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Woo HG, Kim HJ, Park J, Lee J, Lee H, Kim MS, Koyanagi A, Smith L, Rahmati M, Yeo SG, Yon DK. Global burden of vaccine-associated multiple sclerosis, 1967-2022: A comprehensive analysis of the international pharmacovigilance database. J Med Virol 2024; 96:e29591. [PMID: 38572940 DOI: 10.1002/jmv.29591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Vaccine-associated multiple sclerosis (MS) is rare, with insufficient evidence from case reports. Given the scarcity of large-scale data investigating the association between vaccine administration and adverse events, we investigated the global burden of vaccine-associated MS and potential related vaccines from 1967 to 2022. Reports on vaccine-associated MS between 1967 and 2022 were obtained from the World Health Organization International Pharmacovigilance Database (total number of reports = 120 715 116). We evaluated global reports, reporting odds ratio (ROR), and information components (IC) to investigate associations between 19 vaccines and vaccine-associated MS across 156 countries and territories. We identified 8288 reports of vaccine-associated MS among 132 980 cases of all-cause MS. The cumulative number of reports on vaccine-associated MS gradually increased over time, with a substantial increase after 2020, owing to COVID-19 mRNA vaccine-associated MS. Vaccine-associated MS develops more frequently in males and adolescents. Nine vaccines were significantly associated with higher MS reporting, and the highest disproportional associations were observed for hepatitis B vaccines (ROR 19.82; IC025 4.18), followed by encephalitis (ROR 7.42; IC025 2.59), hepatitis A (ROR 4.46; IC025 1.95), and papillomavirus vaccines (ROR 4.45; IC025 2.01). Additionally, MS showed a significantly disproportionate signal for COVID-19 mRNA vaccines (ROR 1.55; IC025 0.52). Fatal clinical outcomes were reported in only 0.3% (21/8288) of all cases of vaccine-associated MS. Although various vaccines are potentially associated with increased risk of MS, we should be cautious about the increased risk of MS following vaccination, particularly hepatitis B and COVID-19 mRNA vaccines, and should consider the risk factors associated with vaccine-associated MS.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Min Seo Kim
- Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille (APHM), Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Seung Geun Yeo
- Department of Otolaryngology-Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Shi J, Danesh-Meyer HV. A review of neuro-ophthalmic sequelae following COVID-19 infection and vaccination. Front Cell Infect Microbiol 2024; 14:1345683. [PMID: 38299114 PMCID: PMC10827868 DOI: 10.3389/fcimb.2024.1345683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Background It has become increasingly clear that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect most organs in the human body, including the neurologic and ophthalmic systems. Vaccination campaigns have been developed at rapid pace around the world to protect the population from the fast-mutating virus. This review seeks to summarise current knowledge of the neuro-ophthalmic manifestations of both COVID-19 infection and vaccination. Evidence acquisition Electronic searches for published literature were conducted using EMBASE and MEDLINE on the 30th of July 2023. The search strategy comprised of controlled vocabulary and free-text synonyms for the following terms in various combinations: "coronavirus, COVID-19, SARS-CoV-2, 2019-nCoV, vaccination, vaccine, immunisation and neuro-ophthalmology". No time range limits were set for the literature search. Published English abstracts for articles written in a different language were screened if available. Results A total of 54 case reports and case series were selected for use in the final report. 34 articles documenting neuro-ophthalmic manifestations following COVID-19 infection and 20 articles with neuro-ophthalmic complications following COVID-19 vaccination were included, comprising of 79 patients in total. The most commonly occurring condition was optic neuritis, with 25 cases following COVID-19 infection and 27 cases following vaccination against COVID-19. Conclusions The various COVID-19 vaccines that are currently available are part of the global effort to protect the most vulnerable of the human population. The incidence of neuro-ophthalmic consequences following infection with COVID-19 is hundred-folds higher and associated with more harrowing systemic effects than vaccination against the virus.
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Affiliation(s)
- Jane Shi
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Ophthalmology, Greenlane Clinical Centre, Te Whatu Ora – Health New Zealand, Auckland, New Zealand
| | - Helen V. Danesh-Meyer
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Ophthalmology, Greenlane Clinical Centre, Te Whatu Ora – Health New Zealand, Auckland, New Zealand
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Grimaldi-Bensouda L, Papeix C, Hamon Y, Benichou J, Abenhaim L. Association between vaccination and the risk of central demyelination: results from a case-referent study. J Neurol 2023; 270:4678-4686. [PMID: 37351662 PMCID: PMC10511379 DOI: 10.1007/s00415-023-11822-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Few studies documented the potential association between vaccination and the risk of central demyelination (CD). Specifically, anti-hepatitis B and anti-human papillomavirus (HPV) vaccines have been the subject of distrust with regard to their implication to trigger CD. METHODS From a systematic national registry, patients with first signs of CD (cases) were identified and documented for their exposure to vaccination up to 24 months before the first signs occurred. This exposure was compared to that of a representative sample of general practice patients without a history of CD, randomly selected from a national registry (referents). CD cases were 2:1 matched on age, sex, index date (ID), and region of residence. Vaccines against influenza, HPV, hepatitis B and diphtheria-tetanus-pertussis-poliomyelitis-haemophilus (DTPPHae) were considered. Associations between vaccination and CD were assessed using multivariate conditional logistic regressions, controlled for confounding factors. FINDINGS 564 CD cases were matched to 1,128 randomly selected referents (age range: 2-79 years old). Overall, 123 (22%) CD cases and 320 (28%) referents had received at least one vaccine within 24 months before ID. Adjusted odds ratios (ORs) for any vaccination were 0.69, 95% confidence interval (CI) [0.54-0.88] with respect to any CD first signs, 0.68 [0.51-0.90] for myelitis and 0.70 [0.42-1.17] for optic neuritis. Adjusted ORs for any CD first signs were 1.02 [0.71-1.47] for influenza vaccine (administered in 9.6% of cases and 10.4% of referents) and 0.72 [0.53-0.99] for DTPPHae vaccine (administered in 10.8% of cases and 14.5% of referents). Vaccines against hepatitis B and HPV were only administered in 1.1% and 1.2% of cases and in 2.9% and 3.2% of referents respectively, which statistically explained the point estimates < 1 (ORs of 0.39 [0.16-0.94] and of 0.32 [0.13-0.80]). INTERPRETATION No increased risk of CD incidence was observed amongst vaccinated patients. Lower rates of vaccination against hepatitis B and HPV observed in patients with CD compared to referents may be due to the reluctance of physicians to vaccinate patients considered at risk of CD.
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Affiliation(s)
- Lamiae Grimaldi-Bensouda
- The PGRx Study Group, Paris, France
- Pharmacology Department, Hospital Group Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Garches, France
- University of Versailles-Paris Saclay, Montigny Le Bretonneux, France
- Inserm U 1018 CESP, Villejuif, France
| | - Caroline Papeix
- Neurology Department of Hospital foundation A de Rothschild, Paris, France
- Paris-Cité University, Paris, France
| | - Yann Hamon
- The PGRx Study Group, Paris, France
- RESAL, LA-SER Group, Paris, France
| | - Jacques Benichou
- Inserm U 1018 CESP, Villejuif, France
- Department of Biostatistics and Clinical Research, CHU Rouen, 76000 Rouen, France
- Université de Rouen-Normandie, Rouen, France
| | - Lucien Abenhaim
- The PGRx Study Group, Paris, France
- RESAL, LA-SER Group, Paris, France
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Risk Research Inc., Montreal, Canada
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Cohen M, Thomel-Rocchi O, Siva A, Okuda DT, Karabudak R, Efendi H, Terzi M, Carra-Dalliere C, Durand-Dubief F, Thouvenot E, Ciron J, Zephir H, Bourre B, Casez O, De Seze J, Moreau T, Neau JP, Pelletier D, Kantarci O, Tutuncu M, Derache N, Bensa C, Louapre C, Benoit J, Landes-Chateau C, Lebrun-Frenay C. Impact of COVID-19 vaccination or infection on disease activity in a radiologically isolated syndrome cohort: The VaxiRIS study. Mult Scler 2023; 29:1099-1106. [PMID: 37322880 PMCID: PMC10273053 DOI: 10.1177/13524585231179669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Vaccination in patients with multiple sclerosis (MS) treated with immunosuppressive drugs is highly recommended. Regarding COVID-19 vaccination, no specific concern has been raised. OBJECTIVES We aimed to evaluate if COVID-19 vaccination or infection increased the risk of disease activity, either radiological or clinical, with conversion to MS in a cohort of people with a radiologically isolated syndrome (RIS). METHODS This multicentric observational study analyzed patients in the RIS Consortium cohort during the pandemic between January 2020 and December 2022. We compared the occurrence of disease activity in patients according to their vaccination status. The same analysis was conducted by comparing patients' history of COVID-19 infection. RESULTS No difference was found concerning clinical conversion to MS in the vaccinated versus unvaccinated group (6.7% vs 8.5%, p > 0.9). The rate of disease activity was not statistically different (13.6% and 7.4%, respectively, p = 0.54). The clinical conversion rate to MS was not significantly different in patients with a documented COVID-19 infection versus non-infected patients. CONCLUSION Our study suggests that COVID-19 infection or immunization in RIS individuals does not increase the risk of disease activity. Our results support that COVID-19 vaccination can be safely proposed and repeated for these subjects.
