Age: 17.0
Sex: F
Vaccine: HEPA, TTOX, TYP, YF, HEPA, TD, TYP, YF, DPP, HEPA, TYP, YF
Symptoms: Malaise, Muscular weakness, Respiratory failure
Clinical narrative: From initial information received on 05/06/04 through an enhanced surveillance program conducted regarding an adverse event that occurred, it was reported that a 17 year old female pt received the following vaccinations in preparation for a mission. YF Vax, lot # and route of administration unknown, a dose of Typhoid vaccine, lot #, manufacturer and route of administration unknown, a dose of Hepatitis A vaccine, lot #, manufacturer and route of administration unknown, and a dose of Diphtheria and Tetanus toxoids, lot # manufacturer and route of administration unknown on 02/11/04.  One week after the receipt of the vaccines on 02/18/04, the pt was admitted to the hospital with a one to two day history of weakness in walking, a general ill feeling and shortness of breath. She was started on BiPAP for decreased respiratory function. She was seen by a neurologist and her diagnosis was thought to be most likely GBS, but it was an unusual presentation for such. Myasthenia gravis antibodies were negative. CBCs were predominantly within normal range. WBC was in the 3-4 range with about 30% neutrophils and 40 to 50 % lymphocytes. HGB was stable throughout. Iron and iron binding studies were normal. Vitamin B12 was normal. Sed rate was normal. UA was normal.  Blood gas was 7.39PH, PaCO2 was 44, pA02 was 105 prior to starting BiPAP. Electrolyte panels were normal including LFTs. CPK was normal. TSH was normal. Protein electrophoresis was normal. Spinal tap had 1 RBC, 1 enucleated cell, 24 protein, glucose of 58 and negative culture. RPRs were nonreactive. Lead test was normal. EMG was normal. CXR was negative. EKG did show some sinus arrhythmia, but due to hospital course and clinical suspicion, Guillain-Barre variant was the most likely diagnosis. The pt was treated with IV IG therapy for the presumed GBS.  She steadily improved and was transferred from the ICU to the medical floor. Respiratory function improved. She had some peripheral weakness and decreased reflexes so GBS variant was thought to be the most likely diagnosis.  She was weaned off BiPAP. She was discharged on 02/23/04, 5 days after admission with adequate pulmonary function although still decreased from presumed baseline. Her activity was as tolerated with outpt physical and occupational therapy follow-up, and she had a wheelchair to use as needed.  The pt's medical doctor was spoken to on 03/18/04 about one month after discharge and he said she had not completely resolved her weakness and still had poor endurance.  The labs were sent and the results are as follows: a CSF sample was collected on the day of onset,  02/18/04. The sample was negative for Yellow-Fever vaccine virus in TaqMan PCR and also negative for Yellow-Fever IgM antibody on Elisa testing. It was suggested to submit a convalescent serum sample to determine whether the pt developed an appropriate response to the vaccine. On 05/06/04, the treating physician agreed to obtain a convalescent serum sample in the next week or so. He has not seen the pt in several weeks and will contact the mother to bring her in to obtain the sample.