Age: 21.0
Sex: M
Vaccine: YF
Symptoms: Abdominal pain lower, Abdominal tenderness, Antibody test negative, Blood alkaline phosphatase normal, Blood bilirubin normal
Clinical narrative: Initial report received from scientific literature on 11 June 2012. The following is verbatim from the article: "Yellow fever is a mosquito-transmitted hemorrhagic viral disease that is endemic to tropical regions. It remains a significant health concern for personnel, accordingly vaccination is frequently performed on employees. Although the vaccine is generally administered with only minor complications, rare severe complications are also reported. Herein, we report a mild case of yellow fever vaccine-associated viscerotropic disease 4 days after administration of the vaccine. The various complications of the vaccine and their pathogenesis are also reviewed." A 21-year-old otherwise healthy male (no history of immunosuppresion, alcohol abuse, or other disease) underwent primary vaccination against the YF virus with YF-VAX. Four days later, he began to experience sharp right lower quadrant abdominal pain, subjective fevers, nausea, myalgia, and anorexia, which prompted him to seek medical attention. He was found to be febrile with a temperature of 101.2 degrees F, but otherwise with normal vital signs. His physical examination was remarkable for tenderness to palpation in the right lower quadrant of the abdomen with an absence of peritoneal signs. Laboratory analysis demonstrated a white blood cell count of 10.7 x 10^9 cells/L with 92% granulocytes (normal 3.010.5 x10^9 cells/L), platelet count of 132 cells z 10^9 cells/L (normal 150-440 x 10^9 cells/L, alkaline phosphatase of 65 units/L (normal 37-113 units/L), and total bilirubin of 0.7 mg/dL (0.2-1.0 mg/dL). A computed tomography scan of the abdomen and pelvis demonstrated normal anatomy. He was subsequently admitted to the hospital for continued observation and pain control. Over the next 36 hours, his pain would resolve and his labs began to normalize. Given the temporal proximity of his symptoms to the vaccination a report was filed with Vaccine Adverse Event Reporting System (VAERS) and additional serological testing was completed. Serum collected 6 days after vaccination underwent reverse transcription polymerase chain reaction (RT-PCR) and detected the presence of YF-VAX virus at a concentration of < 100 pfu/mL. YF IgM antibodies were not detected in the serum by enzyme-linked immunosorbent assay and were < 10 by plaque reduction neutralization test. Repeat serum analysis the following day failed to detect the presence of virus by RT-PCR, with the other tests were unchanged. The patient ultimately recovered without further events and was able to be discharged from the hospital 4 days after admission. ." "The case reported here was less severe. The patient presented with many of the common, generalized systemic symptoms seen early following vaccination. However, the only item specific to YF-AVD was an increase in liver enzymes, suggesting some hepatocellular destruction. The more severe cases tend to show a continued worsening of hepatic function along with renal failure, occasionally leading to death. His renal function was not affected as measured by his blood urea nitrogen and creatinine thought his hospital course. Patients with YEL-AVD should demonstrate not only signs of viremia but have detectable virus in either blood or tissues. This patient had what is arguably a normal viremic response to the vaccine. His vaccine viral load was nondetectable on day 3, as were his serum viral antibodies. Thus, he meets the definition of YEL-AVD." Documents held by sender: None.