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Affiliation(s)
- Mikael Cohen
- Department of Neurology, CRC-SEP, CHU de Nice, Pasteur 2 Hospital, Nice, France UR2CA-URRIS, Côte d’Azur University, Nice, France
| | | | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rana Karabudak
- School of Medicine, Hacettepe University, Ankara, Turkey
| | - Hüsnü Efendi
- School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Terzi
- School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Clarisse Carra-Dalliere
- Department of Neurology, CRC-SEP, CHU de Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Francoise Durand-Dubief
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Eric Thouvenot
- Institut de Génomique Fonctionnelle, Université de Montpellier, Centre National de Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Jonathan Ciron
- Department of Neurology, Centre de Ressource et Competence Sclérose En Plaques, Centre Hospitalier Universitaire de Toulouse, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche1291, Centre National de Recherche Scientifique Unité Mixte de Recherche 5051, Université Toulouse III, Toulouse, France
| | - Helene Zephir
- Université de Lille, Inserm Unité Mixte de Recherche-S 1172 LilNcog, Centre Hospitalier Universitaire Lille, Fédération Hospitalo-Universitaire Precise, Lille, France
| | | | - Olivier Casez
- Pathologies Inflammatoires du Système Nerveux, Neurologie, CHU Grenoble Alpes, T-RAIG (Translational Research in Autoimmunity and Inflammation Group) TIMC-IMAG, Université de Grenoble-Alpes, CHU Grenoble-Alpes, Grenoble, France
| | - Jérôme De Seze
- Department Clinical Investigation Center, Department of Neurology, Centre Hospitalier Universitaire de Strasbourg, Institut National de la Santé et de la Recherche Médicale, Strasbourg, France
| | - Thibault Moreau
- Department of Neurology, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Jean-Philippe Neau
- Department of Neurology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | | | - Melih Tutuncu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nathalie Derache
- Department of Neurology, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Caroline Bensa
- Neurology Department, CRC-SEP, Hopital Fondation Adolphe de Rothschild, Paris, France
| | - Celine Louapre
- CIC Neurosciences, Department of Neurology, Sorbonne University, Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeanne Benoit
- Department of Neurology, CRC-SEP, CHU de Nice, Pasteur 2 Hospital, Nice, France UR2CA-URRIS, Côte d’Azur University, Nice, France
| | - Cassandre Landes-Chateau
- Department of Neurology, CRC-SEP, CHU de Nice, Pasteur 2 Hospital, Nice, France UR2CA-URRIS, Côte d’Azur University, Nice, France
| | - Christine Lebrun-Frenay
- Department of Neurology, CRC-SEP, CHU de Nice, Pasteur 2 Hospital, Nice, France UR2CA-URRIS, Côte d’Azur University, Nice, France
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Kramvis A, Mammas IN, Spandidos DA. Exploring the optimal vaccination strategy against hepatitis B virus in childhood (Review). Biomed Rep 2023; 19:48. [PMID: 37383679 PMCID: PMC10293880 DOI: 10.3892/br.2023.1631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) remains the most effective strategy against HBV infection in humans. The present review summarized the optimal vaccination strategies against HBV in childhood. The following points are discussed: i) When and how the first HBV vaccines were developed; ii) the dosages, schedules and injection routes that are used for HBV vaccination; iii) the contraindications for HBV vaccination in the general paediatric population; iv) the challenges with the use of multivalent vaccines; v) the long-term immunogenicity and duration of protection against HBV; vi) the use of selective HBV vaccination and the hepatitis B immune globulin strategy in HBV-exposed infants; and vii) the effectiveness of the current HBV vaccination schemes. The present review is based on a Paediatric Virology Study Group (PVSG) webinar performed in the context of the 8th Workshop on Paediatric Virology.
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Affiliation(s)
- Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg 2193, South Africa
| | - Ioannis N. Mammas
- Paediatric Clinic, Aliveri, 34500 Island of Euboea
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
- Department of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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Habibi MA, Nezhad Shamohammadi F, Rajaei T, Namdari H, Pashaei MR, Farajifard H, Ahmadpour S. Immunopathogenesis of viral infections in neurological autoimmune disease. BMC Neurol 2023; 23:201. [PMID: 37221459 DOI: 10.1186/s12883-023-03239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Autoimmune diseases develop due to self-tolerance failure in recognizing self and non-self-antigens. Several factors play a role in inducing autoimmunity, including genetic and environmental elements. Several studies demonstrated the causative role of viruses; however, some studies showed the preventive effect of viruses in the development of autoimmunity. Neurological autoimmune diseases are classified based on the targets of autoantibodies, which target intracellular or extracellular antigens rather than neurons. Several theories have been hypothesized to explain the role of viruses in the pathogenesis of neuroinflammation and autoimmune diseases. This study reviewed the current data on the immunopathogenesis of viruses in autoimmunity of the nervous system.
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Affiliation(s)
- Mohammad Amin Habibi
- Multiple Sclerosis Research Center, Neuroscience Institut, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute , Tehran University of Medical Sciences, Tehran, Iran
| | | | - Taraneh Rajaei
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Haideh Namdari
- Iranian Tissue Bank and Research Center, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Reza Pashaei
- Department of Internal Medicine, School of Medicine, Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Science, Urmia, Iran
| | - Hamid Farajifard
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell and Tissue Research Institute , Tehran University of Medical Sciences, Tehran, Iran.
| | - Sajjad Ahmadpour
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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Alluqmani M. New Onset Multiple Sclerosis Post-COVID-19 Vaccination and Correlation With Possible Predictors in a Case-Control Study. Cureus 2023; 15:e36323. [PMID: 37077605 PMCID: PMC10108897 DOI: 10.7759/cureus.36323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Various inflammatory diseases have been associated with the administration of various vaccines. Several reports have associated vaccine administration with the demyelinating diseases of the central nervous system (CNS). However, no clear or strong scientific evidence exists to support the association of vaccine administration with the onset of demyelinating diseases. Some CNS demyelination diseases such as acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD) were reported following the administration of COVID-19 vaccines. In this study, new onset multiple sclerosis (MS) following COVID-19 vaccine administration was reported. METHODS In this longitudinal observational case-control study, a total of 65 participants were studied, who were divided into two groups. Group A included 32 MS patients who were diagnosed post-COVID-19 vaccine administration and group B included 33 participants who received COVID-19 vaccines and did not develop MS. Group B was used as a control. The Chi-square test and logistic regression analysis were carried out using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Armonk, NY) software. RESULTS Univariate and multivariate logistic regression analysis was performed and a significant correlation between the risk factors and the development of MS post-COVID-19 vaccination was identified. CONCLUSION The risk factors, identified in this study, can be used as significant independent predictors for developing MS post-COVID-19 vaccinations.
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Miao G, Chen Z, Cao H, Wu W, Chu X, Liu H, Zhang L, Zhu H, Cai H, Lu X, Shi J, Liu Y, Feng T. From Immunogen to COVID-19 vaccines: Prospects for the post-pandemic era. Biomed Pharmacother 2023; 158:114208. [PMID: 36800265 PMCID: PMC9805901 DOI: 10.1016/j.biopha.2022.114208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
The COVID-19 pandemic has affected millions of people and posed an unprecedented burden on healthcare systems and economies worldwide since the outbreak of the COVID-19. A considerable number of nations have investigated COVID-19 and proposed a series of prevention and treatment strategies thus far. The pandemic prevention strategies implemented in China have suggested that the spread of COVID-19 can be effectively reduced by restricting large-scale gathering, developing community-scale nucleic acid testing, and conducting epidemiological investigations, whereas sporadic cases have always been identified in numerous places. Currently, there is still no decisive therapy for COVID-19 or related complications. The development of COVID-19 vaccines has raised the hope for mitigating this pandemic based on the intercross immunity induced by COVID-19. Thus far, several types of COVID-19 vaccines have been developed and released to into financial markets. From the perspective of vaccine use in globe, COVID-19 vaccines are beneficial to mitigate the pandemic, whereas the relative adverse events have been reported progressively. This is a review about the development, challenges and prospects of COVID-19 vaccines, and it can provide more insights into all aspects of the vaccines.
