Elsevier

Vaccine

Volume 26, Issue 9, 26 February 2008, Pages 1166-1172
Vaccine

Live attenuated measles and mumps viral strain-containing vaccines and hearing loss: Vaccine Adverse Event Reporting System (VAERS), United States, 1990–2003

https://doi.org/10.1016/j.vaccine.2007.12.049Get rights and content

Summary

Hearing loss (HL) is a known complication of wild measles and mumps viral infections. As vaccines against measles and mumps contain live attenuated viral strains, it is biologically plausible that in some individuals HL could develop as a complication of vaccination against measles and/or mumps. Our objectives for this study were: to find and describe all cases of HL reported in the scientific literature and to the US Vaccine Adverse Events Reporting System (VAERS) for the period 1990–2003; and to determine reporting rate of HL after live attenuated measles and/or mumps viral strain-containing vaccines (MMCV) administration. We searched published reports for cases of HL identified after vaccination with MMCV. We also searched for reports of HL after MMCV administration submitted to VAERS from 1990 through 2003 and determined the dose-adjusted reporting rate of HL. Our main outcome measure was reported cases of HL after immunization with MMCV which were classified as idiopathic. We found 11 published case reports of HL following MMCV. The review of the VAERS reports identified 44 cases of likely idiopathic sensorineural HL after MMCV administration. The onset of HL in the majority of VAERS and published cases was consistent with the incubation periods of wild measles and mumps viruses. Based on the annual usage of measles–mumps–rubella (MMR) vaccine, we estimated the reporting rate of HL to be 1 case per 6–8 million doses. Thus, HL following MMCV has been reported in the literature and to the VAERS. Further studies are needed to better understand if there is a causal relationship between MMCV and HL.

Introduction

Hearing loss (HL) in children and adults is an uncommon but devastating event. In US children the average annual prevalence of moderate to profound HL is an estimated 1.1/1000 [1], and the mean age at which children are found to have HL is 2.9 years [1]. The most common causes of HL among US children are meningitis (0.3/1000), genetic and hereditary conditions (0.2/1000), and congenital rubella syndrome (0.1/1000) [2].

Infectious viral etiologies of HL have been associated with a variety of viruses and viral diseases: coxsackie [3], cytomegalovirus [4], hepatitis (type not specified) [4], herpes (type not specified) [4], influenza [3], measles [4], [5], [6], [7], [8], [9], meningitis (agent not specified) [4], [7], [9], and mumps [5], [6], [7], [8], [9], [10], [11], [12], [13]. Unlike congenital rubella syndrome (CRS), postnatal rubella (German measles) infection has not been shown to cause HL, because the pathogenesis of postnatal rubella is distinctly different from that in the CRS. The pathogenesis of the CRS involves progressive tissue damage caused by mitotic arrest of fetal cells and vasculitis, whereas in acquired rubella the hallmark of pathogenesis is that of invasion of respiratory epithelial and reticuloendothelial tissues [14]. Viral etiologies, which lead most commonly to sensorineural HL, have been described as being pathogenetically related to acoustic neuritis with fibrosis for measles and direct virus-induced cytolysis with atrophy of Corti organ for mumps viruses [8], [10], [13]. The clinical course of HL due to a viral cause can be variable, ranging from unilateral to bilateral involvement and partial to severe HL, often permanent [8], [10], [13].

Routine vaccination against measles and mumps has likely resulted in substantial declines in measles- and mumps-related HL [5]. However, case reports of HL following administration of live attenuated measles and/or mumps viral strain-containing vaccines (MMCV) have been published. Additionally, an Institute of Medicine review in 1994 accepted the biologic plausibility for mumps vaccine-related sensorineural HL and acknowledged a theoretical possibility for measles vaccine-related HL [15]. However, the quality of the evidence was judged to be inadequate to accept or reject a causal relation for either vaccine.

We present a review of the reports of HL following MMCV made to the US Vaccine Adverse Event Reporting System (VAERS) from 1990 to 2003, along with a systematic review of published reports. Additionally, we estimate the reporting rate of HL to VAERS after MMCV administration in the US.

Section snippets

Vaccines

Several strains of live attenuated measles and mumps viruses have been developed and licensed for use in vaccines. Measles vaccine strains used worldwide include various progenies of Edmonston, Leningrad, Schwarz, Shanghai, or Tanabe strains [16], [17]. In the US, live attenuated Edmonston B and Schwarz measles strains were licensed in 1963 and 1965, respectively; however, the distribution of both strains ceased after 1975 [18]. Live attenuated Enders–Edmonston (formerly Moraten) measles strain

Published case reports

We searched for published reports of HL following MMCV to determine whether such cases were observed and reported by clinicians. We found 11 published reports [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31] of HL following MMCV administration. Two reports referred to the same case [28], [29]. Review of these publications showed a total of 15 unique cases of HL (Table 1) reported following MMCV administration, identified from 1972 through 1998. Eight reports originated from the

Discussion

In this first-ever summary of HL from the VAERS database and from the scientific literature, we identified a total of 59 cases (44 from VAERS and 15 from published reports) of idiopathic HL reported following MMCV. Pathogenically, both measles and mumps infections can damage the hearing organ. Thus, given that MMCV contain live attenuated strains of wild measles and mumps viruses, it is biologically possible that HL could be causally associated with these vaccines. The onset of HL in the

References (42)

  • D.G. Pappas et al.

    Sensorineural hearing loss: infectious agents

    Laryngoscope

    (1982)
  • P.W. Alberti

    The prevention of hearing loss worldwide

    Scand Audiol Suppl

    (1996)
  • P.W. Johnston

    Factors associated with deafness in young children

    Public Health Rep

    (1967)
  • C.E. Kinney

    Hearing impairments in children

    Laryngoscope

    (1953)
  • M.J. McKenna

    Measles, mumps, and sensorineural hearing loss

    Ann NY Acad Sci

    (1997)
  • J. Tarkkanen et al.

    Unilateral deafness in children

    Acta Otolaryngol

    (1966)
  • G. Everberg

    Deafness following mumps

    Acta Otolaryngol

    (1957)
  • R. Hall et al.

    Hearing loss due to mumps

    Arch Dis Child

    (1987)
  • A. Kayan et al.

    Bilateral sensorineural hearing loss due to mumps

    Br J Clin Pract

    (1990)
  • J.R. Lindsay et al.

    Inner ear pathology in deafness due to mumps

    Ann Otol Rhinol Laryngol

    (1960)
  • G.L. Mandell

    Principles and practice of infectious diseases

    (2000)
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    1

    Current address: Eli Lilly and Company, Indianapolis, IN, USA.

    2

    Current address: Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

    3

    Current address: Division of Global Migration and Quarantine, National Center for Preparedness, Detection and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

    4

    Current address: Center for Health Research, Southeast, Kaiser Permanente, Atlanta, GA, USA.

    5

    VAERS team members are: Elaine Miller, Penina Haber, Susanne Pickering, Beth Hibbs, Tracy Thomas, and Claudia Vellozzi.

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