Aseptic meningitis in a large MMR vaccine campaign (590,609 people) in Curitiba, Paraná, Brazil, 1998

The aseptic meningitis after Measles-Mumps-Rubella vaccine (MMR) is a well recognized complication, and different incidences have been observed in several studies. We retrospectively analyzed forty cases of aseptic meningitis, during a large public immunization campaign (1998) in Curitiba, Southern Brazil (590,609 people), admitted in our Service. The vaccine utilized was Leningrad-3-Zagreb mumps strain, Edmonston-Zagreb measles strain, and RA 27#3 rubella strain. In all county, a total number of 87 cases were reported, resulting in a incidence of 1.7 cases per 10,000 given doses . The mean age was 23.7 ± 12.8 years. The female:male ratio was 1.35:1. Severe headache with meningismus (92.5%), fever (87.5%), nausea/vomiting (82.5%) were the most common clinical findings. Three cases (7.5%) developed mild mumps. All patients underwent cerebrospinal fluid (CSF) tap with the following findings: mononuclear pleocytosis from 100 to 500 cells/mm³ in 17 cases (42.5%; 257.5 ± 260.6 cells/mm³); increased protein 28 cases (67.5%; 92.1 ± 76.9 mg/dL); glucose was normal in all cases (56.8 ± 11.2 mg/dL) except in 4 (10%) cases, which presented less than 44 mg/dL. All serological tests (latex to bacterial meningitis, Cryptococcus, cysticercosis, VDRL) and bacteriological cultures were negative. Virus identification were also negative in 8 samples. None of the patients had neurological deficits or related symptoms after one year of onset. We believe the benefit of vaccination clearly outweights the incidence of benign vaccine-associated meningitis.

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Mumps Caused by an Inadequately Attenuated Measles, Mumps and Rubella Vaccine

Canadian Journal of Infectious Diseases ◽

10.1155/2001/910649 ◽

2001 ◽

Vol 12 (3) ◽

pp. 144-148 ◽

Cited By ~ 9

Author(s):

WJ Bakker ◽

RG Mathias

Keyword(s):

Cohort Study ◽

Attack Rate ◽

Wild Strain ◽

Mumps Virus ◽

Mmr Vaccine ◽

Rubella Vaccine ◽

Mass Immunization ◽

Separate Region ◽

Production Problems ◽

Immunization Campaign

PROBLEM:Reports of mumps following measles, mumps and rubella (MMR) immunization.OBJECTIVE:To determine whether mumps was caused by immunization or whether there was a concurrent epidemic of a wild strain of mumps.DESIGN AND PARTICIPANTS:Analysis of surveillance data and a cohort study of three schools that participated in the campaign.OUTCOME MEASURES:Cases of clinical mumps and orchitis, and immunization history and records were reviewed. The MMR vaccine was produced by the Serum Institute of India and contained the Leningrad-Zagreb strain of mumps virus. Four lots were used in the specific immunization campaign.RESULTS:Sentinel health facility surveillance showed an increase in mumps after two school immunization campaigns in western Suriname and a mass immunization campaign in the same region. There was also an increase in a geographically separate region following a mass campaign with the same vaccine. Three hundred fifteen children from three schools that were targeted in the immunization campaign were interviewed. The attack rate for mumps in those immunized was 15.1%; in those not immunized, the attack rate was 4.7%. In the affected males, the attack rate for orchitis was five of 19 (21%). Assuming 90% protection by the MMR vaccine, the incidence ratio (observed to expected) was 32.CONCLUSIONS:The mumps outbreak was caused by an inadequately attenuated MMR vaccine. Because this vaccine had not been used in these populations before in Suriname, it was not possible to determine wether the outbreak was due the virulence of the Leningrad-Zagreb mumps strain or due to production problems with one or more specific lots of vaccine. The vaccine was withdrawn from further use.

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MMR Vaccine Susceptibility of Viral Agents Causing Meningitis and Meningoencephalitis in Children

Infectious Disorders - Drug Targets ◽

10.2174/1871526521666210118142601 ◽

2021 ◽

Vol 21 ◽

Author(s):

Parisa Rahmani ◽

Hosein Alimadadi ◽

Reihaneh Mohsenipour ◽

Mohammad Roshanghalb

Keyword(s):

