Allergic reactions to Japanese encephalitis vaccine
Section snippets
Disease occurrence in the Western population
Although the JE infection is primarily a problem for the Asian population, the disease also may occur in people from Western countries who work or travel in the region. People of all ages from nonendemic areas are not immune and are vulnerable to JE infection. Although the risk for JE is low for most travelers, individual risk is variable and depends on factors such as the location and duration of travel and the traveler's activities. Exposure in rural areas, especially for long periods, is the
Clinical illness
Most infections are asymptomatic, and only 1 in 250 infections results in symptomatic illness. The principal clinical sign is encephalitis, but milder neurologic presentations, including aseptic meningitis and febrile illness with headache, may be manifestations of JE infection. The incubation period is 5 to 15 days. The attack usually starts with a high fever, a change in mental status, headache, and gastrointestinal symptoms. Speech disturbances and motor dysfunction, including paresis, may
Vaccines
It has been estimated that in 25 years, approximately 500 million doses of JE vaccine (JEV) have been administered in China, Japan, Korea, and Taiwan [12]. Three types of JEV have been available worldwide, and more vaccines are being developed, including the following:
- 1.
Inactivated mouse-brain–derived vaccine
- 2.
Inactivated primary hamster-kidney (PHK)-cell–derived vaccine
- 3.
Live attenuated JEV
Only the inactivated mouse-brain–derived vaccine is distributed commercially and is available internationally.
Allergic mucocutaneous reactions to Japanese encephalitis vaccine
Most of the information on allergic adverse reactions concerns the inactivated mouse-brain–derived JEV, which is the most widely used vaccine in Western countries. In 1947, Sabin reported 19 cases of allergy, including urticaria and angioedema, after JE vaccination of 53,139 persons and suggested that these reactions might be caused by sensitization to the solution of formaldehyde [42]. In 1990, Poland reported that after vaccination of 1328 subjects, two persons had anaphylactic reactions
Denmark 1991
A mandatory, postmarketing adverse-event–reporting system in Denmark detected 15 reactions of allergic mucocutaneous character to Biken's inactivated JEV during a 1-year-period from September 1989 to October 1990 (Table 1) [43]. In the preceding years, no side effects were registered, although a similar JEV from Biken had been used. In some patients, other vaccines had been given at the same time as the JEV. Allergic reactions to typhoid or cholera vaccine used in larger amounts and
Canada 1991
In a prospective study, information was obtained by questionnaire from 96 vaccinees (Table 4). One patient developed urticaria [51].
India 1993
A trial with the Biken vaccine involved 113 schoolchildren [52]. Minor complaints were registered in 55% of subjects, but only one case had a definite allergic reaction: This girl had itching all over the body on the second day after the first dose and for 4 days. On the third day, she had puffiness of the face, which subsided after 2 days. She was treated with
Australia 1995
A case-control study was performed in Australia (Table 5) [54]. The subjects had developed an allergic reaction (rash or edema) within 1 week after receiving a dose of the Bikens JEV; the reactions had been reported to the Adverse Reactions Advisory Committee. Hypersensitivity was defined as rash, angioedema, or a generalized reaction. Participants completed a questionnaire.
Neurologic reactions to Japanese encephalitis vaccine
Neurologic complications after immunizations constitute a pathologic spectrum and may involve any part of the central and peripheral nervous systems. The reactions are of different pathogenesis, among which immunoallergic mechanisms are probably the most important. Cases of neurologic complications occurring after vaccination have been reported with different vaccines. Studies performed to try to clarify a causal relationship of such observations mostly have been negative.
The JEV contains
Summary
The JEV widely is used in Asian countries each year and is an important vaccine for travelers to the East from other parts of the world. JE virus is a zoonotic disease with natural reservoirs and cannot be eliminated. Although a declining incidence of JE has been observed in Asia because of reduced transmission by agricultural approaches and vaccination, the most important control measure now, and in the future, is vaccination of humans against JE [12].
The inactivated vaccine, produced from
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