocytosis probably due to measles vaccination. She did not respond fully to first-line immunosuppressive therapy and required immunochemotherapy with cytotoxic drugs. CONCLUSION: To the best of our knowledge, this is the first detailed report of haemophagocytic lymphohistiocyosis associated with measles vaccination documented in the English literature. Haemophagocytic lymphohistiocyosis should be kept in mind as one of the rare adverse effects of vaccination.