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Affiliation(s)
- Ganggang Miao
- Department of General Surgery, The People’s Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang, China,Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiqiang Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Hengsong Cao
- Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Wenhao Wu
- Department of Clinical Medicine, Nanjing Medical University The First School of Clinical Medicine, Nanjing, China
| | - Xi Chu
- Department of Radiology, Nanjing Medical University The Fourth School of Clinical Medicine, Nanjing, China
| | - Hanyuan Liu
- Department of General Surgery, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Leyao Zhang
- Department of Clinical Medicine, Nanjing Medical University The First School of Clinical Medicine, Nanjing, China
| | - Hongfei Zhu
- Department of Clinical Medicine, Nanjing Medical University The First School of Clinical Medicine, Nanjing, China
| | - Hongzhou Cai
- Department of Urology, Jiangsu Cancer Hospital &The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China.
| | - Xiaolan Lu
- Department of Clinical laboratory, Canglang Hospital of Suzhou, Suzhou, China.
| | - Junfeng Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Department of Molecular and Celluar Biochemistry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
| | - Yuan Liu
- Department of Infectious Disease,The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Tingting Feng
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China.
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Mirmosayyeb O, Ghaffary E, Vaheb S, Pourkazemi R, Shaygannejad V. Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) following COVID-19 vaccines: A systematic review. Rev Neurol (Paris) 2023; 179:265-281. [PMID: 36658048 PMCID: PMC9844421 DOI: 10.1016/j.neurol.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The global COVID-19 pandemic began in March 2019, and given the number of casualties and adverse effects on the economy, society, and all aspects of the health system, efforts have been made to develop vaccines from the beginning of the pandemic. Numerous vaccines against COVID-19 infection have been developed in several technologies and have spread rapidly. There have been reported multiple complications of the COVID-19 vaccines as with other vaccines. A number of studies have reported multiple sclerosis (MS ) and neuromyelitis optica spectrum disorder (NMOSD) as complications of COVID-19 vaccines. METHODS First, we found 954 studies from 4 databases (PubMed, Embase, Scopus, and Web of Science) from inception to March 1st, 2022. Next, duplicate articles were eliminated, and 476 studies remained. Then 412 studies were removed according to inclusion and exclusion criteria. After obtaining the full text of 64 articles, 12 studies were selected finally. RESULTS The data were extracted from included studies in a table. Our data includes demographic data, comorbidities, vaccines information and side effects, NMOSD and MS symptoms, laboratory and cerebrospinal fluid (CSF) findings, magnetic resonance imaging (MRI) results, treatment, and outcome of all cases. CONCLUSION MS and NMOSD are two neuroinflammatory disorders that arise in the CNS. Cases of MS and NMOSD have been reported following COVID-19 vaccination. Nevertheless, more studies with more subjects are needed to assess any possible relationship between the COVID-19 vaccine and central nervous system demyelination.
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Affiliation(s)
- O. Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - E.M. Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - S. Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R. Pourkazemi
- Nursing and Midwifery Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - V. Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Corresponding author. Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Lamprinou M, Sachinidis A, Stamoula E, Vavilis T, Papazisis G. COVID-19 vaccines adverse events: potential molecular mechanisms. Immunol Res 2023; 71:356-372. [PMID: 36607502 PMCID: PMC9821369 DOI: 10.1007/s12026-023-09357-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
COVID-19 is an infectious disease caused by a single-stranded RNA (ssRNA) virus, known as SARS-CoV-2. The disease, since its first outbreak in Wuhan, China, in December 2019, has led to a global pandemic. The pharmaceutical industry has developed several vaccines, of different vector technologies, against the virus. Of note, among these vaccines, seven have been fully approved by WHO. However, despite the benefits of COVID-19 vaccination, some rare adverse effects have been reported and have been associated with the use of the vaccines developed against SARS-CoV-2, especially those based on mRNA and non-replicating viral vector technology. Rare adverse events reported include allergic and anaphylactic reactions, thrombosis and thrombocytopenia, myocarditis, Bell's palsy, transient myelitis, Guillen-Barre syndrome, recurrences of herpes-zoster, autoimmunity flares, epilepsy, and tachycardia. In this review, we discuss the potential molecular mechanisms leading to these rare adverse events of interest and we also attempt an association with the various vaccine components and platforms. A better understanding of the underlying mechanisms, according to which the vaccines cause side effects, in conjunction with the identification of the vaccine components and/or platforms that are responsible for these reactions, in terms of pharmacovigilance, could probably enable the improvement of future vaccines against COVID-19 and/or even other pathological conditions.
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Affiliation(s)
- Malamatenia Lamprinou
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Athanasios Sachinidis
- 4th Department of Internal Medicine, School of Medicine, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Stamoula
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Theofanis Vavilis
- Laboratory of Medical Biology and Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece ,Department of Dentistry, School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Georgios Papazisis
- Laboratory of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece ,Clinical Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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Saxton E, Panchasara B, Sarangapani S. Optic Neuritis following Second Administration of COVID-19 Vaccine: A Case Report. Case Rep Ophthalmol 2023; 14:394-399. [PMID: 37901633 PMCID: PMC10601799 DOI: 10.1159/000531526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 10/31/2023] Open
Abstract
A 28-year-old woman presented to eye casualty with signs and symptoms suggestive of optic neuritis following a recent COVID-19 vaccination (the Moderna mRNA-1273 vaccine). The best corrected visual acuity was 6/15 in the right eye and 6/6 in the left eye with a relative afferent pupillary defect in the right eye. Following examination and investigation, she was found to fit the McDonald criteria for multiple sclerosis and was commenced on disease-modifying therapy. Demyelinating events have been identified to occur following COVID-19 vaccinations. In this case, we have found that the Moderna mRNA-1273 vaccine could have contributed to the development of optic neuritis following a second dose of the vaccine.
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Affiliation(s)
- Edward Saxton
- Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
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12
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Kuntz S, Saab G, Schneider R. Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:130. [PMID: 35761845 PMCID: PMC9219391 DOI: 10.1007/s42399-022-01213-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/30/2022]
Abstract
In the era of the COVID-19 pandemic declared in March 2020, widespread vaccination protocols were initiated to mitigate the severity and spread of COVID-19. Although COVID-19 vaccines have been generally considered safe, adverse events post-vaccination have been reported, including the development of demyelinating disease. We report a rare case of de novo aquaporin-4-positive neuromyelitis optica spectrum disorder (NMOSD) in an 80-year-old man following BNT162b SARS-CoV-2 vaccination to raise the awareness of this possible severe adverse event in an older adult. An 80-year-old South Asian man presented 2 days following his second dose of the Pfizer-BioNTech COVID-19 mRNA BNT162b2 vaccine with progressive left-sided leg weakness and numbness resulting in falls. MRI of the spine revealed a longitudinally extensive transverse myelitis from T3–T4 to T9–T10. Serum antibody testing revealed positive aquaporin-4 (AQP4) antibodies. He was diagnosed with AQP4-positive NMOSD and was treated with high-dose intravenous methylprednisolone and plasma exchange with some improvement. He was subsequently treated with mycophenolate mofetil and a slow steroid wean. This case report adds to the existing literature and suggests that COVID-19 vaccinations may trigger de novo NMOSD or NMOSD relapses in some individuals. Although rare, our patient presented with new-onset NMOSD in his 80 s following COVID-19 vaccination. As such, it is relevant to consider AQP4 testing in those presenting with a post-vaccination myelitis, regardless of age. Ongoing vaccine surveillance and research are needed to understand the risk of NMOSD post-COVID-19 vaccinations further.
