Q J Med 2003; 96: 611
© 2003 Association of Physicians
Correspondence |
Peripheral neurological symptoms after hepatitis B virus vaccination
Sir,Hepatitis B virus (HBV), which is usually transmitted through sexual contact, unnoticed percutaneous and permucosal exposures, vertically from mothers to neonates at birth, or exposure to blood or blood products, can lead to serious long-term complications, including chronic hepatitis, hepatocellular carcinoma and liver failure, all resulting in a high number of hospitalizations and deaths. Approximately 300 000 acute infections with HBV occur each year, and more than 1 million people have chronic HBV infection in the US.1
To minimize the occurrence of HBV infection, universal hepatitis B vaccination for newborns and routine vaccination of adolescents was recommended recently, and at present, two recombinant hepatitis B vaccines are available with relatively safe adverse reaction profiles. However, serious reactions have occurred, and physicians should be cautious if patients present with any symptoms that are related to vaccination.
We report a case of peripheral neurological symptoms after hepatitis B virus vaccination. A 28-year-old woman with no history of neurological diseases was re-vaccinated with recombinant-DNA yeast-derived hepatitis B vaccine (Engerix-B) 10 years after first vaccination. One day later, she complained of vertigo and dysarthria. On examination, there was incomplete paraparesis of the legs and paresis of the arm into which the vaccine was injected. Symptoms improved spontaneously within 5 days and no further pathological signs were found upon general, laboratory and neurological examination.
HBV vaccination appears to be very effective, and only a few cases of acute hepatitis B infection after vaccination have been reported.2 The vaccination has also a very good safety profile and so far, only a few adverse reactions such as liver dysfunction,3 thrombocytopenic purpura4 and visual loss5 have been reported. Although the association between HBV vaccination and transient peripheral neurological symptoms may be rare, clinicians should be alerted if patients present with these symptoms.
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Charité School of Medicine
Humboldt University
Berlin
Germany
e-mail: david.groneberg{at}charite.de
References
1. Alter MJ, Hadler SC, Margolis HS, Alexander WJ, Hu PY, Judson FN, Mares A, Miller JK, Moyer LA. The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies. JAMA 1990; 263:1218–22.
2. Goffin E, Horsmans Y, Cornu C, Geubel A, Pirson Y. Acute hepatitis B infection after vaccination. Lancet 1995; 345:263.[Medline]
3. Lilic D, Ghosh SK. Liver dysfunction and DNA antibodies after hepatitis B vaccination. Lancet 1994; 344:1292–3.[Web of Science][Medline]
4. Poullin P, Gabriel B. Thrombocytopenic purpura after recombinant hepatitis B vaccine. Lancet 1994; 344:1293.[Web of Science][Medline]
5. Brezin A, Lautier-Frau M, Hamedani M, Rogeaux O, Hoang PL. Visual loss and eosinophilia after recombinant hepatitis B vaccine. Lancet 1993; 342:563–1.
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