Neurologic Disease after Yellow Fever Vaccination, Sao Paulo, Brazil 2017-2018

Yellow fever (YE) vaccine can cause neurologic complications. We examined YF vaccine-associated neurologic disease reported from 3 tertiary referral centers in Sao Paulo, Brazil, during 2017-2018 and compared the performance of criteria established by the Yellow Fever Vaccine Working Group/Centers for Disease Control and Prevention and the Brighton Collaboration. Among 50 patients who met inclusion criteria, 32 had meningoencephalitis (14 with reactive YF IgM in cerebrospinal fluid), 2 died, and 1 may have transmitted infection to an infant through breast milk. Of 7 cases of autoimmune neurologic disease after YF vaccination, 2 were acute disseminated encephalomyelitis, 2 myelitis, and 3 Guillain-Barre syndrome. Neurologic disease can follow fractional vaccine doses, and novel potential vaccine-associated syndromes include autoimmune encephalitis, opsoclonus-myoclonus-ataxia syndrome, optic neuritis, and ataxia. Although the Brighton Collaboration criteria lack direct vaccine causal assessment, they are more inclusive than the Centers for Disease Control and Prevention criteria.

Automated summary

Research on yellow fever vaccine-associated neurologic disease in São Paulo, Brazil revealed cases of meningoencephalitis and autoimmune neurologic disease following vaccination. The study also found that neurologic diseases can occur after fractional vaccine doses, and identified potential vaccine-associated syndromes such as autoimmune encephalitis and Guillain-Barre syndrome. Additionally, the Brighton Collaboration criteria were noted to be more inclusive than the Centers for Disease Control and Prevention criteria in diagnosing vaccine-associated neurologic complications.