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Affiliation(s)
- Stephanie Kuntz
- Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | - Georges Saab
- Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | - Raphael Schneider
- Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8 Canada
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Abu-Abaa M, Dawood G, Arshad H, Jumaah O, Landau D. A Possible Case of Autoimmune Encephalitis After mRNA COVID-19 Booster Vaccine: A Case Report. Cureus 2022; 14:e31118. [DOI: 10.7759/cureus.31118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/07/2022] Open
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14
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Kim E, Haag A, Nguyen J, Kesselman MM, Demory Beckler M. Vaccination of multiple sclerosis patients during the COVID-19 era: Novel insights into vaccine safety and immunogenicity. Mult Scler Relat Disord 2022; 67:104172. [PMID: 36116380 PMCID: PMC9462931 DOI: 10.1016/j.msard.2022.104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 09/08/2022] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) is an incurable autoimmune disease known to cause widespread demyelinating lesions in the central nervous system (CNS) and a host of debilitating symptoms in patients. The development of MS is believed to be driven by the breakdown of the blood brain barrier, subsequent infiltration by CD4+ and CD8+ T cells, and widespread CNS inflammation and demyelination. Disease modifying therapies (DMTs) profoundly disrupt these processes and therefore compose an essential component of disease management. However, the effects of these therapeutic agents on vaccine safety and immunogenicity in individuals with MS are not yet fully understood. As such, the primary objective of this review article was to summarize the findings of recently conducted studies on vaccine safety and immunogenicity in MS patients treated with DMTs, particularly in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Discussed in this review are vaccinations against influenza, yellow fever, human papillomavirus, measles, mumps, rubella, Streptococcus pneumoniae, hepatitis B, and COVID-19. This article additionally reviews our current understanding of COVID-19 severity and incidence in this patient population, the risks and benefits of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and vaccination guidelines set forth by MS societies and organizations.
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Affiliation(s)
- Enoch Kim
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Alyssa Haag
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Jackie Nguyen
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Marc M Kesselman
- Division of Rheumatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Michelle Demory Beckler
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
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15
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Oueijan RI, Hill OR, Ahiawodzi PD, Fasinu PS, Thompson DK. Rare Heterogeneous Adverse Events Associated with mRNA-Based COVID-19 Vaccines: A Systematic Review. MEDICINES 2022; 9:medicines9080043. [PMID: 36005648 PMCID: PMC9416135 DOI: 10.3390/medicines9080043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Background: Since the successful development, approval, and administration of vaccines against SARS-CoV-2, the causative agent of COVID-19, there have been reports in the published literature, passive surveillance systems, and other pharmacovigilance platforms of a broad spectrum of adverse events following COVID-19 vaccination. A comprehensive review of the more serious adverse events associated with the Pfizer-BioNTech and Moderna mRNA vaccines is warranted, given the massive number of vaccine doses administered worldwide and the novel mechanism of action of these mRNA vaccines in the healthcare industry. Methods: A systematic review of the literature was conducted to identify relevant studies that have reported mRNA COVID-19 vaccine-related adverse events. Results: Serious and severe adverse events following mRNA COVID-19 vaccinations are rare. While a definitive causal relationship was not established in most cases, important adverse events associated with post-vaccination included rare and non-fatal myocarditis and pericarditis in younger vaccine recipients, thrombocytopenia, neurological effects such as seizures and orofacial events, skin reactions, and allergic hypersensitivities. Conclusions: As a relatively new set of vaccines already administered to billions of people, COVID-19 mRNA-based vaccines are generally safe and efficacious. Further studies on long-term adverse events and other unpredictable reactions in close proximity to mRNA vaccination are required.
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Affiliation(s)
- Rana I. Oueijan
- School of Pharmacy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| | - Olivia R. Hill
- School of Pharmacy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| | - Peter D. Ahiawodzi
- Department of Public Health, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
| | - Pius S. Fasinu
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Dorothea K. Thompson
- Department of Pharmaceutical and Clinical Sciences, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27501, USA
- Correspondence: ; Tel.: +1-910-893-7463
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16
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Lotan I, Lydston M, Levy M. Neuro-Ophthalmological Complications of the COVID-19 Vaccines: A Systematic Review. J Neuroophthalmol 2022; 42:154-162. [PMID: 35427282 DOI: 10.1097/wno.0000000000001537] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A worldwide mass vaccination campaign against the coronavirus disease 2019 (COVID-19) pandemic is currently underway. Although the safety data of the clinical trials did not report specific concerns regarding neuro-ophthalmological adverse events, they involved a limited number of individuals and were conducted over a relatively short time. The aim of the current review is to summarize the available postmarketing data regarding the occurrence of neuro-ophthalmological and other ocular complications of the COVID-19 vaccines. EVIDENCE ACQUISITION Electronic searches for published literature were conducted using Ovid MEDLINE, Embase, Web of Science, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search strategy incorporated controlled vocabulary and free-text synonyms for the concepts of COVID, vaccines, and visual and neuro-ophthalmologic diseases and symptoms. RESULTS A total of 14 case reports and 2 case series have been selected for inclusion in the final report, reporting 76 cases of post-COVID-vaccination adverse events. The most common adverse event was optic neuritis (n = 61), followed by uveitis (n = 3), herpes zoster ophthalmicus (n = 2), acute macular neuroretinopathy (n = 2), optic disc edema as an atypical presentation of Guillain-Barré syndrome (n = 1), (arteritic anterior ischemic optic neuropathy; n = 1), abducens nerve palsy (n = 1), oculomotor nerve palsy (n = 1), Tolosa-Hunt syndrome (n = 1), central serous retinopathy (n = 1), acute zonal occult outer retinopathy (n = 1), and bilateral choroiditis (n = 1). Most cases were treated with high-dose steroids and had a favorable clinical outcome. CONCLUSION Since the implementation of the COVID-19 vaccination campaign in the past year, several post-COVID-vaccination neuro-ophthalmological complications have been described. However, considering the number of individuals that have been exposed to the vaccines, the risk seems very low, and the clinical outcome in most cases is favorable. Therefore, on a population level, the benefits of the vaccines far outweigh the risk of neuro-ophthalmological complications.
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Affiliation(s)
- Itay Lotan
- Department of Neurology (IL, ML), Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and Treadwell Virtual Library for the Massachusetts General Hospital (ML), Boston, Massachusetts
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Silva GD, de Oliveira VF, Mendonça LO. Challenges and insights in immunization in patients with demyelinating diseases: a bench-to-bedside and evidence-based review. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:173-181. [PMID: 35976311 PMCID: PMC9491426 DOI: 10.1590/0004-282x-anp-2022-s121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Infections are among the main causes of death in patients with demyelinating diseases of the central nervous system (CNSDD). Vaccines are effective methods in reducing hospitalization and death from infectious diseases, but they are challenging in patients with CNSDD because of autoimmunity and immunosuppression. OBJECTIVES To summarize the pathophysiological rationale and main evidence for vaccine recommendations in patients with CNSDD. METHODS Specialists with different backgrounds on the subject: a neurologist specialized in demyelinating diseases, an infectious diseases specialist and an immunologist, presented a critical narrative review of vaccination literature in patients with CNSDD, highlighting which vaccines should or should not be administered and the best time for it. RESULTS Patients with DDSNC are at increased risk of vaccine-preventable viral and bacterial infections. Vaccines can prevent herpes zoster, hepatitis B reactivation, HPV-associated warts and tumors, viral and bacterial pneumonia, and meningitis. Live attenuated virus vaccines should not be used when the patient is on immunosuppression. Vaccines should be avoided during relapses. The greatest vaccine efficacy is given before treatment or at the end of medication. CONCLUSION Patients with DDSNC need differentiated immunization in relation to additional vaccines, contraindicated vaccines and timing of vaccination.
