Arm Paralysis After Routine Childhood Vaccinations: Application of Advanced Molecular Methods to the Causality Assessment of an Adverse Event After Immunization.
Post-licensure surveillance for adverse events following immunizations (AEFI) can identify rare complications of vaccinations and rigorous vaccine adverse event causality assessments can help to identify possible causal relationships. We report the development of arm paralysis after varicella vaccination in a 1-year-old child. Paralysis was initially presumed to be due to vOka because of the temporal relationship between vaccination and onset of arm weakness; however, molecular studies identified wild-type varicella zoster virus VZV (WT-VZV) in the CSF, leading the authors to conclude that WT-VZV was the probable cause. This case illustrates the complexity of assessing AEFI causality, and the importance of careful and complete evaluations when determining the most likely cause of an AEFI.
Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University, Golisano Children's Hospital, Syracuse.
Jana
J
Shaw
Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Neal A
NA
Halsey
Departments of Pediatrics, Medicine and Pathology, Director, Molecular and Virology Clinical Laboratories, University of Colorado Denver, Aurora.
Adriana
A
Weinberg
National Center for Immunizations and Respiratory Diseases, Division of Viral Diseases, Atlanta, Georgia.
D
D
Scott Schmid
Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Clinical Professor, Department of Biomedical Sciences, University at Albany, SUNY.
Kirsten St
KS
George
Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
William C
WC
Weldon
Pediatrics, Divisions of Immunobiology, and Bone Marrow Transplantation and Immune Deficiency Cincinnati Children's Hospital/University of Cincinnati, Ohio.
Michael
M
Jordan
Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany.
Patrick W
PW
Bryant
Department of Pediatrics, Division of Pediatric Infectious Diseases, Columbia University, New York, New York.
Philip S
PS
LaRussa
Department of Neurology, Upstate Medical University, New York, New York.
Deborah Y
DY
Bradshaw
Centers for Disease Control and Prevention, National Center for Emerging, Zoonotic, and Infectious Diseases, Division of Healthcare Quality Promotion, Immunization Safety Office, Clinical Immunization Safety Assessment Project, Atlanta, Georgia.
Theresa
T
Harrington
Columbia University College of Physicians and Surgeons, New York, New York.
Anne
A
Gershon
D001132:Arm; D002648:Child; D006801:Humans; D007223:Infant; D008297:Male; D010243:Paralysis / Q000209:etiology*; D011358:Product Surveillance, Postmarketing; D014611:Vaccination / Q000009:adverse effects*
adverse event after vaccination; child; paralysis; vaccine; varicella-zoster virus