Late onset of vaccine-associated measles in an adult with severe clinical symptoms: a case report.

Measles is a highly contagious disease causing an estimated 2.6 million deaths per year before a vaccine was developed. However, the attenuated measles vaccine has brought the disease under control. Vaccine-associated measles can occur in children and immunocompromised individuals. Little is known about the occurrence of vaccine-associated measles in healthy adults because preschool children usually are vaccinated. We describe an adult who presented with vaccine-associated measles and severe clinical symptoms after an atypical incubation period. A 23-year-old healthy man was given a measles vaccine, not rubella or mumps vaccine at the same time, on March 27, 2013, as part of an occupational health protocol; however, he presented with a high fever (40 C) at 18 days postvaccination. At 20 days post-vaccination, a rash appeared on his trunk, legs, and arms. Koplik’s spots, a runny nose, and red eyes also were noted. Two days after disease onset, blood samples, a throat swab, and a urine sample were collected and tested for measles virus by reverse transcription-polymerase chain reaction. A sequence corresponding to the measles N protein (533 bp) was amplified from the serum, peripheral blood mononuclear cells, and throat swab, and was identical to that of the genotype A virus (DQ345721). The subject had no history of travel before the vaccination or contact with patients with measles. Before vaccination, he tested negative for serum antibodies against the measles virus. Thus, he was diagnosed with vaccine-associated measles. According to the National Infectious Disease Surveillance Center of Japan, genotype A measles virus was detected in 71 individuals who showed adverse effects after measles vaccination between May 2006 and May 2013 (w0.0004% of vaccinations at most). The age range of the patients was 1 to 14 years (median, 1 year). No adult cases