Adverse events following yellow fever immunization: Report and analysis of 67 neurological cases in Brazil.

Neurological adverse events following administration of the 17DD substrain of yellow fever vaccine (YEL-AND) in the Brazilian population are described and analyzed. Based on information obtained from the National Immunization Program through passive surveillance or intensified passive surveillance, from 2007 to 2012, descriptive analysis, national and regional rates of YFV associated neurotropic, neurological autoimmune disease, and reporting rate ratios with their respective 95% confidence intervals were calculated for first time vaccinees stratified on age and year. Sixty-seven neurological cases were found, with the highest rate of neurological adverse events in the age group from 5 to 9 years (2.66 per 100,000 vaccine doses in Rio Grande do Sul state, and 0.83 per 100,000 doses in national analysis). Two cases had a combination of neurotropic and autoimmune features. This is the largest sample of YEL-AND already analyzed. Rates are similar to other recent studies, but on this study the age group from 5 to 9 years of age had the highest risk. As neurological adverse events have in general a good prognosis, they should not contraindicate the use of yellow fever vaccine in face of risk of infection by yellow fever virus.

Surveillance for yellow Fever virus in non-human primates in southern Brazil, 2001-2011: a tool for prioritizing human populations for vaccination.

In Brazil, epizootics among New World monkey species may indicate circulation of yellow fever (YF) virus and provide early warning of risk to humans. Between 1999 and 2001, the southern Brazilian state of Rio Grande do Sul initiated surveillance for epizootics of YF in non-human primates to inform vaccination of human populations. Following a YF outbreak, we analyzed epizootic surveillance data and assessed YF vaccine coverage, timeliness of implementation of vaccination in unvaccinated human populations. From October 2008 through June 2009, circulation of YF virus was confirmed in 67 municipalities in Rio Grande do Sul State; vaccination was recommended in 23 (34%) prior to the outbreak and in 16 (24%) within two weeks of first epizootic report. In 28 (42%) municipalities, vaccination began more than two weeks after first epizootic report. Eleven (52%) of 21 laboratory-confirmed human YF cases occurred in two municipalities with delayed vaccination. By 2010, municipalities with confirmed YF epizootics reported higher vaccine coverage than other municipalities that began vaccination. In unvaccinated human populations timely response to epizootic events is critical to prevent human yellow fever cases.

Prospective evaluation of pregnant women vaccinated against rubella in southern Brazil.

The rubella virus is a potent human teratogen. The highest risk of this infection occurs during pregnancy, as the virus may cause fetal damage known as congenital rubella syndrome (CRS). Since the rubella vaccine is made with attenuated live virus, there is a high level of anxiety concerning exposure during pregnancy. Although no case of CRS has been proved in children of immunized susceptible pregnant women, a risk below 1.6% cannot be ruled out. Our main purpose was to evaluate the occurrence of CRS in women who were vaccinated against rubella and did not know that they were pregnant, or became pregnant within 30 days after vaccination. We collected, prospectively, data on 171 pregnant women who were susceptible at the time of vaccination and compared them with data on the total population of pregnant women in the state of Rio Grande do Sul (RS), Brazil. A serologic sample was collected in 149 infants of susceptible mothers. A total of 10 infants (6.7%) had anti-rubella antibodies. When these were compared with the results obtained in the total population of births in RS, no difference was found in mean birth weight, low birth weight and sex. None of the ten infants with IgM(+) presented congenital defects involving CRS, during the physical examinations performed at the time of birth and at 3 months of age. Our study allows the safety of rubella vaccination to be extended to pregnant women.

Avaliação prospectica de gestantes vacinadas contra rubéola no sul do Brasil / Prospective evaluation of pregnant women that received rubella vaccine in south

Objetivos: Avaliar a ocorrência de Síndrome da Rubéola Congênita em mulheres que foram vacinadas contra rubéola e que não sabiam que estavam grávidas, ou que engravidaram até 30 dias após a vacinação. Métodos: foram coletados, prospectivamente, dados de 171 gestantes que se encontravam suscetíveis no momento da vacinação. No momento do parto foi colhido sangue dos recém-nascidos para exames. Todos os bebês com IgM anti rubéola positiva foram clinicamente avaliados conforme protocolo para detecção de sequelas da síndrome da rubéola congênita. Foi realizada a coleta de secreção nasofaríngea para isolamento e identificação viral. Resultados: foi coletada amostra sorológica de 152 bebês, filhos de mãe suscetíveis. Um total de 10 bebês (6,3%) apresentou presença de anticorpos IgM anti-rubéola, ou seja, foram infectados pelo vírus vacinal durante a gestação. Nenhum deles apresentou defeitos congênitos relacionados à rubéola. Conclusões: o estudo permite ampliar a segurança da vacinação para rubéola em mulheres grávidas.