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Affiliation(s)
- Guilherme Diogo Silva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil
| | - Vítor Falcão de Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo SP, Brazil
| | - Leonardo Oliveira Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Imunologia Clínica e Alergia, São Paulo SP, Brazil
- Rede DASA-Hospital 9 de Julho, Divisão de Imunologia Clínica e Alergia, São Paulo SP, Brazil
- Rede DASA-Hospital 9 de Julho, Centro de Doenças Raras e da Imunidade, São Paulo SP, Brazil
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18
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Vaccination Coverage against Tetanus, Diphtheria, Pertussis and Poliomyelitis and Validity of Self-Reported Vaccination Status in Patients with Multiple Sclerosis. J Pers Med 2022; 12:jpm12050677. [PMID: 35629100 PMCID: PMC9146089 DOI: 10.3390/jpm12050677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated disease with a neurodegenerative component of the central nervous system. Immunomodulatory therapy can increase the risk of infection, which is a particular risk for MS patients. Therefore, a complete vaccination status is of utmost importance as protection against vaccine-preventable infectious diseases. Our aim was to investigate the vaccination status, vaccination card knowledge and the vaccination behavior of MS patients with regard to vaccinations against tetanus, diphtheria, pertussis and poliomyelitis. Three hundred twenty-seven patients with MS were evaluated by anamnesis, clinical examination, structured interview and vaccination card control in this two-center study. Based on the recommendations of the Robert Koch Institute, we assessed the completeness of the vaccination status of the examined vaccinations. Furthermore, a comparative analysis of patients with complete/incomplete or correctly/wrongly self-reported vaccination status was performed. In the cohort analyzed, the vaccination coverage was 79.5% for tetanus, 79.2% for diphtheria, 74.8% for pertussis and 84.8% for poliomyelitis. The assumed vaccination status was higher for tetanus (86.5%) and lower for diphtheria (69.4%), pertussis (61.2%) and poliomyelitis (75.9%). Patients who were unvaccinated or only partially vaccinated against tetanus had received vaccination advice from a physician less often in the past year (13.4 vs. 36.9%, p < 0.001) and had no one to check the vaccination card more often (35.8 vs. 12.3%, p < 0.001). High sensitivity (93.7%) and low specificity (30.3%) were determined regarding the validity of self-reported tetanus vaccination status. Patients with a correctly reported tetanus vaccination status were more likely to have their vaccination card checked by a physician than those who overestimated or underestimated their vaccination status (76.7 vs. 63.0/43.8%, p = 0.002). Similar findings were seen with regard to diphtheria, pertussis and poliomyelitis vaccination. Patients without a regular vaccination card control (17.1%) were more likely to be male (44.6 vs. 29.4%, p = 0.037), had fewer siblings on average (1.1 vs. 1.6, p = 0.016), dealt less frequently with the issue of vaccination in the past year (32.1 vs. 69.3%, p < 0.001) and more frequently had the wish to receive vaccination advice (48.2 vs. 34.4%, p = 0.030) than patients in whom the vaccination card was checked regularly by a physician. To minimize the risk of infection in MS patients, treating physicians should provide regular vaccination counseling and perform vaccination card controls, as these factors are associated with a higher vaccination coverage and a higher validity of self-reported vaccination statuses.
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Streckenbach B, Baldt J, Heidler F, Frahm N, Langhorst SE, Mashhadiakbar P, Burian K, Zettl UK, Richter J. General vaccination willingness and current vaccination status in relation to clinical and psychological variables in patients with multiple sclerosis. Vaccine 2022; 40:3236-3243. [DOI: 10.1016/j.vaccine.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
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COVID-19 Vaccination and Neurological Manifestations: A Review of Case Reports and Case Series. Brain Sci 2022; 12:brainsci12030407. [PMID: 35326363 PMCID: PMC8946610 DOI: 10.3390/brainsci12030407] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023] Open
Abstract
Background: With 10 vaccines approved by the WHO and nearly 48% of people fully vaccinated worldwide, we have observed several individual case studies of neurological manifestations post-COVID-19 vaccination. Through this systematic review, we aim to discern these CNS and PNS manifestations following the COVID-19 vaccine to help produce methods to mitigate them. Methods: We conducted a thorough literature search of Google Scholar and PubMed from 1 December 2020 until 10 October 2021 and included all the case studies of COVID-19 vaccine-associated neurological side effects. The literature search and data analysis were performed by two independent reviewers according to prespecified inclusion and exclusion criteria using PRISMA. Results: The most common CNS manifestation was CVST (14.47%), found in females (64%) younger than 50 years (71%) after the first AstraZeneca dose (93%). Others included CNS demyelinating disorders (TM, ADEM, MS, NMOSD) (9.30%), encephalopathy/encephalitis (3.10%), and others (4.13%). The most common PNS manifestation was GBS (14.67%) found in males (71%) older than 50 years (79%), followed by Bell’s palsy (5.24%) and others (2.10%). Most occurred with the AstraZeneca (28.55%), Pfizer-BioNTech (9.18%), and Moderna (8.16%) vaccines. Nine (64%) out of the 14 patients with CVST died. However, most cases overall (42 out of 51) were non-fatal (82%). Conclusion: Several CNS and PNS adverse events have occurred post-COVID-19 vaccination, including CVST, GBS, and TM. High vigilance with early identification and treatment leads to better outcomes. Further studies with non-vaccinated controls might help in understanding the pathophysiologic mechanisms of these neurological manifestations following COVID-19 vaccination.
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Ballout AA, Babaie A, Kolesnik M, Li JY, Hameed N, Waldman G, Chaudhry F, Saba S, Harel A, Najjar S. A Single-Health System Case Series of New-Onset CNS Inflammatory Disorders Temporally Associated With mRNA-Based SARS-CoV-2 Vaccines. Front Neurol 2022; 13:796882. [PMID: 35280277 PMCID: PMC8908032 DOI: 10.3389/fneur.2022.796882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSince 2020, over 250 million doses of mRNA-based SARS-CoV-2 vaccines have been administered in the United States and hundreds of millions worldwide between the Pfizer-BioNTech and Moderna SARS-CoV-2 vaccines. To date, there have been rare reports associating mRNA-based SARS-CoV-2 vaccines with episodes of inflammatory and autoimmune CNS disorders. We report a case series of five patients with new-onset neurological disorders of inflammatory or immunological origin temporally associated with these vaccines.MethodsA case-series of five patients within a single 23-hospital health system who developed new-onset CNS inflammatory disease within 2 weeks of receiving a dose of an mRNA-based SARS-CoV-2 vaccine.ResultsFive cases of post-vaccination CNS disorders of immune origin (fatal ADEM; n = 1, new-onset NMOSD; n = 2, new-clinical onset MS-like syndrome but with preexisting clinically silent mild demyelination; n = 1, meningoencephalitis; n = 1) observed within 2 weeks of inoculation with either the first or second dose of mRNA-based SARS-CoV-2 vaccines (Moderna = 3, Pfizer = 2).DiscussionTo our knowledge, these are among the emerging cases of CNS adverse events of immunological or inflammatory origin. These findings should be interpreted with great caution as they neither prove a mechanistic link nor imply a potential long-term increased risk in post-vaccination CNS autoimmunity. Larger prospective studies assessing the potential association between mRNA-based vaccination and the development of neurological adverse events of suspected immune origin, particularly among those with underlying CNS or systemic autoimmune disorders, are needed. The use of mRNA-based SARS-CoV-2 vaccines should continue to be strongly encouraged given their high efficacy in overcoming this pandemic.
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Affiliation(s)
- Ahmad A. Ballout
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Anna Babaie
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Michael Kolesnik
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Jian Yi Li
- Pathology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Natasha Hameed
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Glenn Waldman
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Frasat Chaudhry
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Sami Saba
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Asaff Harel
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Souhel Najjar
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- *Correspondence: Souhel Najjar
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22
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Eom H, Kim SW, Kim M, Kim YE, Kim JH, Shin HY, Lee HL. Case Reports of Acute Transverse Myelitis Associated With mRNA Vaccine for COVID-19. J Korean Med Sci 2022; 37:e52. [PMID: 35191229 PMCID: PMC8860770 DOI: 10.3346/jkms.2022.37.e52] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/16/2022] [Indexed: 11/20/2022] Open
Abstract
Acute transverse myelitis (ATM) has been reported as rare complication of vaccination. Herein, we report 2 cases of ATM after the administration of an mRNA vaccine for coronavirus disease 2019 (COVID-19). The first one is an 81-year-old man who received the BNT162b2 vaccine. He presented with bilateral hand weakness. Spine magnetic resonance imaging (MRI) showed high signal intensity from the C1 to C3 vertebrae. The second is a 23-year-old woman who received the BNT162b2 vaccine and experienced tingling in her legs. Spine MRI showed a high signal intensity lesion at the conus medullaris. These patients were treated with intravenous methylprednisolone and their symptoms improved slightly. Careful follow-up is needed to identify adverse events after the administration of mRNA vaccines for COVID-19.
