Age: 0.8
Sex: F
Vaccine: DTAP, HEP, IPV, PPV
Symptoms: Influenza virus test negative, Metabolic function test normal, Mycoplasma test, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal
Clinical narrative: This case was reported in a literature article and described the occurrence of status epilepticus in a 10-month-old female subject who was vaccinated with HEPATITIS B (manufacturer unspecified), DTAP, pneumococcal 7-valent conjugate vaccine (non-gsk) and IPV (non-gsk). The subject's medical history included cough and rhinorrhea during one week prior to vaccination otherwise, she was healthy. Her father had childhood febrile seizures. On an unspecified date, the subject received 3rd dose of HEPATITIS B vaccine (administration site and route unknown, batch number not provided), 3rd dose of DTAP (administration site and route unknown, batch number not provided), an unspecified dose of pneumococcal 7-valent conjugate vaccine (NON-GSK) (unknown) and 3rd dose of IPV (NON-GSK) (unknown). 18 hours after vaccination with DTAP, HEPATITIS B vaccine, pneumococcal 7-valent conjugate vaccine (NON-GSK) and IPV (Non-GSK), the subject experienced status epilepticus, generalized tonic-clonic seizure, hypertonia nos, hyper reflexia and fever (101.3 F). Otherwise, the physical exam was normal. The subject was hospitalised. Laboratory evaluation included a normal complete blood count, metabolic panel, and cerebrospinal fluid (CSF) analysis. Blood, urine and CSF bacterial cultures were negative. She had a normal head MRI and CT scan, negative pertussis direct fluorescent antibody and culture, and negative fluorescent antibody test for adenovirus, RSV, and influenza. Serology was negative for arboviruses, EBV, and mycoplasma. CSF was negative for HSV and enterovirus by polymerase chain reaction. The subject was treated with anticonvulsant, acyclovir, ceftriaxone and intubation. At the time of reporting, the events were resolved. The author considered the events were probably related to vaccination with HEPATITIS B vaccine, DTAP, pneumococcal 7-valent conjugate vaccine (NON-GSK) and IPV (Non-GSK). Summary of the literature article: In 2004 the Clinical Consult Case Review (CCCR) working group was formed within the CDC-funded Clinical Immunization Safety Assessment (CISA) Network to review individual cases of adverse events following immunizations (AEFI). Cases were referred by practitioners, health departments, or CDC employees. Vaccine Adverse Event Reporting System (VAERS) searches and literature reviews for similar cases were performed prior to review. After CCCR discussion, AEFI were assessed for a causal relationship with vaccination and recommendations regarding future immunizations were relayed back to the referring physicians. In 2010, surveys were sent to referring physicians to determine the utility and effectiveness of the CCCR service. CISA investigators reviewed 76 cases during 68 conference calls between April 2004 and December 2009. Almost half of the cases (35/76) were neurological in nature. Similar AEFI for the specific vaccines received were discovered for 63 cases through VAERS searches and for 38 cases through PubMed searches. Causality assessment using the probably related, 16 as possibly related, 18 as unlikely related, 10 as unrelated, and 17 had insufficient information to assign causality. The physician satisfaction survey was returned by 30 (57.7%) of those surveyed and a majority of respondents (93.3%) felt that the CCCR service was useful. The author's conclusion stated that the CCCR provides advice about AEFI to practitioners, assigns potential causality, and contributes to an improved understanding of adverse health events following immunizations.