Fatal Measles Case Caused by Vaccine in Immunocompromised Teen

By Reuters Staff

September 23, 2021

(Reuters Health) - A team of doctors in Los Angeles and Atlanta is calling for renewed vigilance to screen children for immune system problems before vaccination after an undocumented 17-year-old girl received the measles vaccine and died from the live virus it contained.

Her measles was not diagnosed until after she died. Her immune system was severely compromised because she suffered from Hodgkin's lymphoma.

"This case highlights the need for screening for new or preexisting conditions that can cause profound immunocompromised status before administration of live vaccines such as the measles-mumps-rubella vaccine and for considering vaccine-related viral infection in the differential diagnosis of disseminated infection in severely immunocompromised patients," said the team led by Dr. Jamie Stokke of Children's Hospital of Los Angeles, writing in the New England Journal of Medicine.

"This unfortunate outcome is extremely rare and should not diminish the importance of routine and timely vaccination to minimize community spread," they said.

The teen had arrived from Central America two months before, in the fall of 2019.

She had received her MMR vaccination at a detention center as part of the policy of giving catch-up vaccinations recommended by the Centers for Disease Control and Prevention.

At the time, the teen had a neck mass and a mediastinal mass was seen on a chest X-ray. She was diagnosed with Hodgkin's at a Texas children's hospital seven days later but was sent to Los Angeles for treatment seven days after that because her mother lived in California.

She was admitted to the hospital for febrile neutropenia that developed during her third cycle of chemotherapy for her Hodgkin's lymphoma.

She also developed diffuse abdominal pain, a recurrent rash, a varicella-zoster infection and respiratory distress, which worsened rapidly. She died three months after the vaccination from respiratory failure.

Her autopsy showed measles viral inclusions in her lungs, liver and pituitary gland. The virus turned out to be a strain used in vaccines.

Attempts to contact Dr. Stokke through Children's Hospital were unsuccessful.

SOURCE: https://bit.ly/39jWPNP The New England Journal of Medicine, online September 22, 2021.