Health Time

This case highlights the previously unrecognized risk for paralytic polio among unvaccinated persons exposed to oral polio vaccine during travel abroad.

PMID:

MMWR Morb Mortal Wkly Rep. 2006 Feb 3 ;55(4):97-9. PMID: 16456525

Abstract Title:

Imported vaccine-associated paralytic poliomyelitis–United States, 2005.

Abstract:

Paralytic poliomyelitis is rare in the United States because of the success of universal childhood immunization and the Global Polio Eradication Initiative. Poliovirus vaccine was introduced in the 1950s. Since then, the United States has eliminated indigenous wild poliovirus transmission, controlled imported wild poliovirus cases, and, through a vaccine policy change (i.e., from live, attenuated oral polio vaccine [OPV] to inactivated polio vaccine [IPV]), eliminated vaccine-associated paralytic polio (VAPP) cases. The most recent VAPP case occurred in 1999. The primary risk for paralytic polio for U.S. residents is through travel to countries where polio remains endemic or where polio outbreaks are occurring. This report describes the first known occurrence of imported VAPP in an unvaccinated U.S. adult who traveled abroad, where she likely was exposed through contact with an infant recently vaccinated with OPV. This case highlights the previously unrecognized risk for paralytic polio among unvaccinated persons exposed to OPV during travel abroad.

A case report of progressive quadriparesis with bilateral facial diplegia after immunization with recombinant hepatitis B vaccine 3 days prior.

PMID:

J Med Assoc Thai. 2000 Sep ;83(9):1124-6. PMID: 11075984

Abstract Title:

Guillain – Barre' syndrome following recombinant hepatitis B vaccine and literature review.

Abstract:

A 17 year-old woman developed progressive quadriparesis with bilateral facial diplegia after immunization with recombinant hepatitis B vaccine 3 days prior. Cerebrospinal fluid analysis revealed acellular fluid with high protein level. The electrodiagnosis was compatible with demyelinating polyneuropathy. Other potential causes of Guillain-Barre' syndrome (GBS) were ruled out. Her motor power gradually improved and returned to normal later. The temporal relationship between GBS and vaccination was suggestive of a vaccine-induced cause. Mechanisms of this very rare complication are proposed with a literature review.

A case report of shoulder and lumbar spine’s pain, limbs weakness and facial paralysis with unfavorable clinical evolution 10 days following the H1N1 vaccination in the third trimester.

PMID:

Case Rep Obstet Gynecol. 2012 ;2012:323625. Epub 2012 Dec 5. PMID: 23259096

Abstract Title:

Guillain-Barré Syndrome after H1N1 Shot in Pregnancy: Maternal and Fetal Care in the Third Trimester-Case Report.

Abstract:

Guillain-Barré syndrome is a rare neurological disease of progressive installation, usually following a previous acute infectious state, has a rare incidence, especially in pregnancy, and can induce major complications and high mortality risk. Its occurrence, after immunization to influenza during the last trimester pregnancy, has not been reported before. We presented a case of a 36-year-old pregnant woman that was immunized to H1N1 in the last trimester; 10 days later she developed shoulder and lumbar spine's pain, limbs weakness and facial paralysis with unfavorable clinical evolution and was submittedto intensive therapy care. We described clinical and obstetrical approach, pointing out peculiarities involved in this pathology in pregnancy.

Long-term excretion of vaccine strains of poliovirus has been documented for many years and instances of paralytic poliomyelitis in hypogammaglobulinaemic patients who were subsequently found to have been excreting virus for prolonged periods are reported

PMID:

Dev Biol (Basel). 2001 ;105:75-80. PMID: 11763340

Abstract Title:

Characteristics of poliovirus strains from long-term excretors with primary immunodeficiencies.

Abstract:

Individuals who are deficient in humoral immunity are particularly at risk from infection with enteroviruses, and poliovirus in particular, where antibodies are the main source of protection from disease. Long-term excretion of vaccine strains of poliovirus has been documented for many years and instances of paralytic poliomyelitis in hypogammaglobulinaemic patients who were subsequently found to have been excreting virus for prolonged periods have been reported in the U.S.A., Germany and Japan. The identification of a healthy immunodeficient patient in the U.K. who has probably been excreting type 2 poliovirus for 15 years will be described, with the characteristics of the virus and the results of attempts at treatment so far. Such individuals pose a significant risk to the eradication programme unless they can be identified and treated.

Four case reports of ascending paralysis following administration of sheep brain tissue anti-rabies vaccine for presumed rabies exposure.

PMID:

Ethiop Med J. 2011 Oct ;49(4):373-6. PMID: 23409403

Abstract Title:

Case report of post sheep brain rabies vaccine neuroparalytic complications at Tikur Anbessa Teaching Hospital, in Ethiopia.

Abstract:

We report four cases of ascending paralysis admitted to Tikur Anbessa Specialized Hospital (TASH) within six months period between December 2010 and June 2011 following administration of sheep brain tissue anti rabies vaccine for presumed rabies exposure. The paralysis started after a minimum of twelve doses of the vaccine. Two of the patients were discharged with severe paralysis and two died in the hospital.

These data suggest that antibodies to GM1 and GD1a gangliosides may play a pathogenic role in the demyelinating and/or inflammatory processes characteristic of rabies vaccine-induced acute neurologic complications.

PMID:

J Neuroimmunol. 1998 Nov 2 ;91(1-2):63-72. PMID: 9846820

Abstract Title:

Antibodies to human myelin proteins and gangliosides in patients with acute neuroparalytic accidents induced by brain-derived rabies vaccine.

Abstract:

Antibody responses to myelin antigens were analysed in 15 patients who developed acute neuroparalytic accidents (ANPA) during post-exposure rabies vaccination using a rabies vaccine prepared on brain tissues and in 30 individuals who were uneventfully vaccinated. High titers (>or = 100) of IgG and IgM antibodies to GM1 or GD1a gangliosides were detected by enzyme linked immunosorbent-assay (ELISA) in plasmas from ANPA patients but not in controls. These data suggest that antibodies to GM1 and GD1a gangliosides may play a pathogenic role in the demyelinating and/or inflammatory processes characteristic of rabies vaccine-induced acute neurologic complications.

Of the 13,749 acute flaccid paralysis cases investigated, 58.9% received at least three doses of oral polio vaccine.

PMID:

Pan Afr Med J. 2016 ;24:154. Epub 2016 Jun 22. PMID: 27642491

Abstract Title:

Acute flaccid paralysis surveillance indicators in the Democratic Republic of Congo during 2008-2014.

Abstract:

INTRODUCTION: The last wild poliovirus (WPV) case in Africa was reported in July 2014, thus underscoring the tremendous progress towards polio eradication worldwide. This study aimed to analyze the results of a seven-year surveillance of Acute Flaccid Paralysis (AFP) in the Democratic Republic of Congo (DRC) and to identify potential gaps that need to be addressed.METHODS: Epidemiological and virological data obtained from AFP surveillance among AFP cases less than 15 years from January 2008 to December 2014 in DRC were retrospectively considered and analyzed in this study.RESULTS: Of the 13,749 AFP cases investigated, 58.9% received at least three doses of oral polio vaccine (OPV), 7.3% never received OPV, while the status of 18.3% was unknown. Analysis of surveillance performances showed that all, but two, indicators were below the required WHO-specified targets. Non-polio enterovirus (NPEV) isolation rate was consistently below the minimum requirement at≥10% and the proportions of stool specimens that reached the laboratory within 72 hours of being sent were always below 15% (WHO target is ≥80%). Virus isolation and differentiation showed that 1.5% of AFP cases were infected by WPVs, 5.5% by Sabin strains, 0.5% by vaccine-derived polioviruses (VDPVs) and 7.2% by NPEVs.CONCLUSION: Our findings indicate that additional efforts are needed to address the timeliness of adequate stool specimens' arrival to the laboratory. It remains essential to maintain high polio vaccine coverage and high AFP surveillance standards to ensure rapid detection and containment of either WPV importation or VDPV re-emergence in DRC.

A case report of a male who developed membranous glomerulonephritis 23 days after the vaccination against Influenza A (H1N1) virus.

