Bell's Palsy is the sudden onset of unilateral temporary paralysis of facial muscles resulting from seventh cranial nerve dysfunction. Presented here is a two-year old female patient with right peripheral facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's Palsy, as a rare complication of hepatitis B vaccination.

BACKGROUND:Bell's palsy or idiopathic facial paralysis is an acute facial paralysis caused by the inflammation of facial nerve. Several previous studies showed that acupuncture was beneficial in the treatment of facial paralysis. However, its effectiveness is still controversial compared with drug therapy. Therefore, this systematic review and meta-analysis was performed to assess the efficacy of acupuncture for Bell's palsy.

METHODS:This is a systematic review and meta-analysis of clinical studies among patients with Bell's palsy. We did a systematic literature search in PubMed, Embase, and the Cochrane Register of Controlled Trials to identify studies comparing the efficacy of acupuncture and drug treatment in treating facial paralysis. The search was last updated on July 2018.

RESULTS:The study included 11 randomized controlled trials with an overall sample of 1258 individuals. Acupuncture treatment was associated with an increased cure rate [relative risk (RR) = 1.77, 95% confidence interval (CI): 1.41-2.21], with significant heterogeneity in the pooled results (I = 67%, P = .0008). There was a significant difference in total effective rate in acupuncture and drug treatment for Bell's palsy (RR = 1.18,95% CI: 1.07-1.31), with substantialheterogeneity (I = 90%, P < .00001).

CONCLUSION:Although there was not enough evidence to prove its safety, acupuncture seems to be an effective therapy for Bell's palsy. Results of the present meta-analysis showed that acupuncture was associated with increased cure rate and total effective rate of the treatment of Bell's palsy in comparison with drugs. However, the results should be interpreted cautiously, because of the poor quality and heterogeneity of the included studies. In the future, more and more high quality randomized controlled trials (RCT) are needed to prove the safety and effectiveness of acupuncture.

BACKGROUND:Meningococcal conjugate vaccination is recommended in the United States. This study evaluates the safety of quadrivalent meningococcal conjugate vaccine in a cohort aged 11 to 21 years.

METHODS:This cohort study with self-controlled case-series analysis was conducted at Kaiser Permanente Southern California. Individuals receiving MenACWY-CRM, a quadrivalent meningococcal conjugate vaccine, during September 30, 2011 to June 30, 2013, were included. Twenty-six prespecified events of interest (EOIs), including neurologic, rheumatologic, hematologic, endocrine, renal, pediatric, and pediatric infectious disease EOIs, were identified through electronic health records 1 year after vaccination. Of these, 16 were reviewed by case review committees. Specific risk and comparison windows after vaccination were predefined for each EOI. The relative incidence (RI) and 95% confidence intervals (CIs) were estimated through conditional Poisson regression models, adjusted for seasonality.

RESULTS:This study included 48 899 vaccinated individuals. No cases were observed in the risk window for 14 of 26 EOIs. The RI for Bell's palsy, a case review committee-reviewed EOI, was statistically significant (adjusted RI: 2.9, 95% CI: 1.1-7.5). Stratified analyses demonstrated an increased risk for Bell's palsy in subjects receiving concomitant vaccines (RI = 5.0, 95% CI = 1.4-17.8), and no increased risk for those without concomitant vaccine (RI = 1.1, 95% CI = 0.2-5.5).

CONCLUSIONS:We observed a temporal association between occurrence of Bell's palsy and receipt of MenACWY-CRM concomitantly with other vaccines. The association needs further investigation as it could be due to chance, concomitant vaccination, or underlying medical history predisposing to Bell's palsy.

Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation.