MUMPS Meningitis following MMRV Vaccination (Jeryl Lynn strain)
2Infectious Diseases Unit, Samson Assuta Ashdod University hospital, ישראל
3Microbiology Labaratory, Samson Assuta Ashdod University Hospital, ישראל
4Central Virology Labaratory,Public Health Services, Sheba Medical Center, Tel Hashomer, ישראל
5Faculty of Health Sciences, Ben Gurion University in the Negev
Background: Mumps live attenuated vaccine, given as MMR/MMRV combination, is part of the routine immunization program in developed countries. Despite its favorable safety profile, cases of aseptic meningitis have been previously reported with strains of this vaccine used in other countries, albeit not with the Jeryl-Lynn strain used in Israel.
Case presentation: An otherwise healthy 6-year-old girl presented with 4-day fever, vomiting, headache and photophobia. On examination she was irritable, with no neck stiffness. On ophthalmological examination papilledema was noted, and a head CT was normal. A lumbar puncture was performed with a high opening pressure of 60 mm Hg. CSF analyses showed 542 WBC, with normal glucose and protein levels. The patient received Ceftriaxone and rapid improvement in her symptoms occurred after LP. PCR for viruses from the CSF was positive for MUMPS. Additional history revealed she had received an MMRV vaccine (Priorix-tetra, GSK) 1 month prior to her admission. PCR for Urine and Saliva samples was negative for MUMPS. RNA sequencing of the CSF isolate showed it to be identical to the Jeryl-Lynn vaccine strain used for Priorix-tetra.
Conclusions: Aseptic meningitis is a rare adverse event of MUMPS vaccine. Previous reports of aseptic meningitis have shown an association with the Urabe and Leningrad-Zagreb strains of MUMPS vaccine. This is the first report of MUMPS meningitis secondary to the Jeryl Lynn mumps vaccination strain.