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Affiliation(s)
- Hyunjong Eom
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyoung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ye Eun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Recombinant hepatitis B vaccine uptake and multiple sclerosis risk: A marginal structural modeling approach. Mult Scler Relat Disord 2022; 58:103487. [PMID: 35007824 DOI: 10.1016/j.msard.2022.103487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/17/2021] [Accepted: 01/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND There has been an ongoing debate regarding the association between uptake of recombinant vaccine against hepatitis B virus (HBV) and multiple sclerosis (MS) risk. This case-control study tested the hypothesis whether recombinant HBV vaccination status is causally associated with MS risk using targeted maximum likelihood estimation (TMLE) technique. METHODS Confirmed 110 MS cases and age (± 5 years), sex and nativity matched (1:1) 110 controls were enrolled. Data were collected on sociodemographics, environmental factors, history of vaccinations and past morbidities through face-to-face interview both from cases and controls. To estimate the causal parameters including marginal odds ratio (OR), causal relative risk (RR), causal risk difference (RD) and their 95% confidence intervals (CIs), we implemented case-control-weighted TMLE for a matched design that uses data-adaptive flexible stacked ensemble-based machine learning system namely Super Learner. Additionally, population preventable fraction (PPF) of MS risk was computed. RESULTS This study demonstrated a significant nonspecific protective effect of HBV vaccination against MS risk (marginal OR 0.44; 95% CI: 0.19-0.68; p = 0.006; causal RR 0.64, 95% CI: 0.46-0.89; p = 0.004). The significant causal RD showed that among the vaccinated 19% fewer MS cases occurred owing to their HBV vaccination (causal RD -0.19; 95% CI: -0.32 - -0.06; p = 0.014). In the source population, vaccination against HBV led to 17.4% reduced MS risk (PPF = 17.4%; 95% CI: 3.8%, 36.3%). CONCLUSION The results suggest a significant nonspecific protective effect of recombinant HBV vaccine against MS risk. Future studies may contemplate to confirm these results.
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Cauchi M, Ball H, Ben-Shlomo Y, Robertson N. Interpretation of vaccine associated neurological adverse events: a methodological and historical review. J Neurol 2022; 269:493-503. [PMID: 34398270 PMCID: PMC8366487 DOI: 10.1007/s00415-021-10747-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022]
Abstract
As a result of significant recent scientific investment, the range of vaccines available for COVID-19 prevention continues to expand and uptake is increasing globally. Although initial trial safety data have been generally reassuring, a number of adverse events, including vaccine induced thrombosis and thrombocytopenia (VITT), have come to light which have the potential to undermine the success of the vaccination program. However, it can be difficult to interpret available data and put these into context and to communicate this effectively. In this review, we discuss contemporary methodologies employed to investigate possible associations between vaccination and adverse neurological outcomes and why determining causality can be challenging. We demonstrate these issues by discussing relevant historical exemplars and explore the relevance for the current pandemic and vaccination program. We also discuss challenges in understanding and communicating such risks to clinicians and the general population within the context of the 'infodemic' facilitated by the Internet and other media.
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Affiliation(s)
- Marija Cauchi
- Division of Psychological Medicine and Clinical Neuroscience, Department of Neurology, University Hospital of Wales, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.
| | - Harriet Ball
- Population Health Sciences, Bristol Medical School, Bristol, BS8 2PS UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, BS8 2PS UK
| | - Neil Robertson
- Division of Psychological Medicine and Clinical Neuroscience, Department of Neurology, University Hospital of Wales, Cardiff University, Heath Park, Cardiff, CF14 4XN UK
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25
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COVID-19 mRNA vaccination leading to CNS inflammation: a case series. J Neurol 2021; 269:1093-1106. [PMID: 34480607 PMCID: PMC8417681 DOI: 10.1007/s00415-021-10780-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 01/08/2023]
Abstract
The availability of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provides hope towards mitigation of the coronavirus disease 2019 (COVID-19) pandemic. Vaccine safety and efficacy has not been established in individuals with chronic autoimmune diseases such as multiple sclerosis (MS). Anecdotal reports suggest that the vaccines may be associated with brain, spinal cord, peripheral nervous system, and cardiac inflammation. Based on the high morbidity and unpredictable course of COVID-19, and the need to achieve herd immunity, vaccination has been recommended for patients with MS. We report clinical and MRI features of seven individuals who received the Moderna (n = 3) or Pfizer (n = 4) SARS-CoV-2 mRNA vaccines. Within one to 21 days of either the first (n = 2) or second (n = 5) vaccine dose, these patients developed neurologic symptoms and MRI findings consistent with active CNS demyelination of the optic nerve, brain, and/or spinal cord. Symptoms included visual loss, dysmetria, gait instability, paresthesias, sphincter disturbance, and limb weakness. Age ranged from 24 to 64 (mean 39.1) years; five were woman (71.4%). The final diagnosis was exacerbation of known stable MS (n = 4, two were receiving disease-modifying therapy at the time of vaccination), new onset MS (n = 2), or new onset neuromyelitis optica (n = 1). All responded to corticosteroid (n = 7) or plasma exchange (n = 1) therapy, with five returning to baseline and two approaching baseline. Large prospective studies are required to further investigate any possible relationship between COVID-19 vaccines and acute CNS demyelination.
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26
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Leber HM, Sant'Ana L, Konichi da Silva NR, Raio MC, Mazzeo TJMM, Endo CM, Nascimento H, de Souza CE. Acute Thyroiditis and Bilateral Optic Neuritis following SARS-CoV-2 Vaccination with CoronaVac: A Case Report. Ocul Immunol Inflamm 2021; 29:1200-1206. [PMID: 34402726 DOI: 10.1080/09273948.2021.1961815] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: To describe a case of acute thyroiditis and bilateral optic neuritis associated with SARS-CoV-2 vaccination. Methods: A single case report from a tertiary referral center. Results: The patient described in the following case report developed acute thyroiditis and bilateral optic neuritis following SARS-CoV-2 vaccination. The patient underwent pulse therapy followed by oral tapering corticosteroid therapy with an improvement of the bilateral disc swelling and the visual field, and recovery of thyroid-stimulating hormone to the normal limits. Conclusions: Although the association between immunization and the onset of demyelinating manifestations of the central nervous system is well documented, this is the first reported case of bilateral optic neuritis and acute thyroiditis and subsequent to administration of vaccination against SARS-CoV-2.
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Affiliation(s)
- Henrique M Leber
- Department of Ophthalmology, Suel Abujamra Institute, São Paulo, Brazil
| | - Leticia Sant'Ana
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, Oswaldo Cruz Hospital, São Paulo, Brazil
| | | | | | | | | | - Heloisa Nascimento
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos E de Souza
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
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27
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Olivieri B, Betterle C, Zanoni G. Vaccinations and Autoimmune Diseases. Vaccines (Basel) 2021; 9:vaccines9080815. [PMID: 34451940 PMCID: PMC8402446 DOI: 10.3390/vaccines9080815] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022] Open
Abstract
Vaccines represent one of the most effective measures of public health medicine, saving countless lives and preventing lifelong disabilities. Vaccines are extremely safe, however, no vaccine is completely free from risks and adverse events can occur following vaccination. An adverse event following immunization (AEFI) may be a true adverse reaction caused by the vaccine or an event that temporally occurred after immunization but is not caused by it. Among the adverse reactions to vaccines, one of the most feared is the triggering of autoimmune diseases, which are a heterogeneous group of disorders characterized by dysregulation of the immune system. Currently, no mechanisms have been demonstrated that could explain the correlation between vaccination and the development of autoimmune diseases. Furthermore, epidemiological studies do not support the hypothesis that vaccines cause systemic autoimmune diseases. The only confirmed associations, although very rare, are those between the flu vaccine and Guillain-Barré syndrome, especially with old vaccine preparations, and measles-mumps-rubella (MMR) vaccine and thrombocytopenia. Due to the SARS-CoV2 pandemic, new types of vaccines have been developed and are now available. Close vaccine safety-surveillance is currently underway for these new vaccines.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, 37134 Verona, Italy;
| | - Corrado Betterle
- Department of Medicine (DIMED), Clinical Immunology and Allergy, University of Padua, 35128 Padua, Italy;
| | - Giovanna Zanoni
- Immunology Unit, University Hospital, 37134 Verona, Italy
- Correspondence:
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28
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Lu L, Xiong W, Mu J, Zhang Q, Zhang H, Zou L, Li W, He L, Sander JW, Zhou D. The potential neurological effect of the COVID-19 vaccines: A review. Acta Neurol Scand 2021; 144:3-12. [PMID: 33779985 PMCID: PMC8250748 DOI: 10.1111/ane.13417] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
The coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has become a pandemic with people infected in almost all countries. The most efficient solution to end this pandemic is a safe and efficient vaccine. Classic platforms are used to develop vaccines including live‐attenuated vaccine, inactivated vaccine, protein subunit vaccine, and viral vector. Nucleic acid vaccine uses next‐generation platforms for their development. Vaccines are now rushing to the market. Eleven candidates are in advance development. These comprise inactivated vaccines, viral vector vaccine, nucleic acid vaccine, and the protein subunit vaccine platform, which are now quite advanced in trials in various geographic and ethnic populations. The reported severe adverse effects raised the worries about their safety. It becomes critical to know whether these vaccines will cause neurologic disorders like previously recognized vaccine‐related demyelinating diseases, fever‐induced seizure, and other possible deficits. We reviewed the most promising COVID‐2 vaccines with a particular interest in mechanism(s) and adverse effect(s). We exemplify potential neurological problems these vaccines could cause by looking at previous studies. The current evidence indicated a minor risk of the acute neurological disorders after the application. The observation of the long‐time effect is still needed.
