Postvaccination transverse myelitis developed within 5 days following measles, mumps, and rubella vaccine in a 20 year old man diagnosed and treated at the Hurstwood Park Neurological Centre, Haywards Heath, West Sussex, England. The combined vaccine had been substituted for the rubella vaccine required for employment at a children’s facility in the United States. Fever, malaise, sore throat and rash fluctuated over 2 weeks and were followed by urinary retention, ascending paresthesia, and flaccid paraplegia. Cerebrospinal fluid contained 370x106 white cells (80% lymphocytes), 1.8 mg/1 protein, and 3 mmol/1 glucose. Serological tests showed a significant rise only in rubella antibody titers. MRI was normal. Treatment with IV steroids provided limited improvement and paralysis persisted below T6. [1]

COMMENT. The authors cite 3 previous reports of rubella postvaccinal transverse myelitis. They caution that antibody status be checked before immunization and only the required vaccine be used. My mentors, WG Wyllie and Randolph K Byers, were convinced of the potential neurological complications of immunization. My own clinical bias, though based on case studies, is in agreement with their views and teachings. Today, the tendency is to minimize the dangers of vaccines as only temporally related, probably coincidental, and unproven by statistics. It was Thomas Carlyle who said “one can prove anything with figures.” The tragic consequence of a seemingly simple and innocuous injection in a young person on the threshold of a new life and occupation as an immigrant to the US, as reported above, should be a reason for pause and moderation of the enthusiasm of some for universal immunization, including the new varicella vaccine.

Non-specific benefits from measles immunization are reported from the Epidemiology Research Unit, Copenhagen, Denmark [2]. Analysis of mortality studies from developing countries showed that protective efficacy against death after measles immunization ranged from 30% to 86%, much higher than the proportion of deaths that could be attributed to acute measles. DTP and polio vaccinations were not associated with mortality reduction. The prevention of measles did not explain the reduced mortality among immunized children. Child survival might benefit from standard titre measles immunization before 9 months of age and by reimmunization.