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Volume 29, Number 3—March 2023
Synopsis

Yellow Fever Vaccine–Associated Viscerotropic Disease among Siblings, São Paulo State, Brazil

Eder Gatti FernandesComments to Author , Victor Bertollo Gomes Porto, Patrícia Mouta Nunes de Oliveira, Amaro Nunes Duarte-Neto, Maria de Lourdes de Sousa Maia, Letícia Kegele Lignani, Juliana Silva Nogueira, Gabriellen Vitiello Teixeira, Silvia D’Andretta Iglezias, Roberta Morozetti Blanco, and Helena Keico Sato
Author affiliations: Instituto de Infectologia Emílio Ribas, São Paulo, Brazil (E.G. Fernandes); Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac,” São Paulo (E.G. Fernandes, H.K. Sato); Programa Nacional de Imunizações, Brasilia, Brazil (V.B.G. Porto); Bio-Manguinhos, Rio de Janeiro, Brazil (P.M.N. de Oliveira, M. de Lourdes de Sousa Maia, L.K. Lignani, G.V. Teixeira); Faculdade de Medicina da Universidade de São Paulo, São Paulo (A.N. Duarte-Neto); Instituto Adolfo Lutz, São Paulo (A.N. Duarte-Neto, J.S. Nogueira, S. D'Andretta Iglezias, R.M. Blanco)

Main Article

Table

Clinical findings of cases of adverse events after YF vaccination in siblings from 2 familial clusters, São Paulo state, Brazil, 2017–2018*

Case information
 Cluster 1
Cluster 2
Case 1
 Case 2
 Case 3
 Case 4
 Case 5
Patient age, y/sex 40/M 35/M 28/F 32/M 29/M
Patient race
 White
 White
White
 White
 White
Kind of YF vaccine
 Standard
 Standard
Fractionated
 Fractionated
 Fractionated
Days from vaccination to symptom onset
 3
 4
4
 1
 4
Symptoms
 Fever, headache, vomiting, abdominal pain, jaundice, bleeding
 Fever, myalgia, vomiting, diarrhea, jaundice, seizures
Fever, myalgia, abdominal pain, dysuria, vomiting, bleeding
 Fever, myalgia, abdominal pain, jaundice, bleeding
 Fever, vomiting, myalgia, headache
Platelets, per μL† 38,000 29,000 23,000 29,000 75,000
Aspartate transaminase, U/L† 366 2,254 769 1,930 137
Alanine aminotransferase, U/L 166 617 180 503 122
International normalized ratio† 1.94 1.8 1.9 2.0 2.0
Total bilirubin, mg/dL† 8.5 8.5 6.5 7.6 0.6
Creatinine, mg/dL† 6.7 5.9 2.9 5.9 1.4
Creatinine phosphokinase†
 428
 1,061
13,080
 2,770
 514
Outcome
 Died
 Died
Died
 Died
 Recovered
RT-PCR for YF vaccine in blood Positive, 9 DAV Positive, 10 DAV Positive, 11 DAV Positive, 10 DAV Positive, 14 DAV
Viral isolation in serum sample >7 DAV Positive, 9 DAV ND ND ND ND
YF IgM Detected, 9 DAV ND ND Detected, 10 DAV Negative, 14 DAV
Liver histopathological pattern at autopsy Typical‡ ND ND Typical‡ ND
YF immunohistochemistry in hepatic tissue Positive NA NA Positive NA
RT-PCR for YF in liver ND ND ND Positive ND

*DAV, days after vaccination; NA, not applicable; ND, not done; RT-PCR, reverse transcription PCR; YF, yellow fever. †Most altered result. ‡The liver exhibited discrete microvesicular fatty change and mixed sinusoidal inflammatory infiltrate, with no evidence of hepatocellular necrosis in the sample.

Main Article

Page created: January 04, 2023
Page updated: February 19, 2023
Page reviewed: February 19, 2023
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.
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