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Active, healthy 11-y/o boy develops degenerative neurologic symptoms. PMH relevant for measles at age 1 year, MMR vaccine at 8 months. Is there a connection?
The CDC periodical Morbidity and Mortality Weekly Report recently published a case report of an 11-year-old, previously completely healthy boy, a straight-A student, active on soccer and basketball teams, who, in 2012, began to develop progressively severe neurologic symptoms. Four months prior to admission and diagnosis at a tertiary children’s hospital he began to struggle with school, drop items unintentionally, and have difficulty staying awake, even falling asleep once while walking. He developed myoclonic jerks and his coordination deteriorated. Results of initial head MRI and lumbar puncture (LP) were normal. EEG showed some nonspecific bifrontal slowing. Pediatric neurologists were baffled.
The child’s past medical history was relevant for measles contracted at age 1 year in the Philippines despite a measles vaccine at age 8 months. Family history was negative for any progressive neurologic diseases. His cognitive and motor skills continued to decline. He became aggressive and cried continuously. Shortly before his admission to the hospital, he lost the ability to walk, became incontinent, and no longer recognized family members. A repeat EEG after admission showed diffuse background slowing and disorganization with multiple spikes and waves, a finding characteristic with his eventual diagnosis. Results of a repeat LP and blood work confirmed the untreatable diagnosis. He was sent home and died 43 months later in 2015.
What do you think?
1. Was this child’s disease a vaccine-preventable condition?
Liko J, Guzman-Cottrill JA, Cieslak PR. Notes from the Field: Subacute sclerosing panencephalitis death - Oregon, 2015. MMWR Morb Mortal Wkly Rep. 2016;65:10–11.
Krugman S, Ward R. Infectious Diseases of Children and Adults. 5th ed. Saint Louis, MO: The C. V. Mosby Company; 1973.
Note: This older Krugman, Ward infectious disease textbook was published at a time when many cases of SSPE were still popping up since the MMR vaccine was first approved in 1971.