Conclusion

The evidence is inadequate to accept or reject a causal relation between measles vaccine and optic neuritis.

TRANSVERSE MYELITIS

Clinical Description

Transverse myelitis is a focal, demyelinating lesion that can occur in isolation or as a component of diffuse demyelinating diseases such as acute disseminated encephalomyelitis and multiple sclerosis. Transverse myelitis is characterized by an acute onset of signs of spinal cord disease, usually involving the descending motor tracts and the ascending sensory fibers, suggesting a lesion at one level of the spinal cord. Chapter 3 contains a general discussion of transverse myelitis. The annual incidence of transverse myelitis in Rochester, Minnesota, from 1970 to 1980 was estimated to be 0.83 per 100,000 people (Beghi et al., 1982). The authors noted that this incidence is approximately sixfold higher than the rate calculated for Israel. They attribute this to differences in case ascertainment.

History of Suspected Association

Measles virus is known to be associated with demyelinating disorders. The committee was charged with investigating a possible causal relation between only measles vaccine and transverse myelitis.

Evidence for Association

Biologic Plausibility

Chapter 3 contains an in-depth discussion of the biologic plausibility of a relation between vaccines and demyelinating disorders. Measles virus is associated with central demyelinating diseases.

Case Reports, Case Studies, and Uncontrolled Observational Studies

A case report (in abstract form) linking transverse myelitis with live attenuated measles vaccine was identified (Clark et al., 1977). Thirteen days after vaccination with Schwarz strain measles vaccine, a 16-year-old girl developed symptoms of transverse myelitis. Measles virus was recovered from her throat and stool. The authors hypothesized a relation between



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