Meningitis & vaccine citations
Meningitis & vaccines

da Cunha SS, Rodrigues LC, Barreto ML, Dourado I. Outbreak of aseptic meningitis and mumps after mass vaccination with MMR vaccine using the Leningrad-Zagreb mumps strain. Vaccine. 2002 Jan 15;20(7-8):1106-12.PMID: 11803071 [PubMed - in process]
[2002] Outbreak of aseptic meningitis and mumps after mass vaccination with MMR vaccine using the Leningrad-Zagreb mumps strain
da Cunha, SS; Rodrigues, LC; Barreto, ML; Dourado, I; (2002) Outbreak of aseptic meningitis and mumps after mass vaccination with MMR vaccine using the Leningrad-Zagreb mumps strain. Vaccine, 20 (7-8). pp. 1106-12. ISSN 0264-410X DOI: 10.1016/S0264-410X(01)00438-8 Abstract: Data from routine surveillance during two mass immunisation campaigns (MIC) with Measles-mumps-rubella (MMR)vaccine using Leningrad-Zagreb mumps strain in two states in Brazil were analysed to estimate the risk of vaccine-related meningitis and mumps. Increase in the incidence of the two diseases was observed in both states, 3 weeks after the vaccination campaigns. The estimated number of doses applied per one case of vaccine-related meningitis ranged from 6199 (95% CI: 4854-8058) to 19,247 (95% CI: 12,648-29,513) depending on the diagnostic criteria used and state. It was 300 doses (95% CI: 286-317) for each case of mumps. The implications for vaccination policy are discussed.

"Aseptic meningitis after vaccination against measles and mumps," Paediatric Infectious Diseases, vol. 8, 1989, pp. 302-8.]

"Epidemics of aseptic meningitis due to enteroviruses following national immunization days in Bahrain" (Annals of Tropical Paediatrics, vol. 18, no. 2, June 1998, pp. 101-9): Two successive epidemics of aseptic meningitis due to enteroviruses were observed after national immunization days against polio, comprising 286 and 169 cases, respectively, from July 1995-September 1996. Another report, "Update of enterovirus infection in infants and children" states, in a section titled "Viral meningitis," that natural polioviruses were an important cause of viral meningitis before vaccination (cases were called "nonparalytic poliomyelitis"). Now, "rare" cases of viral meningitis are attributed to the attenuated polioviruses in vaccines, in both vaccine recipients and their contacts

"Neurologic complications associated with oral poliovirus vaccine and genomic variability of the vaccine strains after multiplication in humans," Acta Virologica, vol. 42, number 3, June 1998, pp. 187-94: The oral poliovirus vaccine (OPV) sometimes occasions paralytic poliomyelitis in vaccine recipients and their susceptible contacts. Molecular biology studies of polioviruses from these patients demonstrate genomic modifications known or suspected to increase neurovirulence. The same genomic modifications have been identified in strains isolated from non-symptomatic vaccinees. Other neurologic complications such as meningitis, encephalitis, convulsions, transverse myelitis and Guillain-Barre Syndrome have also been associated with this vaccine.

"Mumps meningitis following measles, mumps, and rubella immunisation [letter]" (The Lancet, vol. 2, July 8, 1989, p. 98; comments in vol. 2, August 12, 1989, pp. 394-5; vol. 2, September 16, 1989, p. 677): in the primary letter, mumps meningitis was reported in a three-year-old girl twenty-one days after measles, mumps, and rubella (MMR) immunization. The child exhibited lethargy, vomiting, headache, dry cough, fever, irritability, and meningeal irritation. There was no known exposure to the measles, mumps or rubella natural infections. No bacterial or other infections were found. In the August 12 issue of Lancet, a West German physician reported, also in a letter, a two-year-old boy with mumps meningitis twenty-one days following a different manufacturer's MMR vaccine. There was no exposure to natural mumps virus. The author of August 12 concludes, "The incubation time for mumps is about 21 days. In some patients, time-lag between immunisation and manifestation of meningitis was very close to 3 weeks, without known previous mumps contacts. These facts strongly suggest that some patients may have had vaccine mumps meningitis, and not wild mumps infection." In the September 16 issue of Lancet, two British physicians report two 16-month-old boys with mumps meningitis admitted to the hospital 18 and 19 days following MMR immunization. Mumps virus was isolated from cerebrospinal fluid of both boys. One boy did not exhibit a rise in mumps antibodies in spite of vaccination and post-vaccinal meningitis. [Other vaccinal mumps meningitis citations: "Mumps meningitis, possibly vaccine related,"