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Affiliation(s)
- Lu Lu
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
| | - Weixi Xiong
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
| | - Jie Mu
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
| | - Qi Zhang
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
| | - Hesheng Zhang
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
| | - Ling Zou
- Department of Radiology West China Hospital of Sichuan UniversityThe International OfficeWest China Hospital of Sichuan University Chengdu China
| | - Weimin Li
- Department of Pulmonary & Critical Care Medicine West China Hospital of Sichuan University Chengdu China
| | - Li He
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
| | - Josemir W. Sander
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of Neurology London United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede Netherlands
| | - Dong Zhou
- Department of Neurology West China Hospital of Sichuan University Chengdu China
- DInstitute of Brain science and Brain‐inspired technology of West China Hospital Sichuan University Chengdu China
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29
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Solmaz I, Anlar B. Immunization in multiple sclerosis and other childhood immune-mediated disorders of the central nervous system: A review of the literature. Eur J Paediatr Neurol 2021; 33:125-134. [PMID: 34214824 DOI: 10.1016/j.ejpn.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
Childhood is a period where most vaccines are administered in order to build-up immunological memory, and immunization against vaccine-preventable diseases is an essential part of child care and health. The administration of vaccines to children with inflammatory diseases is a frequent point of concern for parents and physicians. Published information on the relation between vaccines and autoinflammatory diseases of the central nervous system (CNS) consists of case and cohort studies and reviews, in great majority on adult patients. Vaccines do not have any established causative or triggering effects on these diseases. Another issue is the immunization schedule of patients with autoinflammatory CNS diseases, specifically the interactions between the disorder, the clinical status, the treatment and the vaccine. In this review, we summarize the existing information between autoinflammatory disorders of the CNS and vaccines in childhood and underline the points to be considered under various treatment regimens.
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Affiliation(s)
- Ismail Solmaz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, 06230, Ankara, Turkey.
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, 06230, Ankara, Turkey
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30
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Cheng JY, Margo CE. Ocular adverse events following vaccination: overview and update. Surv Ophthalmol 2021; 67:293-306. [PMID: 33865883 DOI: 10.1016/j.survophthal.2021.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 01/30/2023]
Abstract
The Food and Drug Administration has licensed, approved, and expanded guidelines for dozens of vaccines since 2010. Although advancements in biotechnology have made vaccines more effective and safer, none are completely free from adverse effects. Many vaccines have been implicated in causing ocular adverse events based on the temporal association of exposure and putative complication. Determination of causality is difficult. We provide an overview of vaccine side effects and also examine the English literature and the Vaccine Adverse Events Reporting System (VAERS) from 2010 through 2020 for vaccine-implicated ocular adverse events. While reactions of eyelids and conjunctiva are commonly reported, the most frequently implicated serious adverse events are optic neuritis and various patterns of intraocular inflammation. Live attenuated vaccines have the potential to cause ocular infection from vaccine-strain organisms, particularly in those immunosuppressed. While postmarketing registries for suspect vaccination adverse events, such as VAERS, are unable to determine causal associations, they are a mainstay in signaling suspected trends that require investigation. The majority of probable and possible serious ocular adverse effects are distinctly uncommon.
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Affiliation(s)
- John Yu Cheng
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Curtis E Margo
- Departments of Ophthalmology, Pathology and Molecular Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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31
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Current Immunological and Clinical Perspective on Vaccinations in Multiple Sclerosis Patients: Are They Safe after All? Int J Mol Sci 2021; 22:ijms22083859. [PMID: 33917860 PMCID: PMC8068297 DOI: 10.3390/ijms22083859] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
Vaccines work by stimulating the immune system, and their immunogenicity is key in achieving protection against specific pathogens. Questions have been raised whether in Multiple Sclerosis (MS) patients they could induce disease exacerbation and whether vaccines could possibly act as a trigger in the onset of MS in susceptible populations. So far, no correlation has been found between the vaccinations against influenza, hepatitis B, tetanus, human papillomavirus, measles, mumps, rubella, varicella zoster, tuberculosis, yellow fever, or typhoid fever and the risk of MS. Further research is needed for the potential protective implications of the tetanus and Bacillus Calmette-Guerin vaccines in MS patients. Nowadays with the emerging coronavirus disease 2019 (COVID-19) and recent vaccinations approval and arrival, the risk-benefit in MS patients with regards to safety and efficacy of COVID-19 vaccination in those treated with immunosuppressive therapies is of paramount importance. In this manuscript, we demonstrate how different vaccine types could be related to the immunopathogenesis of MS and discuss the risks and benefits of different vaccinations in MS patients.
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32
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Huppertz HI. [Recommendations on the approach when unusual neurological symptoms occur in temporal association with vaccinations in childhood and adolescence]. Monatsschr Kinderheilkd 2020; 169:62-68. [PMID: 32836398 PMCID: PMC7372975 DOI: 10.1007/s00112-020-00975-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vaccinations are often administered at an age when many neurological diseases of childhood and adolescence also occur. Febrile seizures may occur following vaccination in patients with an appropriate genetic predisposition. The occurrence of narcolepsy has been described more frequently after pandemic influenza A-H1N1 vaccinations. The causality has not been proven. Data regarding an association between Guillain-Barré syndrome and influenza vaccinations are inconclusive. It was conclusively shown that vaccinations do not cause neurological disorders, such as autism and do not trigger multiple sclerosis. In summary, there is currently no confirmed evidence for the occurrence of chronic neurological diseases as a consequence of generally recommended vaccinations in Germany. If unusual neurological symptoms are observed in temporal association with vaccinations, a comprehensive evaluation is necessary to exclude a causal relationship and to diagnose the underlying neurological disease independent of the vaccination. This statement gives specific recommendations for the practical approach when neurological symptoms are observed in temporal association with vaccinations with respect to taking the patient history, initial diagnostic procedures, accurate and prompt documentation and the obligation to report the event. The committee also proposes procedures for further clarification and differential diagnostics of causal neurological diseases in childhood and adolescence.
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Affiliation(s)
- Hans-Iko Huppertz
- Deutsche Akademie für Kinder- und Jugendmedizin e. V., Chausseestr. 128/129, 10115 Berlin, Deutschland
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33
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Reyes S, Ramsay M, Ladhani S, Amirthalingam G, Singh N, Cores C, Mathews J, Lambourne J, Marta M, Turner B, Gnanapavan S, Dobson R, Schmierer K, Giovannoni G. Protecting people with multiple sclerosis through vaccination. Pract Neurol 2020; 20:435-445. [DOI: 10.1136/practneurol-2020-002527] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
Vaccination is one of the most effective and cost-efficient methods for protecting people with multiple sclerosis (MS) from infections. However, use of vaccines has often been problematic because of misguided concerns that they may exacerbate the disease and/or that some disease-modifying therapies may influence the immune response to immunisations and/or their safety. People with MS risk higher morbidity and mortality from vaccine-preventable infections. It is, therefore, important to address any patient’s reluctance to accept vaccination and to provide clear guidance for clinicians on which vaccinations to consider proactively. We have reviewed the current literature and provide recommendations regarding vaccines in adults with MS, including specific advice regarding vaccination safety in patients receiving—or going to receive—disease-modifying therapies, vaccination during pregnancy, pretravel counselling and patient education.
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34
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DeStefano F, Bodenstab HM, Offit PA. Principal Controversies in Vaccine Safety in the United States. Clin Infect Dis 2020; 69:726-731. [PMID: 30753348 DOI: 10.1093/cid/ciz135] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 12/27/2022] Open
Abstract
Concerns about vaccine safety can lead to decreased acceptance of vaccines and resurgence of vaccine-preventable diseases. We summarize the key evidence on some of the main current vaccine safety controversies in the United States, including (1) measles, mumps, and rubella vaccine and autism; (2) thimerosal, a mercury-based vaccine preservative and the risk of neurodevelopmental disorders; (3) vaccine-induced Guillain-Barré syndrome (GBS); (4) vaccine-induced autoimmune diseases; (5) safety of human papillomavirus vaccine; (6) aluminum adjuvant-induced autoimmune diseases and other disorders; and (7) too many vaccines given early in life predisposing children to health and developmental problems. A possible small increased risk of GBS following influenza vaccination has been identified, but the magnitude of the increase is less than the risk of GBS following influenza infection. Otherwise, the biological and epidemiologic evidence does not support any of the reviewed vaccine safety concerns.
