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Effect of measles, mumps, rubella vaccination on pattern of encephalitis in children

M Koskiniemi1, A Vaheri

  • 1Children's Hospital, Helsinki, Finland.

Lancet (London, England)
|January 7, 1989
PubMed

Insights

Childhood encephalitis cases declined after measles, mumps, and rubella vaccination. However, severe outcomes persist, highlighting the need for prompt treatment of treatable infections like Mycoplasma pneumoniae.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • Encephalitis is a serious neurological condition in children.
  • Understanding causative agents and outcomes is crucial for effective management.
  • Trends in childhood encephalitis incidence and etiology have evolved over time.

Purpose of the Study:

  • To analyze the incidence, etiology, and outcomes of childhood encephalitis over a 20-year period.
  • To assess the impact of the measles, parotitis, and rubella (MPR) vaccination program on encephalitis trends.
  • To identify risk factors for poor outcomes in pediatric encephalitis.

Main Methods:

  • Retrospective analysis of 462 pediatric encephalitis cases treated between 1974 and 1993.
  • Data collection on patient demographics, causative agents, treatment, and outcomes.
  • Incidence rate calculation and trend analysis.

Main Results:

  • Encephalitis incidence decreased from 19.8 to 2.5 per 100,000 child-years.
  • Mumps, measles, and varicella viruses, and Mycoplasma pneumoniae were initial common causes.
  • Post-MPR vaccination, measles and mumps-associated encephalitis vanished; varicella-zoster, M. pneumoniae, and enteroviruses became more prevalent.
  • Mortality was 3%, with 7% severe disability; poor outcomes linked to multiple infections, herpes simplex virus, cytomegalovirus, or M. pneumoniae.
  • The decline in total cases did not correlate with a decrease in severe outcomes.

Conclusions:

  • The MPR vaccination program significantly reduced encephalitis incidence from vaccine-preventable diseases.
  • Despite declining overall incidence, severe outcomes remain a concern, emphasizing the need for prompt diagnosis and treatment.
  • Mycoplasma pneumoniae and certain viral infections (e.g., herpes viruses) require urgent attention due to poor prognosis.

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