Vaccine-associated measles in a patient treated with natalizumab: a case report
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CASE REPORT
Open Access
Vaccine-associated measles in a patient treated with natalizumab: a case report Alix Miauton1*† , Rainer Tan1†, Vasiliki Pantazou2, Renaud Du Pasquier2 and Blaise Genton1
Abstract 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: 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 RTPCR throat swab. The patient’s symptoms resolved without any sequelae. Conclusion: 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. Keywords: Case report, Measles mumps rubella vaccine, Measles, Natalizumab, Immunosuppression, Vaccine adverse event, Multiple sclerosis, Vaccine
Background Live-attenuated vaccines, including the Measles-MumpsRubella (MMR) vaccine, consist of an attenuated microorganism still capable of replicating. They are generally contraindicated in patients with immunosuppressive therapies, by fear of systemic infection due to vaccine strain replication [1]. Paradoxically, those patients are more vulnerable to infectious diseases and would particularly benefit from immunization. Emergence of increasingly diverse immunosuppressive treatments, whose immunologic effect is not always clear, challenges this * Correspondence: [email protected] † Alix Miauton and Rainer Tan contributed equally to this work. 1 Tropical, travel and vaccination clinic, Unisanté, Center for primary care and public health, Bugnon 44, 1011 Lausanne, Switzerland Full list of author information is available at the end of the article
general contraindication. At present, little data exists on the safety of live-attenuated vaccines in those patients, and recommendations are based on expert opinion that may differ [2–6]. We describe here the first known case of vaccineassociated measles in a young female vaccine recipient with relapsing-remitting multiple sclerosis (RRMS), treated with natalizumab. Our aim is to explore the safety of vaccination in patients with multi
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