between the time of vaccination and publication of the report (Alves et al., 1992). A 14-month-old girl received the wellcome measles vaccine and developed convulsions 12 days later (Barbor and Grant, 1969). She became confused, restless, and then unconscious. Although the authors called this an encephalitis, there was no CSF pleocytosis on days 13 or 21 postvaccination. She made little progress in the 4 months between hospitalization and publication of the report. An electroencephalographic record of slow waves, which are not characteristic of measles encephalitis, and possible slight head trauma 9 days after vaccination suggested a temporal, not a causal, relation between the convulsions and the measles vaccination. A 13-month-old girl was admitted to the hospital with involuntary jerking movements of her limbs 10 days after receiving a further attenuated Enders live measles vaccine (Jagdis et al., 1975). She was afebrile, although she had fever for 2 days prior to admission. The CSF was turbid and showed pleocytosis. She had a convulsion followed by apnea. She died 13 days after vaccination. Postmortem examination suggested viral encephalitis; Cowdry type A inclusion bodies suggested measles virus as the etiologic agent, but no measles virus was isolated. She had no known exposure to wild-type measles virus, but an epidemic in the community was ending. Haun and Ehrhardt (1973) described a boy age 11 months who developed drowsiness, convulsions, and coma 12 days following vaccination with the L-16 SSW measles vaccine (a variant derived from the Soviet strain Leningrad-16). There was pleocytosis in the CSF. He died the same day as onset of symptoms. Autopsy findings were suggestive of disseminated intravascular coagulation as the cause of death. A boy age 2 years was administered live measles vaccine 10 days before the development of persistent convulsions (Starke et al., 1970). The child suffered convulsions accompanied by unconsciousness until his death a month later. He had experienced convulsions in the first year of life during a bout of pneumonia. The autopsy stated there was CNS death, "encephalitis" following measles inoculation, and septic pulmonary infarction. No further details are given.

Several reports of encephalopathy following measles vaccination can be found in the Vaccine Adverse Event Reporting System (VAERS) (submitted between November 1990 and July 1992). As with many VAERS reports, the information that is supplied is frequently inadequate to support or reject a diagnosis or to exclude the possibility that other factors are responsible for the disorder, if the case was encephalopathy or encephalitis. The committee found that 17 VAERS reports were suggestive of encephalopathy or encephalitis in vaccinees (mostly MMR) from ages 5 months to 16 years. Reported latencies ranged from 1 to 14 days after immunization. The patients presented with symptoms such as fever, ataxia, somnolence, convulsions, and flaccid paralysis. Several reports contained too little information to suggest a diagnosis or to shed light on causality.



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