PMID:

Indian J Pathol Microbiol. 2012 Apr-Jun;55(2):239-41. PMID: 22771654

Abstract Title:

Can influenza H1N1 vaccination lead to the membranous glomerulonephritis?

Abstract:

In 2009 winter, Influenza A (H1N1) monovalent split virus vaccine was used prevalently in the whole world as a result of the pandemic caused by Influenza (H1N1) virus. The vaccine's adverse effects were observed closely and vaccination has been found as safe in most studies. But some reports about immune response related diseases after influenza vaccinations are remarkable. The close relationship between membranous glomerulonephritis and antigens is known, particularly in seconder forms which occur after viral infections and vaccinations. So this case report is about a 56-year-old man, who developed membranous glomerulonephritis 23 days after the vaccination against Influenza A (H1N1) virus.

Metal-induced inflammation might be an important risk factor in a subset of patients with fibromyalgia.

PMID:

Neuro Endocrinol Lett. 2013 ;34(6):559-65. PMID: 24378456

Abstract Title:

Metal-induced inflammation triggers fibromyalgia in metal-allergic patients.

Abstract:

BACKGROUND: Fibromyalgia (FM) is a disease of unknown etiology. Inflammation could be one of the mechanisms behind this disease.OBJECTIVES: We studied the frequency and clinical relevance of metal allergy in FM patients.METHODS: Fifteen female FM patients were included in the study. Metal allergy was measured by a lymphocyte transformation test, MELISA®. Ten healthy age-matched women were used as controls for in vitro studies. Reduction of metal exposure in the FM patients was achieved by replacement of dental metal restorations and by the avoidance of known sources of metal exposure. Objective health assessment was performed 5 years after treatment. Subjective health assessment was established by a questionnaire, completed 2, 5 and in some cases 10 years after the start of the study. Follow-up MELISA was also performed.RESULTS: All FM patients tested positive to at least one of the metals tested. The most frequent reactions were to nickel, followed by inorganic mercury, cadmium and lead. Some healthy controls responded to inorganic mercury in vitro but most of the tests were negative. Objective examination 5 years later showed that half of the patients no longer fulfilled the FM diagnosis, 20% had improved and the remaining 30% still had FM. All patients reported subjective health improvement. This correlated with the normalisation of metal-specific responses in vitro.CONCLUSION: Metal allergy is frequent in FM patients. The reduction of metal exposure resulted in improved health in the majority of metal-sensitized patients. This suggests that metal-induced inflammation might be an important risk factor in a subset of patients with FM.

Undifferentiated connective tissue disease and fibromyalgia resemble the picture of Autoimmune/Inflammatory Syndrome Induced by Adjuvants.

PMID:

Curr Opin Rheumatol. 2017 07 ;29(4):355-360. PMID: 28368979

Abstract Title:

Undifferentiated connective tissue disease, fibromyalgia and the environmental factors.

Abstract:

PURPOSE OF REVIEW: The aim of this study was to discuss the role of environmental factors in the induction and perpetuation of autoimmunity, with particular focus on undifferentiated connective tissue disease (UCTD) and fibromyalgia. These two entities may share undefined clinical and laboratory features and recognize environmental exposures as triggering factors. From this particular point of view, both UCTD and fibromyalgia may resemble the picture of the 'Autoimmune/Inflammatory Syndrome Induced by Adjuvants' (ASIA).RECENT FINDINGS: A case-control study on environmental exposures showed that patients with UCTD were significantly more exposed to several adjuvants (vaccines, metal implants, proximity to metal factories and foundries) than age and sex-matched healthy controls. UCTD exposed to major ASIA triggers (vaccines, silicone) displayed typical features of ASIA (general weakness, chronic fatigue, irritable bowel syndrome) in the context of a predisposing genetic background (familiarity for autoimmunity).SUMMARY: The induction and perpetuation of autoimmunity is a complex process that requires the interaction between the individual genetic background and the environment. Environmental factors are gaining increasing attention since the description of ASIA, a syndrome that includes symptoms typically seen in patients with fibromyalgia and UCTD. A recent case-control study focusing on environmental exposures suggested that nearly half of patients with UCTD may fall within the ASIA spectrum.