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Clinical and epidemiologic features of mumps meningoencephalitis and possible vaccine-related disease
J C McDonald1, D L Moore, P Quennec
1Department of Paediatrics, Montreal Children's Hospital, Quebec, Canada.
Abstract:
All cases of mumps meningoencephalitis diagnosed at our institution during the past 15 years were reviewed. There were 24 cases, 16 between 1973 and 1977, 3 between 1978 and 1985 and 5 in 1986 to 1988. Four of the recent cases occurred 19 to 26 days after receipt of a new mumps vaccine (Urabe Am 9 strain) released in Canada in 1986. The remaining 20 cases were clustered in winter and spring. The average age was 6.2 years and the ratio of males to females was 5:1. Clinical presentations were fever (90%), vomiting (90%), meningismus (70%), headache (65%), parotitis (50%) and seizures (30%). The mean cerebrospinal fluid white blood cell count was 513/mm3 (lymphocyte predominance); 55% of patients had a cerebrospinal fluid protein level of greater than 0.4 g/liter, and the cerebrospinal fluid:blood glucose ratio was greater than 0.4 in all. Two patients had adverse sequelae. The clinical and laboratory features of these cases were not significantly different from the vaccine-associated cases.
Insights
Mumps meningoencephalitis cases were reviewed, with recent cases linked to a new mumps vaccine. Clinical features and outcomes were similar between vaccine-associated and non-vaccine-associated cases.
Area of Science:
- Neurology
- Infectious Diseases
- Vaccinology
Background:
- Review of mumps meningoencephalitis cases over 15 years.
- Analysis of temporal trends and demographics.
Observation:
- Four recent cases of mumps meningoencephalitis occurred after administration of a new mumps vaccine (Urabe Am 9 strain).
- The majority of cases (20/24) occurred during winter and spring.
- Average patient age was 6.2 years with a 5:1 male to female ratio.
Findings:
- Clinical presentations included fever, vomiting, meningismus, headache, parotitis, and seizures.
- Cerebrospinal fluid analysis revealed elevated white blood cell counts, protein levels, and normal glucose ratios.
- Two patients experienced adverse sequelae, with no significant difference in features between vaccine-associated and non-vaccine-associated cases.
Implications:
- The Urabe Am 9 mumps vaccine strain may be associated with meningoencephalitis.
- Understanding the clinical spectrum of mumps meningoencephalitis is crucial for diagnosis and management.
- Further investigation into vaccine safety and potential neurological complications is warranted.