Aseptic Meningitis ◽

Medical Center ◽

Cross Sectional Study ◽

Nausea And Vomiting ◽

Demographic Information ◽

Mmr Vaccine ◽

Rubella Vaccine ◽

Cross Sectional ◽

Parotid Swelling ◽

Post Marketing

Background: Meningitis and meningoencephalitis are very adverse drug reactions that had not been documented in clinical studies. Nevertheless, cases were reported within the post marketing period. The aim of this study is to evaluate the prevalence, clinical and laboratory characteristics of aseptic meningitis and meningoencephalitis following Hoshino MMR (Mumps-Measles-Rubella) vaccine in children. Methods: In this cross-sectional study, children who were diagnosed with meningitis following MMR vaccine in an infectious or emergency department of the Tehran Medical Center were enrolled, and their demographic information was recorded from the file. A questionnaire concerning diagnostic criteria in favor of aseptic meningitis was provided for each child and the results of clinical examinations were recorded. Results : This study was performed on 73 children with meningitis symptoms of aspiration, where, 46 of the children were males and 27 were females. Prevalence of meningitis-related symptoms were: fever 66%, headache 49.3%, nausea and vomiting 74%, parotid swelling 0%, and meningeal symptoms 37%. Lab tests showed that 8.2% of patients had normal WBC whereas, 76.7% had abnormal levels. Conclusion: Our study showed that following MMR vaccine, in children with meningitis symptoms, nausea and vomiting followed by fever were most commonly seen symptoms.

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A Review on Medical Child Abuse and Child Protection

Journal of the Faculty of Medicine Baghdad ◽

10.32007/jfacmedbagdad.6331836 ◽

2021 ◽

Vol 63 (3) ◽

Author(s):

Mustafa Hussein Ajlan Al-Jarshawi ◽

Ahmed Al-Imam

Keyword(s):

Child Abuse ◽

Child Protection ◽

Clinical Findings ◽

Clinical Presentations ◽

Medical Child Abuse ◽

Three Stages ◽

The Mean ◽

One Year ◽

The Uk ◽

High Index Of Suspicion

Background Medical child abuse describes a child receiving unnecessary, harmful, or potentially harmful medical care at the caretaker's instigation. Objectives To focus on medical child abuse as an entity and emphasize its epidemiology, clinical presentations, prevention, and management. Results In the UK, the annual incidence of medical child abuse in children below one year increased to 3:100,000, while its prevalence in Arabs, including Iraq, is ambiguous due to lack of evidence and improper clinician's awareness. The mean age at diagnosis is 14 months to 2.7 years. Female caregivers are the most common offenders. Clinically, medical child abuse could fit into three stages; falsification of illness story, falsification of illness story and physical signs' fabrication, or induction of illness in children. A successful diagnosis mandates a comprehensive review of medical records to identify discrepancies between caregivers' stories versus clinical findings or investigations. Management requires recognizing abuse, halting it, securing the child's safety, maintaining the family's integrity when possible, and aborting unnecessary lateral referrals within the healthcare system. Conclusion Reported cases of medical child abuse are increasing steadily, while less severe ones go unrecognized. No diagnostic tool can help other than the physician's high index of suspicion. The management follows the same principles applied for other forms of child abuse, while good medical practice ensures its prevention.

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A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration

10.21203/rs.2.12933/v1 ◽

2019 ◽

Author(s):

Nachuan Liu ◽

Peng Li ◽

Erlei Zhi ◽

Chencheng Yao ◽

Chao Yang ◽

...

Keyword(s):

Pregnancy Rate ◽

Clinical Findings ◽

Good Choice ◽

Distal Anastomosis ◽

Obstructive Azoospermia ◽

Proximal Anastomosis ◽

Bilateral Surgery ◽

The Mean ◽

One Year

Abstract Background：To evaluate the clinical outcomes and the time of sperm returning to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods：From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. Results: The mean follow-up period was 17 months (range 3-36 months). Patency was assessed by the return of sperm in the ejaculate. The overall patency rate is 55.2 %, and the patency rates were 58.9%, 40.7%, 36.4%, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis and distal anastomosis, respectively. The average time it took to achieve patency is 4.11±2.74 months. And in the first six months, 87.8% (65/74) patency patients were reported to found sperm in the ejaculate. The overall pregnancy rate was 40.9 % (29/66) at the follow-up of 3 to 36 months, and the natural pregnancy rate was 30.3 % (20/66). The natural pregnancy rate was 32.1% for bilateral surgery, 33.3% for the site of distal anastomosis，but surprisingly, it was 0% for the site of proximal anastomosis. Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed ones may be a good choice. The expecting patency time is about within one year. Assisting with intraoperative sperm cryopreservation, patients can achieve better pregnancy outcomes. Moreover, the low natural pregnancy rate for the proximal anastomosis suggested that we should reconsider the indications of SA-LIVE for EOA patients. Key words: obstructive azoospermia; male infertility; vasoepididymostomy; patency; pregnancy

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Effect of gender on reporting of MMR adverse events in Saudi Arabia

Eastern Mediterranean Health Journal ◽

10.26719/2003.9.1-2.152 ◽

2003 ◽

Vol 9 (1-2) ◽

pp. 152-158

Author(s):

M. K. Khalil ◽

Y. Y. Al Mazrou ◽

Y. S. Al Ghamdi ◽

S. Tumsah ◽

M. Al Jeffri ◽

...

