Age: 19.0
Sex: F
Vaccine: YF
Symptoms: Epstein-Barr virus test, Herpes simplex serology, Human herpes virus 6 serology, Human metapneumovirus test, Human rhinovirus test
Clinical narrative: Initial report received from literature on 10 May 2014. Abstract: Yellow fever (YF) is an important public health concern in areas where the disease is endemic. For more than 60 years a highly effective live attenuated vaccine has been available, its widespread use resulting in a dramatic decrease in the number of cases. On rare occasions, YF vaccine can cause mild to severe disease and rare adverse vaccine-associated events have been reported. Additionally, an average viremia of 3-5 days after administration of the YF vaccine has been published. Here we present a case where YF vaccine was isolated in cell culture from a respiratory swab collected from a patient presenting with influenza-like illness. To the best of our knowledge, this is the first report finding replicating YF vaccine in the respiratory sample of a post inoculated individual. A 19-year-old female patient had received a dose of Yellow Fever Vaccine (manufacturer unknown, batch number, dose number, route and site of vaccination not reported) on an unspecified date. On an unspecified date, the patient presented with fever of 103 degree F (39 degree Celsius) for 3 days, nausea, vomiting, cough and myalgia. The patient history did not note any recent travel, vaccination, animal contact or insect bites. ILI was the initial diagnosis and a respiratory swab was sent for influenza testing. CPE was observed at 9 days in the Caco-2 cells and all other cell lines exhibited no viral changes after a total of 14 days incubation. Further, the ResPlex II assay and all of the real-time (RT)-PCR assays were negative. Since replicating YF vaccine was isolated and propagated in cell culture, and in the absence of detection of other known infectious agents, the potential cause of the ILI was the YF vaccine the patient received 8 days previously. The testing algorithm included both molecular assays and conventional cell culture. The respiratory swab was inoculated into primary Rhesus monkey kidney cells, human lung adenocarcinoma cells (A549), human embryonic lung cells (HEL) and epithelial colorectal adenocarcinoma (Caco-2) cells. All inoculated cell lines were examined for cytopathic effect (CPE) three times a week for 2 weeks. In parallel, the primary sample was extracted using the bioMerieux easyMAG, tested for influenza A and B using the Centers for Disease Control and Prevention (CDC) Human Influenza Virus Real-time RT-PCR Diagnostic Panel (unpublished protocol, details are available from the CDC on request), and for Influenza A and B, respiratory syncytial virus A and B, human metapneumovirus, rhinovirus, enterovirus, parainfluenza viruses 1-4, and human coronaviruses OC43, 229E, NL63 and HKU1 with the ResPlex II kit. Multiple real-time (RT)-PCR assays were used for the detection of cytomegalovirus, Epstein-Barr virus, human herpes virus 6, adenovirus, enterovirus, herpes simplex virus 1, herpes simplex virus 2, varicella zoster virus [3], rhinovirus [4], Mycoplasma pneumonia [5], Legionella pneumophila [6], and Chlamydia pneumonia. At the time of this report, the outcome was unknown. Documents held by sender: None.