SSPE (subacute sclerosing panencephalitis)

SSPE is a rare complication of measles. A risk factor for development of this fatal degenerative disease of the central nervous system is measles infection at an early age ( <2 years). On average, the symptoms of SSPE begin 7-10 years after measles infection (range: 1 month- 27 years).

In two recent studies (Bellini et al., 2005 and Miller et al., 1992) the risk of developing SSPE was calculated using the number of reported measles cases for a given period (corrected for underreporting) as the denominator. The study by Bellini et al. indicated that the risk of SSPE ranges from 6.5-11 cases of SSPE /100,000 measles cases that occurred during the measles epidemic in 1989-1991. This risk is approximately 10-fold higher than the risk estimated in the US in 1982 (8.5 cases of SSPE /1,000,000 measles cases) that is often cited in literature.

All of the genetic analyses of viral material derived from brain tissue of SSPE patients have revealed sequences of wild-type measles virus, never vaccine virus. There is no evidence that measles vaccine can cause SSPE. Cases of SSPE in patients who have a history of measles vaccination but no knowledge of having had measles either had an undiagnosed rash illness or possibly a mild measles infection early in life due to the presence of maternal antibody. Therefore, physicians should consider SSPE in the differential diagnosis of encephalitis even when the patient does not have a history of measles.

References

Bellini, W.J., Rota, J.S., Lowe L.E., et al. Subacute sclerosing panencephalitis: More cases of this fatal disease are prevented by measles immunization than previously recognized. J Infect Dis. 2005;192:1686-1693. (text-only)

Centers for Disease Control and Prevention. Subacute sclerosing panencephalitis surveillance-United States. MMWR. 1982. 31:585-8.

Barrero PR, Grippo J, Viegas M, Mistchenko AS. Wild-type measles virus in brain tissue of children with subacute sclerosing panencephalitis, Argentina. Emerg Infect Dis. 2003; 9:1333-1336.

Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. Chapter 10, Measles. 8th Edition, 2004.

Jin L, Beard S, Brown DWG, Miller E. Characterization of measles virus strains causing SSPE: A study of 11 cases. J of Neurovirol. 2002; 8:335-344.

Miller C, Farrington CP, Harbert K. The epidemiology of subacute sclerosing panencephalitis in England and Wales 1970-1989. Int J Epidemiol. 1992; 21:998-1006.

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This page last reviewed January 6, 2006

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