Canada Disease Weekly Report, vol. 14-40, 1988, pp. 209-11; "A case of mumps meningitis: a post-immunization complication?" Canada Disease Weekly Report, vol. 13-35, 1987, pp. 155-6; "A case of mumps meningitis: a complication of vaccination?" Canadian Medical Association Journal, vol. 138, 1988, p. 135; "Vaccine-induced mumps-like disease," Development of Biological Standards, vol. 43, 1978, pp. 269-72;

"I know one more case  of serious problems after hepatitis B vaccination   described in internet by doctors. It's unfortunately, in Polish, ...... (they described the case as postvaccination chronic meningitis, but they were very confused that such symptoms occured after hepatitis B vaccination). The address is: Kasperowicz, MSc

 Autret E, et al (1996). [Aseptic meningitis after mumps vaccination]. Therapie. 1996 Nov-Dec;51(6):681-3. French. PMID: 9164005; UI: 97306738.

The aim of this retrospective study was to evaluate the incidence and the characteristics of spontaneously reported aseptic meningitis (AM) in France following mumps vaccination with monovalent or multivalent vaccines containing the Urabe strain. Fifty-four cases of AM were reported to the regional drug surveillance centres or to the manufacturer from the time each vaccine was launched up until June 1992. Twenty cases were associated with the time off administration of a monovalent mumps vaccine and 34 with a trivalent measles, mumps and rubella vaccine (MMR). A mumps virus was isolated in four cases in the cerebrospinal fluid and an Urabe-like strain was characterised twice by polymerase chain reaction (PCR). A probable mumps origin was assumed in 17 other cases where the patients presented with other clinical or biological signs of mumps infection. The clinical outcome of AM was always favourable. The global incidence of mumps vaccine-associated AM was 0.82/100,000 doses, which is significantly lower than the incidence in the unvaccinated population. Even considering that the actual incidence of AM is much higher when assessed by active surveillance studies, the risk/benefit ratio of mumps vaccine remains in favour of vaccination. The incidence of mumps vaccines containing Jeryl Lynn (ROR Vax et Imu ORR) associated with AM needs to be evaluated. PMID: 9164005, UI: 97306738.

Arruda WO, Kondageski C. Related Articles
Aseptic meningitis in a large MMR vaccine campaign (590,609 people) in Curitiba, Parana, Brazil, 1998.
Rev Inst Med Trop Sao Paulo. 2001 Sep-Oct;43(5):301-2.
PMID: 11696855 [PubMed - in process]

Black S, et al.     Risk of hospitalization because of aseptic meningitis after measles-mumps-rubella vaccination in one- to two-year-old children: an analysis of the Vaccine Safety Datalink (VSD) Project. Pediatr Infect Dis J. 1997 May;16(5):500-3.
PMID: 9154545; UI: 97299143.
Basson E, Di Maio M, Stamm D, Cagnin S, Berger C, Floret D.  Arch Pediatr 1996 Apr;3(4):342-4 [Haemophilus influenzae meningitis following vaccination. Consequence or coincidence]?[Article in French] Unite de reanimation pediatrique, hopital Edouard-Herriot, Lyon, France.

BACKGROUND: The introduction of vaccines against Haemophilus influenzae type b (Hib) has had a substantial impact on Hib infections. Their use has established their excellent safety profiles but occasional adverse effects have been reported.
CASE REPORT: A 4 month-old infant was admitted for a severe form of Hib meningitis with septicemia whose first manifestations developed 3 hours after the first immunization with a conjugate vaccine against Hib (PRP-T). The outcome was good without any sequelae.
DISCUSSION: A dramatic decrease in serum antibodies due to antigen-antibody reaction during the first days
after immunization has been reported; this mechanism and some epidemiological data could favor the hypothesis that the vaccine is responsible for the infection, at least the unconjugated vaccines.
CONCLUSION: Any fever occurring in the immediate post-immunization period must alert the possibility of a Hib infection.
Begg N.     Reporting of vaccine associated mumps meningitis. Arch Dis Child. 1993 Apr;68(4):526. No abstract available.PMID: 8503686; UI: 93277169.
Colville A, et al. Mumps meningitis and measles, mumps, and rubella vaccine. Lancet. 1992 Sep 26;340(8822):786. No abstract available.PMID: 1356189; UI: 92408361.
Cizman M, et al.     Aseptic meningitis after vaccination against measles and mumps. Pediatr Infect Dis J. 1989 May;8(5):302-8. PMID: 2726323; UI: 89263453.

