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A fatal case of pneumonitis due to vaccine-strain measles virus in a man with acquired immunodeficiency syndrome.
Angel JB; Snydman DR; Udem SA; DeLellis RA; Walpita P; Lerch R; Sidhu
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(2):17 (abstract no. We.B.110). Unique

Issue: Due to the apparent safety of live attenuated measles vaccine and the possibly devastating consequences of measles infection in people with HIV disease, measles vaccine has been part of routine immunization in HIV-infected children and recommended for HIV-infected adults when an indication arises. This is in contrast to the recommendations regarding measles vaccine for all other immunocompromised individuals. Project: We report a case of vaccine associated measles pneumonitis in a twenty one year old man with AIDS, one year after receiving measles vaccine. Results: Approximately two months into the course of a febrile, respiratory illness, pathology from an open lung biopsy revealed nodular areas of acute and chronic inflammation with areas of necrosis and fibrosis. Numerous multinucleated giant cells were present and some contained both intranuclear and cytoplasmic inclusions. Tissue from a transbronchial biopsy grew measles virus confirming the diagnosis of measles pneumonitis. RNA extracted from the viral isolate was reversed transcribed and PCR amplified. The vaccine strain Moraten) was similarly amplified. Comparative analyses of the genomic sequence of the patient's measles isolate with that of vaccine measles virus demonstrated almost complete identity of the two. Only two conservative amino acid changes in the envelope glycoprotein, the hemagglutinin, distinguished them. In contrast, the isolate was readily distinguished from all examined street virus strains, especially in the crucial and distinctive genomic regulatory sequence domains. Despite treatment with intravenous immune globulin and ribavirin, the patient ultimately died as a result of complications of his respiratory illness. Lesson Learned: We report the first case of disease due to measles vaccine-strain virus in a patient with advanced HIV disease. This raises safety concerns about the blanket use of live attenuated measles vaccine in any immunocompromised group.

*Acquired Immunodeficiency Syndrome/COMPLICATIONS *Lung/PATHOLOGY *Lung Diseases/ETIOLOGY *Measles Vaccine/ADVERSE EFFECTS *Measles Virus/ISOLATION & PURIF *Vaccination *Vaccines, Attenuated/ADVERSE EFFECTS

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