title: A case of sudden death after Japanese encephalitis vaccination.
abstract: Japanese encephalitis (JE) virus is estimated to result in 3500-50,000 clinical cases every year, with mortality rates of up to 20-50% and a high percentage of neurological sequelae in survivors. Vaccination is the single most important measure in preventing this disease. Inactivated Vero cell culture-derived JE vaccines have not been linked to any fatalities, and few serious adverse events after vaccination have been reported. Here, we report a case of sudden death in which a 10-year-old boy experienced cardiopulmonary arrest 5 min after receiving a Japanese encephalitis vaccination. He had been receiving psychotropic drugs for the treatment of pervasive developmental disorders. Postmortem examinations were nonspecific, and no signs of dermatologic or mucosal lesions or an elevation of the serum tryptase level, which are characteristic of anaphylaxis, were observed. A toxicological examination revealed that the blood concentrations of the orally administered psychotropic drugs were within the therapeutic ranges. The patient was considered to have died of an arrhythmia that was not directly associated with the vaccination.
authors.affiliation: Department of Legal Medicine, Gifu University, Graduate School of Medicine, Gifu 501-1194, Japan. Electronic address: bunaiy@gifu-u.ac.jp.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Bunai
authors.affiliation: Department of Legal Medicine and Bioethics, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishii
authors.affiliation: Department of Legal Medicine, Gifu University, Graduate School of Medicine, Gifu 501-1194, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Akaza
authors.affiliation: Department of Legal Medicine, Gifu University, Graduate School of Medicine, Gifu 501-1194, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nagai
authors.affiliation: Department of Legal Medicine, University of Toyama, School of Medicine, Toyama 930-0194, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishida
authors.affiliation: Department of Pediatrics, Shimane University, School of Medicine, Izumo 693-8501, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Yamaguchi
mesh_terms: D000707:Anaphylaxis / Q000150:complications / Q000175:diagnosis / Q000276:immunology*; D001145:Arrhythmias, Cardiac / Q000150:complications*; D001344:Autopsy; D002097:C-Reactive Protein / Q000032:analysis; D002331:Carnitine / Q000031:analogs & derivatives / Q000097:blood; D002423:Cause of Death; D002648:Child; D003645:Death, Sudden / Q000209:etiology*; D004672:Encephalitis, Japanese / Q000276:immunology / Q000517:prevention & control*; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D022321:Japanese Encephalitis Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000473:pathology*; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D053719:Tandem Mass Spectrometry / Q000379:methods; D035501:Uncertainty
chemical_list: D022321:Japanese Encephalitis Vaccines; D011619:Psychotropic Drugs; C116917:acylcarnitine; D002097:C-Reactive Protein; D002331:Carnitine
keywords: Adverse effects; Fatal arrhythmia; Japanese encephalitis vaccine; Psychotropic drugs; Sudden death; Vasovagal syncope