Vaccine-associated measles in a patient treated with natalizumab: a case report.
Adult
Exanthema
/ chemically induced
Female
Fever
/ etiology
Humans
Immunologic Factors
/ therapeutic use
Immunosuppression Therapy
/ adverse effects
Immunosuppressive Agents
/ adverse effects
Measles
/ diagnosis
Measles Vaccine
/ adverse effects
Measles-Mumps-Rubella Vaccine
/ adverse effects
Multiple Sclerosis, Relapsing-Remitting
/ drug therapy
Natalizumab
/ immunology
Vaccines, Attenuated
/ adverse effects
Case report
Immunosuppression
Measles
Measles mumps rubella vaccine
Multiple sclerosis
Natalizumab
Vaccine
Vaccine adverse event
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
14 Oct 2020
14 Oct 2020
Historique:
received:
29
05
2020
accepted:
05
10
2020
entrez:
15
10
2020
pubmed:
16
10
2020
medline:
11
11
2020
Statut:
epublish
Résumé
Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment. A young female patient with relapsing-remitting multiple sclerosis on natalizumab treatment received the live attenuated measles, mumps, and rubella vaccine in preparation for a change in her treatment in favour of fingolimod, with established immunosuppressive qualities. Seven days after receiving the vaccine, our patient experienced diffuse muscle pain, fatigue, and thereafter developed a fever and then an erythematous maculopapular rash, compatible with vaccine associated measles. This was later confirmed by a positive measles RT-PCR throat swab. The patient's symptoms resolved without any sequelae. In this case report we review the immunosuppressive qualities of natalizumab and the evidence in favour and against live vaccines in patients on this treatment. Our findings reveal the insufficient understanding of the immunosuppressive effects of new immunomodulators, and thus of the safety of live vaccines in patients on such medications. While this case triggers precaution, there is insufficient evidence to conclude that natalizumab treatment could favor the onset of vaccine-associated measles.
Sections du résumé
BACKGROUND
BACKGROUND
Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment.
CASE PRESENTATION
METHODS
A young female patient with relapsing-remitting multiple sclerosis on natalizumab treatment received the live attenuated measles, mumps, and rubella vaccine in preparation for a change in her treatment in favour of fingolimod, with established immunosuppressive qualities. Seven days after receiving the vaccine, our patient experienced diffuse muscle pain, fatigue, and thereafter developed a fever and then an erythematous maculopapular rash, compatible with vaccine associated measles. This was later confirmed by a positive measles RT-PCR throat swab. The patient's symptoms resolved without any sequelae.
CONCLUSION
CONCLUSIONS
In this case report we review the immunosuppressive qualities of natalizumab and the evidence in favour and against live vaccines in patients on this treatment. Our findings reveal the insufficient understanding of the immunosuppressive effects of new immunomodulators, and thus of the safety of live vaccines in patients on such medications. While this case triggers precaution, there is insufficient evidence to conclude that natalizumab treatment could favor the onset of vaccine-associated measles.
Identifiants
pubmed: 33054715
doi: 10.1186/s12879-020-05475-9
pii: 10.1186/s12879-020-05475-9
pmc: PMC7556935
doi:
Substances chimiques
Immunologic Factors
0
Immunosuppressive Agents
0
Measles Vaccine
0
Measles-Mumps-Rubella Vaccine
0
Natalizumab
0
Vaccines, Attenuated
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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