Keyword(s):

Gender Differences ◽

Saudi Arabia ◽

Adverse Events ◽

Aseptic Meningitis ◽

Incidence Rates ◽

Mmr Vaccine ◽

Future Studies ◽

And Gender ◽

Age Range ◽

Immunization Campaign

We evaluated the safety of a measles-mumps-rubella [MMR] immunization campaign for Saudi children [age range: 6-13 years] and gender differences in reporting post-MMR adverse events. After vaccinations were administered, we monitored 160 schools for 14 days and 19 hospitals in the 8 cities under study for 10 weeks. Incidence rates were: all MMR adverse events, 26.5/10, 000 MMR vaccines [significantly higher in females than males] ; Urabe strain aseptic meningitis, 1.0/295, 000; fever, 40.2/10, 000 [females] and 0.9/10, 000 [males] ; and parotitis, 5.4/10, 000 [females] and 0.9/10, 000 [males]. Combined MMR vaccine containing the Urabe mumps strain was safe for children aged 6-13 years. Gender differences regarding reactogenicity were evident and should be considered when designing future studies

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Mumps Antibody Response in Young Adults After a Third Dose of Measles-Mumps-Rubella Vaccine

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu094 ◽

2014 ◽

Vol 1 (3) ◽

Cited By ~ 32

Author(s):

Amy Parker Fiebelkorn ◽

Laura A. Coleman ◽

Edward A. Belongia ◽

Sandra K. Freeman ◽

Daphne York ◽

...

Keyword(s):

Vaccine Coverage ◽

Geometric Mean ◽

Neutralizing Antibody ◽

Cumulative Distribution ◽

Temporary Increase ◽

Mmr Vaccine ◽

Rubella Vaccine ◽

Antibody Titers ◽

One Year ◽

Antibody Levels

Abstract Background. Mumps outbreaks in populations with high 2-dose measles-mumps-rubella (MMR) vaccine coverage raise the question whether a third dose of MMR vaccine (MMR3) is needed. However, data on the immunogenicity of MMR3 are limited. We assessed mumps virus neutralizing antibody levels pre- and post-MMR3 in a nonoutbreak setting. Methods. Mumps antibody titers were assessed at baseline, 1 month, and 1 year after MMR3 in subjects aged 18–28 years. Results. At baseline, 5 of 656 (0.8%) subjects had seronegative mumps neutralizing antibody titers and 38 (5.8%) had low titers. One year post-MMR3, these numbers declined to 3 (0.5%) and 16 (2.4%), respectively. Subjects with low baseline titers were more likely to have low 1-month and 1-year titers (R2 = 0.81–0.87, P < .0001). Compared to baseline, geometric mean titers were significantly higher at 1 month (P < .0001) and 1 year (P < .01) post-MMR3; however, reverse cumulative distribution curves showed only minimal shifts in mumps titers from baseline to 1 month and 1 year. Conclusions. Very few subjects had negative or low baseline mumps titers. Nonetheless, mumps titers had modest but significant increases when measured 1 month and 1 year post-MMR3. This temporary increase in titers could decrease susceptibility to disease during outbreaks, but may have limited value for routine use in vaccinated populations.

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A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration

10.21203/rs.2.12933/v2 ◽

2020 ◽

Author(s):

Nachuan Liu ◽

Peng Li ◽

Erlei Zhi ◽

Chencheng Yao ◽

Chao Yang ◽

...

Keyword(s):

Pregnancy Rate ◽

Patency Rate ◽

Clinical Findings ◽

Distal Anastomosis ◽

Obstructive Azoospermia ◽

Proximal Anastomosis ◽

Bilateral Surgery ◽

The Mean ◽

One Year

Abstract Background: To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods: From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3–36) months. Results: Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9%, 40.7%, 36.4%, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11±2.74 months. In the first six months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3–36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis. Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within one year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.

