Live attenuated measles and mumps viral strain-containing vaccines and hearing loss: Vaccine Adverse Event Reporting System (VAERS), United States, 1990–2003
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
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2015, Otolaryngologic Clinics of North AmericaCitation Excerpt :Live attenuated measles virus is included in the standard measles vaccine. Information from the Vaccine Adverse Event Reporting System in the United States estimated the reporting rate of SNHL possibly related to mumps/measles vaccine to be 1 case in 6 to 8 million doses.39,40 Measles virus has also been possibly implicated in the development of otosclerosis, although whether this is an association or causation remains unclear.41,42
Mumps vaccine
2012, Vaccines: Sixth EditionDetection of Vaccine Adverse Events Before Package Insert Revisions Using a Japanese Spontaneous Reporting System
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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.