Gerasimon Gregg, Lowry Kristie
Infectious Disease Service, Department of Internal Medicine, Madigan Army Medical Center, Tacoma, WA 98431-1100, USA.
South Med J. 2005 Jun;98(6):653-6. doi: 10.1097/01.SMJ.0000157537.11806.DC.
This report describes a case of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) that occurred after vaccination in a 22-year-old female. Our patient presented with a clinical syndrome of fever, headache, nausea, and vomiting, which quickly progressed to multiorgan failure and ultimately death on hospital day 4. YEL-AVD is an extremely rare condition reported only a few times in the literature. The yellow fever vaccine is a known stimulus of systemic inflammation in the body. A mild subclinical viremia develops, which results in a persistent and robust T-helper-cell-dependent antibody response with long-lasting immune protection. The very rare patient may have an aberrant response to the 17D vaccine strain, causing the multiple organ system failure seen in YEL-AVD. Predisposing host factors that contribute to YEL-AVD are not yet known. Treatment for YEL-AVD is supportive. To the authors' knowledge, this patient was the first to have YEL-AVD as a result of standard US military vaccination protocols.
本报告描述了一例22岁女性接种疫苗后发生的黄热病疫苗相关内脏型疾病（YEL-AVD）。我们的患者表现出发热、头痛、恶心和呕吐的临床综合征，迅速进展为多器官功能衰竭，并最终在住院第4天死亡。YEL-AVD是一种极为罕见的疾病，在文献中仅有少数几次报道。黄热病疫苗是已知的体内系统性炎症刺激物。会出现轻度亚临床病毒血症，从而导致持续且强烈的依赖辅助性T细胞的抗体反应以及持久的免疫保护。极少数患者可能对17D疫苗株有异常反应，导致YEL-AVD中出现的多器官系统衰竭。导致YEL-AVD的宿主易感因素尚不清楚。YEL-AVD的治疗是支持性的。据作者所知，该患者是首例因美国军方标准疫苗接种方案而发生YEL-AVD的病例。
