Acute myocarditis post primary vaccination in a young infant

Abu Bakar, Asrar and Anuar, Muhamad Azamin and Abdul Rahman, Amir Hamzah and Hasan, Taufiq Hidayat (2019) Acute myocarditis post primary vaccination in a young infant. In: MPCS Paediatric Cardiology Symposium 2019, 5th-6th July 2019, Sheraton, Petaling Jaya. (Unpublished)

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Abstract

Acute myocarditis post primary vaccination in a young infant. Background: In Malaysia, a course of vaccination DTaP/IPV/Hib was introduced in 2008, replacing the 2006 DwPT-HBV/Hib+OPV vaccines. Severe systemic adverse reactions after diphtheria, tetanus and pertussis vaccination are uncommon. Cardiac complications are rarely reported and is most probably implicated to the pertussis component. We describe a rare case of acute myocarditis that developed 60 hours after DTaP/IPV/Hib vaccination. Case Summary: A 2-month old infant presented 60 hours after her first diphtheria, tetanus and pertussis vaccination due to severe respiratory distress and cyanosis. The infant has uneventful antenatal, perinatal and postnatal periods. She had her BCG and two Hepatitis B vaccinations previously with no major side effects. Parents reported that she was feverish for 48 hours post DTaP/IPV/Hib vaccination with no other associated symptoms. Two hours prior to presentation, she was febrile and went floppy. On arrival to Emergency Department, she was tachypnoeic, cyanotic with hypoperfusion and hypotensive. She was noted to have hepatomegaly. She was grunting and her level of consciousness deteriorated. She was intubated and her first blood gas showed profound metabolic acidosis with pH 6.6, base excess -24mmol/L, lactate 14mmol/L and bicarbonate 4mmol/L. She required 40mls/kg of fluid boluses and dobutamine infusion. She also received antibiotics and sodium bicarbonate to correct her acidosis. Her chest x-ray revealed pulmonary venous congestion (figure 1). Her echocardiography showed global hypokinesia with structurally normal heart, CK was 3018 and Troponin I levels raised. She was treated with immunoglobulin for myocarditis and was on high frequency oscillation for 4 days before being extubated on day 6 of admission. All her viral serology and cultures came back negative. Her LV function subsequently improved over time after immunoglobulin therapy (figure 2) and she was discharged with full recovery. Discussion: DTaP/IPV/Hib has a very good vaccine safety profile as prevalence of Adverse Events Following Vaccine (AEFI) reports in Malaysia are exceptionally low (figure 3 & 4). Common side effects consists of mild local reactions and self-limiting febrile illness. Cardiac complications and specifically myocardial injury following the vaccine are exceptionally uncommon. This patient developed sudden onset cardiogenic deterioration after an expected fever-like illness post vaccination. Given her viral screening and cultures were negative, this make acute myocarditis post vaccination a remote possibility. We concur that evaluation of cardiac state should be considered in recently vaccinated infants who manifest with cyanosis, hypoperfusion and drowsiness.

Item Type:	Conference or Workshop Item (Poster)
Additional Information:	7951/83442
Uncontrolled Keywords:	myocarditis adverse events following immunisation
Subjects:	R Medicine > RJ Pediatrics R Medicine > RJ Pediatrics > RJ101 Child Heatlh. Child health services. Preventive health services for children
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Paediatrics Kulliyyah of Medicine
Depositing User:	Dr Asrar Abu Bakar
Date Deposited:	08 Oct 2020 14:22
Last Modified:	14 Oct 2020 14:12
URI:	http://irep.iium.edu.my/id/eprint/83442

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