Dourado I, Cunha S, Teixeira MG, Farrington CP, Melo A, Lucena R, Barreto ML.   Outbreak of aseptic meningitis associated with mass vaccination with a urabe-containing measles-mumps-rubella vaccine: implications for immunization programs. Am J Epidemiol. 2000 Mar 1;151(5):524-30. PMID: 10707922 [PubMed - indexed for MEDLINE]

A mass immunization campaign with a Urabe-containing measles-mumps-rubella vaccine was carried out in 1997 in the city of Salvador, northeastern Brazil, with a target population of children aged 1-11 years. There was an outbreak of aseptic meningitis following the mass campaign. Cases of aseptic meningitis were ascertained through data collected from the records of children admitted to the local referral hospital for infectious diseases between March and October of 1997, using previously defined eligibility criteria. Vaccination histories were obtained through home visits or telephone calls. Eighty-seven cases fulfilled the study criteria. Of those, 58 cases were diagnosed after the vaccination campaign. An elevated risk of aseptic meningitis was observed 3 weeks after Brazil's national vaccination day compared with the risk in the prevaccination period (relative risk = 14.3; 95% confidence interval: 7.9, 25.7). This result was confirmed by a case series analysis (relative risk = 30.4; 95% confidence interval: 11.5, 80.8). The estimated risk of aseptic meningitis was 1 in 14,000 doses. This study confirms a link between measles-mumps-rubella vaccination and aseptic meningitis. The authors discuss the implications of this for the organization and planning of mass immunization campaigns.

Forsey T, et al.    Mumps vaccines and meningitis. Lancet. 1992 Oct 17;340(8825):980. No abstract available.PMID: 1357388; UI: 93023309.

Fujinaga T, et al. (1991) A prefecture-wide survey of mumps meningitis associated with measles, mumps and rubella vaccine. Pediatr Infect Dis J. 1991 Mar;10(3):204-9. PMID: 2041667; UI: 91252105.

A survey of untoward reactions, especially central nervous system reactions, after the administration of a newly introduced measles, mumps and rubella (MMR) vaccine in Gunma Prefecture, Japan, was initiated soon after 4 patients were hospitalized for aseptic meningitis. Thirty-five, 6 and 2 children developed meningitis, convulsive disorders and parotitis, respectively, within 2 months after MMR vaccination during the 8-month period extending from April to November, 1989. The time lag between MMR vaccination and meningitis ranged from 14 to 28 days in the 35 cases of meningitis. Mumps virus, isolated from the cerebrospinal fluid in 13 patients with aseptic meningitis, was characterized by determination of the nucleotide sequences of the P gene as mumps vaccine strain. The incidence of aseptic meningitis with positive mumps vaccine virus was estimated to be 0.11% (0.3% as a whole) during the 8 months from April to November and increased to 0.3% (0.7% as a whole) in September and October. We conclude that the incidence of aseptic meningitis after MMR vaccination seems to be higher than that reported previously.

Furesz J, et al.   Vaccine-related mumps meningitis--Canada. Can Dis Wkly Rep. 1990 Dec 15;16(50):253-4. English; French. No abstract available.PMID: 2285950; UI: 91138119.

Gray JA, et al.    Mumps vaccine meningitis. Lancet. 1989 Oct 14;2(8668):927. No abstract available.PMID: 2571853; UI: 90013726   

Gray JA, et al.      Mumps meningitis after mumps, measles, and rubella vaccination. BMJ. 1989 Dec 9;299(6713):1464-5. No abstract available.PMID: 2514842; UI: 90123330.

