Influenza A virus vaccine H1N1
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Acute disseminated encephalomyelitis in a child: case report A 2-year-old boy developed acute disseminated encephalomyelitis (ADEM) manifesting as gait disturbances and optic neuritis subsequent to influenza A virus vaccine H1N1 [Arepanrix]. Four days after initially receiving influenza A virus vaccine H1N1 [dosage and route not stated], the boy presented with an unsteady gait. He was sent home after a normal MRI scan, and his symptoms resolved 4 days later. His second H1N1 influenza vaccination was administered 24 days after receiving his first. Six days later, intermittent inward left-eye movements were observed. His mother noticed him holding books too closely 11 days following his second vaccination. Myopia and mild bilateral tremor were evident on admission, and his visual acuity was decreased. His history was notable for a febrile illness 2 weeks prior to his first dose of influenza A virus vaccine H1N1. Examination revealed bilateral optic disc swelling, with right-eye haemorrhages and venous engorgement. MRI scan was consistent with ADEM. IgM serology indicated a Mycoplasma infection in the past 6 months. Following pulsed methylprednisolone, the boy’s optic nerve swelling resolved and his visual acuity improved. At 6 months’ follow-up, neurological examination was normal. Author comment: "Our case is consistent with the Brighton Collaboration case definition for ADEM with level 1 certainty." Lapphra K, et al. Adverse neurologic reactions after both doses of pandemic H1N1 influenza vaccine with optic neuritis and demyelination. Pediatric Infectious Disease Journal 30: 84-86, No. 1, Jan 2011. Available from: URL: http:// 803048832 dx.doi.org/10.1097/inf.0b013e3181f11126 - Canada
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Reactions 29 Jan 2011 No. 1336
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