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Incomplete Kawasaki disease - a diagnostic and therapeutic challenge

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v9i4.10234 ◽

2014 ◽

Vol 9 (4) ◽

pp. 30-35

Author(s):

S Datta ◽

S Maiti ◽

G Das ◽

A Chatterjee ◽

P Ghosh

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

Incomplete Kawasaki Disease ◽

Duration Of Symptoms ◽

Clinical Criteria ◽

Echocardiographic Finding ◽

2D Echocardiography ◽

Acquired Heart Disease ◽

The Mean ◽

One Year

Background The diagnosis of classical Kawasaki Disease was based on clinical criteria. The conventional criteria is particularly useful in preventing over diagnosis, but at the same time it may result in failure to recognize the incomplete form of Kawasaki Disease. Objective To suspect incomplete Kawasaki Disease, because early diagnosis and proper treatment may reduce substantial risk of developing coronary artery abnormality which is one of the leading causes of acquired heart disease in children. Method Nine cases of incomplete Kawasaki Disease were diagnosed over a period of one year. The diagnosis of incomplete Kawasaki Disease was based on fever for five days with less than four classical clinical features and cardiac abnormality detected by 2D- echocardiography. A repeat echocardiography was done after 6 weeks of onset of illness. The patients were treated with Intravenous Immunoglobulin and/or aspirin. Result The mean age of the patients was 3.83 years and the mean duration of symptoms before diagnosis was 12.1 days. Apart from other criteria all of our patients had edema and extreme irritability. All the patients had abnormal echocardiographic finding. Five patients received only aspirin due to nonaffordability of Intravenous Immunoglobulin and four patients received both aspirin and Intravenous Immunoglobulin, but the outcome was excellent in all the cases. Conclusion Incomplete Kawasaki Disease can be diagnosed with more awareness and aspirin alone may be used as a second line therapy in case of non affordability of Intravenous Immunoglobulin. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10234

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Natural history and treatment options of radiation-induced brain cavernomas: a systematic review

Neurosurgical Review ◽

10.1007/s10143-021-01598-y ◽

2021 ◽

Author(s):

Gildas Patet ◽

Andrea Bartoli ◽

Torstein R. Meling

Keyword(s):

Systematic Review ◽

Natural History ◽

Radiation Treatment ◽

Neurological Deficits ◽

Cochrane Library ◽

Average Dose ◽

Cavernous Malformations ◽

Radiation Induced ◽

The Mean

AbstractRadiation-induced cavernous malformations (RICMs) are delayed complications of brain irradiation during childhood. Its natural history is largely unknown and its incidence may be underestimated as RCIMS tend to develop several years following radiation. No clear consensus exists regarding the long-term follow-up or treatment. A systematic review of Embase, Cochrane Library, PubMed, Google Scholar, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Based on our inclusion/exclusion criteria, 12 articles were included, totaling 113 children with RICMs, 86 were treated conservatively, and 27 with microsurgery. We were unable to precisely define the incidence and natural history from this data. The mean age at radiation treatment was 7.3 years, with a slight male predominance (54%) and an average dose of 50.0 Gy. The mean time to detection of RICM was 9.2 years after radiation. RICM often developed at distance from the primary lesion, more specifically frontal (35%) and temporal lobe (34%). On average, 2.6 RICMs were discovered per child. Sixty-seven percent were asymptomatic. Twenty-one percent presented signs of hemorrhage. Clinical outcome was favorable in all children except in 2. Follow-up data were lacking in most of the studies. RICM is most often asymptomatic but probably an underestimated complication of cerebral irradiation in the pediatric population. Based on the radiological development of RICMs, many authors suggest a follow-up of at least 15 years. Studies suggest observation for asymptomatic lesions, while surgery is reserved for symptomatic growth, hemorrhage, or focal neurological deficits.

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Corneal cross-linking for treatment of progressive keratoconus in a patient with Alport syndrome: A case report

European Journal of Ophthalmology ◽

10.1177/1120672121997672 ◽

2021 ◽

pp. 112067212199767

Author(s):

Iva Krolo ◽

Aida Kasumović ◽

Ivana Radman ◽

Pavao Pavić

Keyword(s):

Case Report ◽

Alport Syndrome ◽

Contact Lenses ◽

Corneal Dystrophy ◽

Clinical Findings ◽

Cross Linking ◽

Posterior Polymorphous Corneal Dystrophy ◽

One Year ◽

Corneal Tomography

Purpose: Ocular features of Alport syndrome include anterior lenticonus, posterior polymorphous corneal dystrophy, and fleck-and-dot retinopathy in most cases. Keratoconus in such patients has been rarely mentioned in previous studies. To our knowledge, this is the first report of corneal cross-linking for halting the progression of keratoconus in a patient with Alport syndrome. Case report: A 22-year-old male was referred for his initial corneal topography, after he was already prescribed with rigid gas-permeable contact lenses. Alport syndrome was diagnosed in his infancy and gene COL4A5 mutation was confirmed. Ophthalmological evaluation confirmed keratoconus. One-year follow-up showed a progression on his right eye and standard corneal cross-linking was performed. Stabilization of the disease marked by normalization in visual function and corneal tomography values was noticed 1 year after the procedure. Conclusions: When diagnosing ocular clinical findings of Alport syndrome, keratoconus should be considered. Standard corneal cross-linking protocol can halt its progression.

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