Review of pediatric encephalitis and encephalopathy cases following immunization reported to the Canadian Immunization Monitoring Program Active (IMPACT) from 1992 to 2012

for the Canadian Immunization Monitoring Program Active Investigators

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

5 Citas (Scopus)

Resumen

Background: Neurological adverse events following immunization (AEFI) remain poorly characterized. Our objective was to describe pediatric acute and chronic encephalopathy and encephalitis cases following immunization reported via active sentinel surveillance from 1992 to 2012. Methods: This case series provides a descriptive analysis of encephalopathy/encephalitis admissions reported to the Canadian Immunization Monitoring Program ACTive (IMPACT). Acute cases were reported if symptom onset (seizures, decreased level of consciousness, change in mental status) occurred 0–7 days after tetanus or pertussis-containing vaccines, 0–15 days after other inactivated vaccines, or 5–30 days after live vaccines. Chronic cases of subacute sclerosing panencephalitis or subacute progressive rubella encephalitis were reported at any interval after vaccination. Clinical data were examined to identify possible causes for encephalopathy/encephalitis other than vaccination. Results: Sixty-one cases of encephalopathy/encephalitis following immunization were reported to IMPACT over 21 years; 57 (93.4%) were classified as acute and 4 (6.6%) were chronic cases of subacute sclerosing panencephalitis. Most patients (73.8%) were previously healthy and immunocompetent. The vaccines most frequently administered prior to presentation were diphtheria-tetanus-pertussis, measles-mumps-rubella, and influenza. At discharge, 38 patients (62.3%) had normal neurological status or were expected to recover. Forty patients (70.2%) with acute encephalopathy/encephalitis had a more likely alternate etiology besides vaccination based on neuroimaging, symptoms suggestive of infection, laboratory-confirmed non-vaccine-related infection, or clinical diagnosis. No cases of encephalitis were causally associated with pertussis or influenza vaccines. Two patients (50%) with subacute sclerosing panencephalitis had known wild-type measles infection prior to immunization. Three deaths were reported during hospitalization (4.9%); all were acute encephalitis/encephalopathy cases and none were confirmed to be vaccine-related. Conclusions: Encephalopathy/encephalitis following immunization remains a rare but serious adverse event. Most cases had another more likely etiology than vaccination. Continued monitoring and analysis of AEFI is paramount to ensure the safety of immunization programs.

Idioma originalEnglish
Páginas (desde-hasta)4457-4463
Número de páginas7
PublicaciónVaccine
Volumen38
N.º28
DOI
EstadoPublished - jun. 9 2020

Nota bibliográfica

Funding Information:
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KAT has received grants from GlaxoSmithKline and consultancy fees from Pfizer outside the submitted work. SAH has received grants and consulting fees from Pfizer and GlaxoSmithKline outside the submitted work. The other authors have no disclosures.

Funding Information:
The authors gratefully acknowledge the expert assistance of the Monitor Liaisons (Heather Samson, Annick Audet), IMPACT nurse monitors, staff of the IMPACT Data Center (Kim Marty) and Melanie Laffin (Canadian Paediatric Society). The Canadian Immunization Monitoring Program Active (IMPACT) is a national surveillance initiative managed by the Canadian Paediatric Society and conducted by the IMPACT network of paediatric investigators on behalf of the Public Health Agency of Canada's Centre for Immunization and Respiratory Infectious Diseases.

Publisher Copyright:
© 2020 The Authors

ASJC Scopus Subject Areas

  • Molecular Medicine
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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