Khalfan S, Aymard M, Lina B, Thouvenot D, Schuffenecker I, Foray S, Fernandes E, Baig B.Epidemics of aseptic meningitis due to enteroviruses following national immunization days in Bahrain. Ann Trop Paediatr. 1998 Jun;18(2):101-9.PMID: 9924570 [PubMed - indexed for MEDLINE]

Rebiere I (1995), Galy-Eyraud C Reseau National de Sante Publique, Saint-Maurice, France.. Estimation of the risk of aseptic meningitis associated with mumps vaccination, France, 1991-1993. Int J Epidemiol 1995 Dec;24(6):1223-7
BACKGROUND: Several published studies have recently shown a higher incidence of aseptic meningitis associated with Urabe AM-9 vaccine strain than that estimated previously. In France, where all mumps vaccines produced and marketed contain the Urabe AM-9 vaccine strain, little was known about the incidence of these side effects although several surveillance systems exist. METHODS: The capture-recapture method can be used to estimate the total number of cases of a disease when at least two independent data sources are available. Applying the capture-recapture method, data provided by the national network of hospital virology laboratories (EPIVIR) and by the Pharmacovigilance Department of the vaccine manufacturer ( during a 3-year period between 1 January 1991 and 31 December 1993 have been used to obtain an estimate of the total number of aseptic meningitis cases associated with Urabe AM-9 vaccine. RESULTS: The number of such aseptic meningitis cases was estimated at 116 (95% confidence interval [CI]: 49-183). The risk of aseptic meningitis can thus be assessed as 1 case per 28,400 doses of Urabe AM-9 sold (95% confidence interval [CI]: 1 case per 18,000-1 case per 67,200). The sensitivity of the systems was 21% for EPIVIR and 23% for The low number of cases recorded by either system makes it difficult to test the statistical independence of the two systems by the calculation of the correlation coefficient of the sensitivity of the systems after stratification. However, the stratified data by age, by sex, by geographical zone and by type of vaccine show that the totals after stratification are not very different from the crude total. CONCLUSIONS: The French Vaccination Committee has recommended promoting the practice of measles-mumps-rubella vaccination in order to limit the circulation of the wild virus and to prevent an epidemic in insufficiently protected groups of the population, whilst awaiting vaccine containing the Jeryl-Lynn strain. PMID: 8824866, UI: 96422249

Murray MW, et al. Mumps meningitis after measles, mumps, and rubella vaccination. Lancet. 1989 Sep 16;2(8664):677. No abstract available.PMID: 2570924; UI: 89383684.
Miller E, (1993) Goldacre M, Pugh S, Colville A, Farrington P, Flower A, Nash J, MacFarlane L, Tettmar R. Risk of aseptic meningitis after measles, mumps, and rubella vaccine in UK children.Lancet 1993 Apr 17;341(8851):979-82. Immunisation Division, PHLS Communicable Disease Surveillance Centre, London.

Cases of aseptic meningitis associated with measles/mumps/rubella vaccine were sought in thirteen UK health districts following a reported cluster in Nottingham which suggested a risk of 1 in 4000 doses, substantially higher than previous estimates based on cases reported by paediatricians (4 per million). Cases were ascertained by obtaining vaccination records of children with aseptic meningitis diagnosed from cerebrospinal fluid samples submitted to Public Health Laboratories or discharged from hospital with a diagnosis of viral meningitis. Both methods identified vaccination 15-35 daysbefore onset as a significant risk factor and therefore indicative of a causal association. With both, half the aseptic meningitis cases identified in children aged 12-24 months were vaccine-associated with onset 15-35 days after vaccine. The study confirmed that the true risk was substantially higher than suggested by case reports from paediatricians, probably about 1 in 11,000 doses. However, the possibility that the aseptic meningitis induced by vaccination was largely asymptomatic and a chance laboratory finding in children investigated for other clinical conditions, particularly febrile convulsions, could not be excluded. Comparison of national reports of virus-positive mumps meningitis cases before and after the introduction of this vaccine indicated that the risk from wild mumps was about 4-fold higher than from vaccine. Altogether, 28 vaccine-associated cases were identified, all in recipients of vaccines containing the Urabe mumps strain. The absence of cases in recipients of vaccine containing the Jeryl Lynn strain, despite its 14% market share, suggested a higher risk fromUrabe vaccine. A prospective adverse event surveillance system using the study methods is currently being established to assess the risk, if any, from the Jeryl Lynn strain which is nowthe only mumps vaccine used in the UK. Comments: Comment in: Lancet 1993 Apr 17;341(8851):994-5 Comment in: Lancet 1993 Jun 12;341(8859):1541

Miller E, et al.   Risk of aseptic meningitis after measles, mumps, and rubella vaccine in UK children. Lancet. 1993 Apr 17;341(8851):979-82. PMID: 8096942; UI: 93225694.

