Received Sep 12, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| MMRV | MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) | MERCK & CO. INC. | 1 | — | — |
Measles Encephalitis; This literature report has been received from the authors of the published article and refers to a 1-year-old female patient The patient's medical history was not reported. The patient's concurrent conditions included acute myeloid leukemia, diffuse morbilliform rash, and paternal haploidentical stem cell transplant. Concomitant therapies were not reported. On an unknown date, the patient was vaccinated with Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD), dose number 1, (lot # and expiration date were not reported) for prophylaxis. The vaccine was reconstituted with sterile diluent (Hollister-Stier STERILE DILUENT) (lot # and expiration date were not reported). On an unknown date, the patient experienced Measles Encephalitis. On an unknown date, metagenomic RNA sequencing showed Acquired 50.7 million reads, 190,303 of which aligned to Edmonston-Enders (Moraten) measles vaccine (MV), 500× coverage over 98.2% of the whole MV genome with mean coverage of 1,540× reads. It was identified no known hyperfusogenic fusion gene mutations. However, 38.0% (68/179) of uracil-containing codons in the matrix (M) gene contained >1 uracil-to-cytosine mutation at levels =5%. M-gene hypermutation; multiplex quantitative reverse transcription PCR showed positive for measles vaccine (MV) RNA. 3 genomic targets: the nucleoprotein, hemagglutinin, and large protein genes. The carboxyl-terminal nucleoprotein typing sequence was identical to the MV component of the Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) vaccine; magnetic resonance imaging showed abnormal signals; positron emission tomography showed hyperperfusion involving the insula and thalamus; mesial temporal lobe biopsy showed deep gray and white matter with astrogliosis but without notable inflammation, neoplastic cells, or definite inclusions. On an unspecified date, the patient died because of the event of measles encephalitis. An autopsy was not performed. The causal relationship between the event and the suspect vaccine Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD), reconstituted suspect sterile diluent (Hollister-Stier STERILE DILUENT) was related (also reported as fatal case of vaccine-associated measles encephalitis). Reported Cause(s) of Death: vaccine-associated measles encephalitis
Acute myeloid leukemia (chemotherapy); Morbilliform rash; Stem cell transplant
Sterile diluent
Test Name: multiplex quantitative reverse transcription PCR; Result Unstructured Data: positive for measles vaccine (MV) RNA. 3 genomic targets: the nucleoprotein, hemagglutinin, and large protein genes. The carboxyl-terminal nucleoprotein typing sequence was identical to the MV component of the ProQuad vaccine; Test Name: magnetic resonance imaging; Result Unstructured Data: abnormal signals; Test Name: positron emission tomography; Result Unstructured Data: hyperperfusion involving the insula and thalamus; Test Name: mesial temporal lobe biopsy; Result Unstructured Data: deep gray and white matter with astrogliosis but without notable inflammation, neoplastic cells, or definite inclusions; Test Name: Metagenomic RNA sequencing; Result Unstructured Data: Acquired 50.7 million reads, 190,303 of which aligned to Edmonston-Enders (Moraten) measles vaccine (MV). 500× coverage over 98.2% of the whole MV genome with mean coverage of 1,540× reads. It was identified no known hyperfusogenic fusion gene mutations. However, 38.0% (68/179) of uracil-containing codons in the matrix (M) gene contained >1 uracil-to-cytosine mutation at levels =5%. M-gene hypermutation.