Transverse myelitis unlikely to be due to measles, mumps, and rubella vaccine

EDITOR,--K A Joyce and J E Rees report on a 20 year old man who developed subacute transverse myelitis two to three weeks after immunisation with measles, mumps, and rubella vaccine.1 Five days after vaccination he developed a feverish exanthematous disease, which fluctuated for two weeks and preceded the onset of the neurological symptoms. Postvaccination transverse myelitis was diagnosed when a significant rise in titres of rubella antibodies was observed. The authors suggest that antibody status should be checked before vaccination.

The course of events is incompatible with rubella related to the vaccine. Rubella-like disease related to vaccination develops nine days after vaccination at the earliest and does not last as long as two weeks. An increase in rubella IgM antibodies is possible after vaccination. Measurement of the titres cannot differentiate between wild virus and the attenuated vaccine strain. As the incubation period of wild rubella is 14-21 days2 the patient may have had natural rubella.

Postvaccination transverse myelitis is diagnosed by exclusion, and serological tests should include tests for viruses such as echovirus and herpes simplex virus as well as coxsackievirus groups A and B--particularly because the patient had a transient rash over his upper body.

Behringwerke has distributed about 8.8 million doses of monovalent rubella vaccine and measles, mumps, and rubella vaccine in the German market since 1980. No case of suspected transverse myelitis has become known to us. On the assumption that the yearly incidence of transverse myelitis in Germany is similar to that in Minnesota (approximately 7.4/100000 people),3 postvaccination transverse myelitis after rubella vaccination is unlikely. Furthermore, the three other published cases of myelitis to which Joyce and Rees refer occurred after the administration of vaccines other than those currently used. There is insufficient evidence to indicate a causal relation between the currently used human diploid cell rubella vaccines and neuropathy.4

In conclusion, Joyce and Rees do not provide sufficient evidence to show that this case of transverse myelitis was caused by measles, mumps, and rubella vaccine. The need to check the patient's antibody status before vaccination cannot be deduced from this case report.