[Neonatal meningitis: related features]. / Meningite neonatal: aspectos associados.

OBJECTIVE: The goal of this study was to identify and to analyze the features related to the occurrence of neonatal meningitis. METHOD: In a case-control study we examined all newborns presenting meningitis between August/2002 and December/2003 in the neonatal Intensive Care Unit. Healthy newborns were enrolled as a Control Group (CG). Data related to pregnancy, labor and the neonate itself were collected. The results with p<0.05 were considered significant. RESULTS: 42 newborns with meningitis were compared to 42 controls. The meningitis group (MG) presented a lower number of medical visits during the prenatal care. The most common abnormalities detected in both groups were: drug addiction, congenital infections, preeclampsia, eclampsia, gestational diabetes mellitus and urinary tract infections. Fetal respiratory distress and the use of respiratory support were related to the occurrence of meningitis. The average weight and the APGAR scores were lower in the MG. The prevalence of premature and small for the gestational age infants was significantly higher in the MG. The neurological examination detected abnormalities in 35.7% of the meningitis cases. CONCLUSION: The association of risk factors related to pregnancy, labor and the newborn itself to the neonatal meningitis outcome in our setting is similar to the described in the literature.

Meningite neofatal: aspectos associados / Neonatal meningitis: related features

INTRODUÇÃO: O objetivo deste estudo foi identificar e analisar fatores relacionados à meningite neonatal. MÉTODO: Em estudo de caso-controle, foram examinados neonatos com meningite no período de agosto/2002 a dezembro/2003 na Unidade de Tratamento Intensivo Neonatal (UTIN) e alocados recém-nascidos hígidos como grupo controle (GC). Foram relatados dados referentes à gestação, ao parto e ao neonato. Os resultados foram considerados significativos quando p (alfa)< 0,05. RESULTADOS: Foram examinados 42 neonatos com meningite e 42 controles. A média numérica de consultas durante o pré-natal foi menor no grupo meningite (GM). As intercorrências mais comuns detectadas nas gestações, em ambos os grupos, foram o uso de substâncias de abuso, infecções, pré-eclâmpsia, diabetes melitus gestacional e infecções do trato urinário. O sofrimento fetal e a utilização de cuidados respiratórios foram associados à meningite. O GM apresentou médias menores de peso e de índice de APGAR em relação ao GC. A prevalência de prematuridade e de neonatos pequenos para a idade gestacional foi significativamente maior no GM. O exame neurológico foi alterado em apenas 35,7 por cento dos casos de meningite. CONCLUSÃO: Em nosso meio, a associação de fatores de risco relacionados à gestação, ao parto e próprios do neonato com o desfecho de meningite neonatal não diferiu da literatura.

The risk of aseptic meningitis associated with the Leningrad-Zagreb mumps vaccine strain following mass vaccination with measles-mumps-rubella vaccine, Rio Grande do Sul, Brazil, 1997.

BACKGROUND: Few data are available on the risk of aseptic meningitis following vaccination with the Leningrad-Zagreb (L-Z) strain of mumps vaccine. In 1997 the mumps vaccine was introduced into the state of Rio Grande do Sul in Brazil through mass vaccination with mumps-measles-rubella (MMR), targeting children aged 1-11 years. Five municipalities used exclusively MMR vaccine containing the L-Z strain of mumps. An outbreak of aseptic meningitis was observed shortly after the mass campaign. METHODS: To estimate the risk of aseptic meningitis associated with this strain, we analysed vaccination and meningitis case surveillance data from the selected municipalities. A case of vaccine-associated aseptic meningitis was defined as one with a pleocytosis of 10-1,500 leukocytes/ml and occurring within 15-35 days after vaccine receipt. RESULTS: We estimated a risk of 2.9 cases per 10,000 doses of L-Z administered, equivalent to 1 case per 3,390 doses administered. The overall risk of aseptic meningitis following the campaign was increased 12.2-fold (95% CI: 6.0-24.7) compared with the same period in 1995-1996. Following the mass campaign, the incidence of mumps declined 93% during 1998-2000. CONCLUSIONS: Vaccination with the L-Z strain of mumps vaccine as part of a mass campaign was associated with a significantly increased risk of aseptic meningitis. Decisions about type of mumps vaccine and mumps vaccination strategies must consider vaccine safety issues in addition to other criteria.

