RESUMO
We report a 3-year-old child who was hospitalized because of severe manifestations of the central nervous system. The child died after 6 days of hospitalization. Analysis of postmortem cerebrospinal fluid showed the presence of yellow fever virus RNA. Nucleotide sequencing confirmed that the virus was wild-type yellow fever virus.
Assuntos
RNA Viral/genética , Febre Amarela/líquido cefalorraquidiano , Febre Amarela/virologia , Vírus da Febre Amarela/genética , Antivirais/farmacologia , Antivirais/uso terapêutico , Autopsia , Biomarcadores , Brasil , Pré-Escolar , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Filogenia , Análise de Sequência de DNA , Avaliação de Sintomas , Tomografia Computadorizada por Raios X , Febre Amarela/diagnóstico , Febre Amarela/tratamento farmacológico , Vírus da Febre Amarela/classificação , Vírus da Febre Amarela/isolamento & purificaçãoRESUMO
The 17D yellow fever vaccine is a live-virus vaccine that has been in use since the 1940s. The incidence of encephalitis after yellow fever vaccination among young infants is much higher than among children older than nine months of age. Until recently, avoidance of vaccination by breastfeeding women who have received yellow fever vaccine had been based on theoretical grounds only. We report the probable transmission of vaccine strain of yellow fever virus from a mother to her infant through breastfeeding.
Assuntos
Aleitamento Materno , Leite Humano/virologia , Vacina contra Febre Amarela/efeitos adversos , Febre Amarela/transmissão , Feminino , Humanos , Lactente , Masculino , Período Pós-Parto , Febre Amarela/sangue , Febre Amarela/líquido cefalorraquidiano , Febre Amarela/tratamento farmacológicoRESUMO
In April, 2009, the state health department of Rio Grande do Sul, Brazil, was notified by the Cachoeira do Sul municipal health department of a case of meningoencephalitis requiring hospitalization in an infant whose mother recently had received yellow fever vaccine during a postpartum visit. The Field Epidemiology Training Program of the Secretariat of Surveillance in Health of the Brazilian Ministry of Health assisted state and municipal health departments with an investigation. This report summarizes the results of that investigation, which determined that the infant acquired yellow fever vaccine virus through breast-feeding. The mother reported 2 days of headache, malaise, and low fever occurring 5 days after receipt of yellow fever vaccine. The infant, who was exclusively breast-fed, was hospitalized at age 23 days with seizures requiring continuous infusion of intravenous anticonvulsants. The infant received antimicrobial and antiviral treatment for meningoencephalitis. The presence of 17DD yellow fever virus was detected by reverse transcription--polymerase chain reaction (RT-PCR) in the infant's cerebrospinal fluid (CSF); yellow fever--specific immunoglobulin M (IgM) antibodies also were present in serum and CSF. The infant recovered completely, was discharged after 24 days of hospitalization, and has had normal neurodevelopment and growth through age 6 months. The findings in this report provide documentation that yellow fever vaccine virus can be transmitted via breast-feeding. Administration of yellow fever vaccine to breast-feeding women should be avoided except in situations where exposure to yellow fever viruses cannot be avoided or postponed.