Reactions 1680, p278 - 2 Dec 2017 Pneumococcal 13 valent crm197 vaccine conjugate Vaccine failure leading to invasive pneumococcal disease: case report An 11-month-old girl developed invasive pneumococcal disease (IPD) due to vaccine failure following immunisation with pneumococcal 13 valent CRM197 vaccine conjugate [route, dosage and time to reaction onset not stated]. The girl presented to the clinic because of fever with acute onset. Her blood evaluations revealed leukopenia and elevated CRP. She was healthy previously. She was vaccinated with pneumococcal vaccination (PCV) of pneumococcal 7 valent CRM197 vaccine conjugate at two months of age. At three months and four months of age, she was vaccinated with pneumococcal 13 valent CRM197 vaccine conjugate. Her vital signs on admission revealed body temperature of 40.5 C, pulse rate of 188 beats/minute and RR of 65 /minute. Her level of consciousness was depressed according to the Glasgow Coma Scale (E2V3M5). Bilateral cervical adenopathy, bilateral tonsillitis with purulent exudates and white spots, and enlargement of liver and spleen were evident. The auscultation of the lungs revealed stridor during respiration. Her blood tests at hospitalisation revealed WBC count of 2960 /mL (neutrophils 0%; lymphocytes 89% and atypical lymphocytes 8%), RBC count of 385104/mL, platelet count, 35.4 × 10 /mL, and CRP of 20.01 mg/dL. Her condition was diagnosed with sepsis in the view of her vital signs and blood test results at time of hospitalisation. The woman was started on treatment with meropenem. Herpes simplex viral infection was suspected due to disturbance of consciousness and associated occurrence of generalised tonic-seizure within a few minutes on the first day of admission, hence she was started on treatment with aciclovir. Although, her fever and agranulocytosis persisted. Penicillin-susceptible Streptococcus pneumoniae was isolated from blood cultures at the time of hospitalisation. She was diagnosed with invasive pneumococcal disease. Her treatment was added with immunoglobulin therapy along with granulocyte-colony stimulating factor. Her leukopenia with agranulocytosis persisted. She was transferred to the pediatric ICU on the fifth day after symptom onset and received a granulocyte transfusions from her mother and paternal uncle. Her fever began to decrease on the next day, and the neutrophil count started to rise a day later. Her antibiotic treatment was changed to ampicillin following improvement of her general condition and vital signs stabilised. Administration of antibiotics was continued for a total of 14 days. On the th 18 day after symptom onset, a follow-up bone marrow examination revealed normal results. She was discharged on th the 26 day after symptom onset. Following the discharge, she underwent regular follow-ups and her agranulocytosis did not recur. Author comment: "The serotype of the pneumococcal strain isolated from the blood culture in this case was 6C, which is not included in PCV13. However, serotype 6C has been reported to have in vitro cross-immunity with serotype 6A, which is included in [Pneumococcal 13 valent crm197 vaccine conjugate]." Nishikawa-Nakamura N, et al. An infant with concurrent serotype 6C invasive pneumococcal disease and infectious mononucleosis. Journal of Infection and Chemotherapy 23: 785-787, No. 11, Nov 2017. Available from: URL: http:// doi.org/10.1016/j.jiac.2017.06.007 - Japan 803285438 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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