An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccines.

OBJECTIVE: To compare the incidence of adverse events following the administration of three commercially available measles-mumps-rubella (MMR) combination vaccines. METHODS: A randomized double-blind clinical trial was performed in 1996 that involved a total of 10 142 students 6-12 years of age in the state of Rio Grande do Sul, in Brazil. An MMR vaccine containing the Edmonston-Zagreb, Leningrad-Zagreb, and RA 27/3 strains ("vaccine A") was administered to 2 226 students (21.9% of the total); an MMR vaccine with the Moraten, Jeryl Lynn, and Wistar 27/3 strains ("vaccine B") was administered to 2 216 children (21.8%); and an MMR vaccine containing the Schwartz, Urabe AM-9, and Wistar 27/3 strains ("vaccine C") was given to 2 179 students (21.5%). A control group of 3 521 students (34.7%) was not vaccinated. Both the vaccinated subjects and the control subjects were followed daily for 30 days to detect any clinical manifestations. RESULTS: Adverse events were more frequent in the vaccinated children than in the control group (P < 0.01). In terms of causing parotitis, vaccine A had a relative risk (RR) of 5.72 (95% confidence interval (CI) = 3.11-10.54) when compared with vaccine B, and an RR of 2.33 (95% CI = 1.52-3.58) when compared with vaccine C. Vaccine A was also associated with an increased risk of lymphadenopathy when compared with vaccine B (RR = 3.11; 95% CI = 1.78-5.45) and with vaccine C (RR = 2.22; 95% CI = 1.35-3.66). Vaccine C was associated with an increased risk of parotitis when compared with vaccine B (RR = 2.46; 95% CI = 1.26-4.80). Three cases of aseptic meningitis were detected among the children in the study group, but only one case of vaccine-related aseptic meningitis was identified, among the children receiving vaccine A. CONCLUSIONS: The three MMR vaccines that we studied are associated with different risks of adverse events. We found vaccine A to cause more reactions than the two other vaccines, especially vaccine B. In addition, vaccine A presented both a temporal and a cause-and-effect association with one case of aseptic meningitis. We hope that this study will contribute information that can be used in choosing MMR vaccines with safe and effective strains, especially for mass vaccination strategies.

An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccines

Objective. To compare the incidence of adverse events following the administration of three commercially available measles-mumps-rubella (MMR) combination vaccines. Methods. A randomized double-blind clinical trial was performed in 1996 that involved a total of 10 142 students 6-12 years of age in the state of Rio Grande do Sul, in Brazil. An MMR vaccine containing the Edmonston-Zagreb, Leningrad-Zagreb, and RA 27/3 strains ("vaccine A") was administered to 2 226 students (21.9 percent of the total); an MMR vaccine with the Moraten, Jeryl Lynn, and Wistar 27/3 strains ("vaccine B") was administered to 2 216 children (21.8 percent); and an MMR vaccine containing the Schwartz, Urabe AM-9, and Wistar 27/3 strains ("vaccine C") was given to 2 179 students (21.5 percent). A control group of 3 521 students (34.7 percent) was not vaccinated. Both the vaccinated subjects and the control subjects were followed daily for 30 days to detect any clinical manifestations. Results. Adverse events were more frequent in the vaccinated children than in the control group (P < 0.01). In terms of causing parotitis, vaccine A had a relative risk (RR) of 5.72 (95 percent confidence interval (CI) = 3.11-10.54) when compared with vaccine B, and an RR of 2.33 (95 percent CI = 1.52-3.58) when compared with vaccine C. Vaccine A was also associated with an increased risk of lymphadenopathy when compared with vaccine B (RR = 3.11; 95 percent CI = 1.78-5.45) and with vaccine C (RR = 2.22; 95 percent CI = 1.35-3.66). Vaccine C was associated with an increased risk of parotitis when compared with vaccine B (RR = 2.46; 95 percent CI = 1.26-4.80). Three cases of aseptic meningitis were detected among the children in the study group, but only one case of vaccine-related aseptic meningitis was identified, among the children receiving vaccine A. Conclusions. The three MMR vaccines that we studied are associated with different risks of adverse events. We found vaccine A to cause more reactions than the two other vaccines, especially vaccine B. In addition, vaccine A presented both a temporal and a cause-and-effect association with one case of aseptic meningitis. We hope that this study will contribute information that can be used in choosing MMR vaccines with safe and effective strains, especially for mass vaccination strategies