Mori I, et al.(1991) [Virological evaluation of mumps meningitis following vaccination against mumps]. Kansenshogaku Zasshi. 1991 Feb;65(2):226-33. Japanese. PMID: 2066606; UI: 91294602.

[No authors listed] Mumps meningitis and MMR vaccination. Lancet. 1989 Oct 28;2(8670):1015-6. Review. No abstract available.PMID: 2572742; UI: 90042705.
No authors listed]   A case of mumps meningitis: a complication of vaccination? CMAJ. 1988 Jan 15;138(2):135. No abstract available.PMID: 3334926; UI: 88079743.
No authors listed]    Mumps meningitis following measles, mumps, and rubella immunisation. Lancet. 1989 Aug 12;2(8659):394-5. No abstract available.PMID: 2569586; UI: 89343382.
[No authors listed]    Meningitis associated with measles-mumps-rubella vaccines. Wkly Epidemiol Rec. 1992 Oct 9;67(41):301-2. English; French. No abstract available.PMID: 1390049; UI: 93002251.

Olin P, Romanus, V, Storsaeter, J, "Invasive Bacterial Infections During an Efficiacy Trial of Acellular Pertussis Vaccines --Implications For Future Surveilance In Pertussis Vaccine Programmes", Tokai J Exp Clin Med, 1988; 13 Suppl: 143-144.

Peltola H.  Mumps vaccination and meningitis. Lancet. 1993 Apr 17;341(8851):994-5. No abstract available.PMID: 8096949; UI: 93225701.

Rebiere I, et al. Estimation of the risk of aseptic meningitis associated with mumps vaccination, France, 1991-1993. Int J Epidemiol. 1995 Dec;24(6):1223-7. PMID: 8824866; UI: 96422249.
Riordan FA, et al.    Bacterial meningitis after MMR immunisation. Postgrad Med J. 1995 Dec;71(842):745-6. PMID: 8552541; UI: 96142748.
Sugiura A, et al (1991) Aseptic meningitis as a complication of mumps vaccination. Pediatr Infect Dis J. 1991 Mar;10(3):209-13. PMID: 2041668; UI: 91252106.

In 1989 a nationwide surveillance of neurologic complications after the administration of mumps vaccine was conducted in Japan, based on the notification of cases and the testing of mumps viruses isolated from cerebrospinal fluid for their relatedness to the vaccine by nucleotide sequence analysis. Among 630,157 recipients of measles-mumps-rubella trivalent (MMR) vaccine containing the Urabe Am9 mumps vaccine, there were at least 311 meningitis cases suspected to be vaccine-related. In 96 of these 311 cases, mumps virus related to the vaccine was isolated from cerebrospinal fluid. The unusually high incidence may have been partly a result of the adverse media publicity of the problem at the time of surveillance. We analyzed clinical features of 165 and 27 laboratory-confirmed mumps vaccine-related meningitis cases that occurred among the recipients of MMR and monovalent mumps vaccines, respectively, during a 1-year period after the introduction of MMR vaccine. The incidence of vaccine-related meningitis was similar among the recipients of MMR and monovalent Urabe Am9 mumps vaccines. Meningitis was generally mild and there were no sequelae from the illness. The complication was more frequent among male than among female children.

Tesovic, G et al, "Aseptic Meningitis after Measles, Mumps and Rubella Vaccine", Lancet, Jun 12, 1993, 341(8859):1541.

Ueda K, et al.   Aseptic meningitis caused by measles-mumps-rubella vaccine in Japan. Lancet. 1995 Sep 9;346(8976):701-2. No abstract available.PMID: 7658837; UI: 95387790.
Wiersbitzky S, et al.  [Increased risk of invasive bacterial infections after preventive mumps-measles-rubella vaccination]? Kinderarztl Prax. 1993 Jun;61(4-5):170-1. German. No abstract available.PMID: 8361148; UI: 93368098.