Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 27, Number 6—June 2021
CME ACTIVITY - Research

Neurologic Disease after Yellow Fever Vaccination, São Paulo, Brazil, 2017–2018

Ana Freitas Ribeiro1, Bruno Fukelmann Guedes1Comments to Author , Jamal M.A.H. Sulleiman, Francisco Tomaz Meneses de Oliveira, Izabel Oliva Marcilio de Souza, Juliana Silva Nogueira, Rosa Maria Nascimento Marcusso, Eder Gatti Fernandes, Guilherme Sciascia do Olival, Pedro Henrique Fonseca Moreira de Figueiredo, Ana Paula Rocha Veiga, Flávia Esper Dahy, Natália Nasser Ximenes, Lecio Figueira Pinto, José Ernesto Vidal, and Augusto Cesar Penalva de Oliveira
Author affiliations: Universidade Nove de Julho, São Paulo, Brazil (A.F. Ribeiro); Instituto de Infectologia Emílio Ribas, São Paulo (A.F. Ribeiro, J.M.A.H. Sulleiman, R.M. Nascimento Marcusso, G. Sciascia do Olival, A.P. Rocha Veiga, F. Esper Dahy, J.E. Vidal, A.C. Penalva de Oliveira); Hospital das Clínicas, Universidade de São Paulo, São Paulo (B.F. Guedes, I.O. Marcilio de Souza, P.H.F. Moreira de Figueiredo, N. Nasser Ximenes, L. Figueira Pinto, J. Ernesto Vidal); Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo (F.T. Meneses de Oliveira); Instituto Adolfo Lutz, São Paulo (J. Silva Nogueira); Centro de Vigilância Epidemiológica Prof. Alexandre Vranjac, São Paulo (E. Gatti Fernandes)

Main Article

Table 1

Diagnostic certainty, clinical, epidemiologic, and immunologic investigations for 42 patients with suspected yellow fever vaccine–associated neurologic disease, according to Brighton Collaboration classification criteria, São Paulo, Brazil, 2017–2018*

Characteristic Aseptic meningitis, n = 24 Encephalitis, n = 8 Guillain-Barré syndrome, n = 3‡ Myelitis, n = 2‡ ADEM, n = 2‡ Unclassified† n = 3‡
Age, y, median (IQR) [range]
 36 (23.75–46.75)
 40 (30.25–58.25)
 59 (43–73)
 33 [25–41]
 37 [22–52]
 28 [25–50]
Sex, no (%)
F 7 (29) 5 (62) 1 (33) 2 (100) 1 (50) 0
M 17 (71) 3 (38) 2 (67) 0 1 (50) 3 (100)
Vaccine–symptom interval, d, median (IQR) [range]
 17 (7.75–20.00)
 7 (3.50–17.25)
 16 [14–31]
 11.5 [0–23]
 10 [5–15]
 13 [3–29]
No. full/fractional/unknown doses 18/4/2 5/3/0 3/0/0 1/1/0 1/1/0 2/0/1
YF virus IgM in CSF, reactive/total tested 10/17 4/7 0/2 0/1 1/2 0/1
YF virus in CSF detected by PCR, detected/total tested
 0/17
 0/6
 0/2
 0/1
 0/1
 0/1
BC level of diagnostic certainty, no. cases
Level 1 17 0 1 0 2 NA
Level 2
 7
 8
 2
 2
 0
 NA
Brazil MoH/CDC classification, no. cases Level 1 NRL: 21; level 2 NRT: 1; definite NRT: 1; suspected NRT: 1 Level 1 NRL: 2; level 2 NRT: 3; definite NRT: 2; suspected NRT: 1 Level 2 PNS: 1; probable PNS:2 Level 1 NRL: 2 Probable CNS: 2 Level 1 NRL: 3

*ADEM, acute disseminated encephalomyelitis; BC, Brighton Collaboration; CDC, Centers for Disease Control and Prevention); CNS, autoimmune neurologic disease with central nervous system involvement; CSF, cerebrospinal fluid; IQR, interquartile range; NA, not applicable; NRL, neurologic disease; NRT, neurotropic disease; MoH, Ministry of Health; PNS, autoimmune neurologic disease with peripheral nervous system involvement; YF, yellow fever.
†Includes 1 case of ataxia, 1 of opsoclonus-myoclonus-ataxia, 1 case of optic neuritis.
‡In groups with <5 cases, range is substituted for IQR.

Main Article

1These authors contributed equally to this article.

Page created: April 12, 2021
Page updated: May 18, 2021
Page reviewed: May 18, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external