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Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality
measles (Moraten strain) and rubella vaccine 5 days before the development of symptoms (unable to stand and support her own weight). The authors eliminated the possibility that the neuralgic reaction was unlikely to be related to rubella vaccine, because the rubella virus titers indicated that the child was already immune to rubella virus when she was given the vaccine. Four years later the authors saw a second patient with characteristics similar to those of their first one. A 10-month-old girl was given measles vaccine (Moraten strain), as well as her second doses of DPT and OPV, and 4 days later she developed early symptoms of GBS. Both children had a primary immune response to measles antigen, as demonstrated by the seroconversion following immunization.
Norrby (1984) described a 12-year-old girl who became ill with a disorder diagnosed as GBS soon after being vaccinated with MMR, but her CSF protein levels were normal, which casts doubt on the diagnosis. The other findings were supportive of a diagnosis of GBS. The authors presented summary data from Merck Sharp & Dohme indicating that 1 in 60 million doses of MMR has been associated with GBS. Landrigan and Witte (1973) used data voluntarily submitted to the Center for Disease Control regarding neuralgic disorders following administration of measles vaccine. From 1963 to 1971, 84 cases of neuralgic disorders with onset less than 30 days after live attenuated measles virus vaccination were reported in the United States, but these did not include GBS. In a review of adverse event reports submitted between 1976 and 1989 to the Behringwerke AG pharmaceutical firm in the former West Germany, Fescharek and colleagues (1990) described three cases of GBS following vaccination with measles or mumps vaccines (the specific vaccines used in the three patients were not identified). Two of the cases were thought to be related to something other than the vaccines; however, this was not elaborated. Assuming that all three cases were causally related, the authors calculated an incidence of 1 in 1.8 million doses of vaccine distributed.
Summary data from MSAEFI record eight cases of GBS following measles immunization reported between 1979 and 1990. One patient received measles-rubella vaccine and seven received MMR. Nine VAERS reports (submitted between November 1990 and July 1992) reviewed by the committee describe the occurrence of GBS after measles immunization. Three of the five VAERS reports indicating the occurrence of GBS after vaccination with MMR alone met the diagnostic criteria for GBS as outlined in Chapter 3. The patients reported in the other four reports received other vaccines in addition to MMR.