Age: 19.0
Sex: M
Vaccine: ANTH, FLUX, HEPA, MMR, TYP, YF
Symptoms: Abasia, Asthenia, Depressed level of consciousness, Difficulty in walking, Encephalitis
Clinical narrative: A report was received from another manufacturer on 12/19/03 concerning a 19 year old male vaccinee who experienced acute disseminated encephalomyelitis and urinary retention 20 days after receiving influenza vaccine, yellow fever, anthrax vaccine, typhoid vaccine, polio vaccine, hepatitis A vaccine, hepatitis B vaccine, MMR, and possibly varicella vaccine on 2/2/03. The vaccinee also received a second anthrax vaccination on 2/2/03. All vaccines were brand unspecified. On 2/22/03, the vaccinee was hospitalized with complaints of fever of 100.4 F, sore throat, headache for five days, numbness from the knees down, weakness and difficulty walking. He also had pressure on the genitalia and urge to urinate. The vaccinee was diagnosed with acute disseminated encephalomyelitis and urinary retention. He was treated with high dose steroids and physical therapy. The vaccinee was discharged to another hospital on 3/1/03. His condition regressed to inability to walk, decrease in sensation, and inability to void after being off steroids for about three to five days. The vaccinee was given another course of high dose steroids for five days and IV immunoglobulins for two days. The vaccinee improved. He was prescribed oral steroids for three weeks. He was discharged from hospital on 3/19/03 with discharge diagnosis of unspecified infectious and parasitic diseases, retention of urine, and post-infectious encephalitis. On 3/21/03 the vaccinee stated that he still had some numbness in his feet, but is otherwise greatly improved. He also stated that he had been ill with an upper respiratory infection about mid-February and was taking amoxicillin, pseudoephedrine hydrochloride, ibuprofen, and paracetamol on 2/20/03 at the time of the anthrax vaccination. Within one to two days afterwards, the symptoms of encephalomyelitis were noted and he was admitted to a local hospital until being transmitted to a second hospital on 3/1/03. Additional information received on 12/9/03 from the yellow fever vaccine testing group indicated that the vaccinee had clinical, radiological and laboratory evidence of acute disseminated encephalomyelitis, with immunoglobulin M in cerebrospinal fluid of 9.8. This cause was reported to be a possible yellow fever vaccine associated neurotropic disease with autoimmune involvement. A lumbar puncture was carried out on 2/23/03. CSF results were: glucose 77, protein 73, WBC 159, RBC 4, mononucleosis 90%. Lyme screen was negative. Blood and urine cultures were negative. A throat culture was negative for streptococcus group A. Testing was carried out at the CDC from a cerebrospinal fluid sample and a serum sample both collected on 3/6/03. The results from the CSF indicated good immunoglobulin M response by MAC-ELISA, negative to West Nile virus, St. Louis, and Powassan, negative virus culture on Vero cells. TagMan polymerase chain reaction for yellow fever was not done and neutralization antibody assay was not done as there is no standard for this. The results from the serum indicated good immunoglobulin response by MAC-ELISA, negative to West Nile virus, St. Louis, and Powassan, plaque-reduction neutralization test to yellow fever virus was positive at a 1:320 titer, negative virus culture on Vero cells, and negative TagMan polymerase chain reaction for yellow fever. The outcome of the events were not reported. There was insufficient information to determine the reporter's causality assessment. Follow up pending.