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Affiliation(s)
- Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Greorgia
| | | | - Paul A Offit
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania
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35
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Hughes AM, Ponsonby AL, Dear K, Dwyer T, Taylor BV, van der Mei I, Valery PC, Lucas RM. Childhood infections, vaccinations, and tonsillectomy and risk of first clinical diagnosis of CNS demyelination in the Ausimmune Study. Mult Scler Relat Disord 2020; 42:102062. [PMID: 32305688 DOI: 10.1016/j.msard.2020.102062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between childhood vaccinations and infections and risk of multiple sclerosis is unclear; few studies have considered age at vaccination/infection. OBJECTIVE To explore age-related associations between childhood vaccinations, infection and tonsillectomy and risk of a first clinical diagnosis of CNS demyelination. METHODS Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported age at time of childhood vaccinations, infections, and tonsillectomy. Conditional logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS Poliomyelitis vaccination prior to school-age was associated with increased risk of a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02-6.68), based on a very small unvaccinated reference group. Late (11-15 years) rubella vaccination (compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI 0.27-0.83). Past infectious mononucleosis at 11-15 years (AOR = 2.84, 95%CI 1.0-7.57) and 16-20 years (AOR = 1.92, 95%CI 1.12-3.27) or tonsillectomy in adolescence (11-15 years: AOR = 2.45, 95%CI 1.12-5.35), including after adjustment for IM, were associated with increased risk of a first clinical diagnosis of CNS demyelination. CONCLUSIONS Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS demyelination. Failing to account for age effects may explain inconsistencies in past findings.
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Affiliation(s)
- A M Hughes
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; The Canberra Hospital, Canberra, Australia
| | - A-L Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - K Dear
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
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36
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Kumar N, Graven K, Joseph NI, Johnson J, Fulton S, Hostoffer R, Abboud H. Case Report: Postvaccination Anti-Myelin Oligodendrocyte Glycoprotein Neuromyelitis Optica Spectrum Disorder: A Case Report and Literature Review of Postvaccination Demyelination. Int J MS Care 2020; 22:85-90. [PMID: 32410903 DOI: 10.7224/1537-2073.2018-104] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stimulation of the immune response after vaccination can occasionally result in adverse effects, including demyelination of the central nervous system. The most common presentation of postvaccination demyelination is acute disseminated encephalomyelitis, but cases of optic neuritis, transverse myelitis, and multiple sclerosis relapses have been reported. More recently, an increasing number of postvaccination neuromyelitis optica spectrum disorder (NMOSD) cases have surfaced in the literature, especially in patients with aquaporin-4 antibodies. In this article, we report an unusual case of myelin oligodendrocyte glycoprotein antibody-related NMOSD after the receipt of multiple vaccines in a first-trimester pregnant woman from Africa. We review the reported cases of postvaccination demyelination in the past decade, with a focus on the relationship between NMOSD and vaccination in patients with aquaporin-4 or myelin oligodendrocyte glycoprotein antibodies. Finally, we discuss the clinical relevance of the present case and similar reported cases as it relates to patient care in the neuroimmunology clinic and identify potential areas for future research.
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37
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Jakimovski D, Weinstock-Guttman B, Ramanathan M, Dwyer MG, Zivadinov R. Infections, Vaccines and Autoimmunity: A Multiple Sclerosis Perspective. Vaccines (Basel) 2020; 8:vaccines8010050. [PMID: 32012815 PMCID: PMC7157658 DOI: 10.3390/vaccines8010050] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease that is associated with multiple environmental factors. Among suspected susceptibility events, studies have questioned the potential role of overt viral and bacterial infections, including the Epstein Bar virus (EBV) and human endogenous retroviruses (HERV). Furthermore, the fast development of immunomodulatory therapies further questions the efficacy of the standard immunization policies in MS patients. Topics reviewed: This narrative review will discuss the potential interplay between viral and bacterial infections and their treatment on MS susceptibility and disease progression. In addition, the review specifically discusses the interactions between MS pathophysiology and vaccination for hepatitis B, influenza, human papillomavirus, diphtheria, pertussis, and tetanus (DTP), and Bacillus Calmette-Guerin (BCG). Data regarding potential interaction between MS disease modifying treatment (DMT) and vaccine effectiveness is also reviewed. Moreover, HERV-targeted therapies such as GNbAC1 (temelimab), EBV-based vaccines for treatment of MS, and the current state regarding the development of T-cell and DNA vaccination are discussed. Lastly, a reviewing commentary on the recent 2019 American Academy of Neurology (AAN) practice recommendations regarding immunization and vaccine-preventable infections in the settings of MS is provided. Conclusion: There is currently no sufficient evidence to support associations between standard vaccination policies and increased risk of MS. MS patients treated with immunomodulatory therapies may have a lower benefit from viral and bacterial vaccination. Despite their historical underperformance, new efforts in creating MS-based vaccines are currently ongoing. MS vaccination programs follow the set back and slow recovery which is widely seen in other fields of medicine.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
- Correspondence:
| | - Bianca Weinstock-Guttman
- Jacobs MS Center, Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Murali Ramanathan
- School of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
| | - Michael G. Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
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Sarfaty AE, Fulbright RK, Compton SR, Asher JL, Zeiss CJ. Transverse myelitis following measles vaccination in a rhesus macaque (Macaca mulatta). J Med Primatol 2019; 49:103-106. [PMID: 31789460 DOI: 10.1111/jmp.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/23/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022]
Abstract
A 16-year-old rhesus macaque presented with progressive, ascending quadriparesis following measles vaccination. He was diagnosed with transverse myelitis following MRI, gross necropsy, and histopathology. This is the first report of transverse myelitis in a rhesus macaque following measles vaccination.
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Affiliation(s)
- Anna E Sarfaty
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
| | - Robert K Fulbright
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Susan R Compton
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
| | - Jennifer L Asher
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
| | - Caroline J Zeiss
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT
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Cole J, Evans E, Mwangi M, Mar S. Acute Disseminated Encephalomyelitis in Children: An Updated Review Based on Current Diagnostic Criteria. Pediatr Neurol 2019; 100:26-34. [PMID: 31371120 DOI: 10.1016/j.pediatrneurol.2019.06.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022]
Abstract
Acute disseminated encephalomyelitis is an inflammatory disorder of the central nervous system. Uniform diagnostic criteria for acute disseminated encephalomyelitis did not exist until publication of expert-defined consensus definitions by the International Pediatric Multiple Sclerosis Society Group in 2007, with updates in 2013. In the expanding field of pediatric neuroimmunology, consistent diagnostic criteria are essential to correctly categorize patients as increasing information regarding prognosis and management becomes available. Scientific literature is relatively lacking in review articles on International Pediatric Multiple Sclerosis Society Group-defined acute disseminated encephalomyelitis. This review focuses primarily on references applying the International Pediatric Multiple Sclerosis Society Group criteria for acute disseminated encephalomyelitis presenting specific, up-to-date, and translatable information regarding the epidemiology, pathophysiology, clinical features, diagnosis, management, and prognosis of acute disseminated encephalomyelitis in the pediatric population.
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Affiliation(s)
- Jordan Cole
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri.
| | - Emily Evans
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri
| | - Martin Mwangi
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri
| | - Soe Mar
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri
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40
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Moro PL, Haber P, McNeil MM. Challenges in evaluating post-licensure vaccine safety: observations from the Centers for Disease Control and Prevention. Expert Rev Vaccines 2019; 18:1091-1101. [PMID: 31580725 DOI: 10.1080/14760584.2019.1676154] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Vaccination is one of the most successful and cost-effective public health interventions. Although vaccines undergo extensive safety and efficacy evaluations prior to licensure, vaccine safety assessment post-licensure is essential for detecting rare and longer-term adverse events (AEs) and maintaining public confidence in vaccines and recommended immunization programs. Despite the proven effect of vaccines to save lives and prevent disease and overwhelming evidence of vaccines' safety and societal benefit, like any drug, no vaccine can be considered as completely safe and completely effective. New vaccines continue to be introduced and require rapid safety assessment post-licensure through pharmacovigilance reports as well as epidemiologic studies to investigate any potential safety signals.Areas covered: We discuss selected challenges for conducting pharmacovigilance and epidemiologic studies of AEs after vaccination in the United States using the post-licensure safety surveillance infrastructure of the Centers for Disease Control and Prevention (CDC).Expert opinion: The availability of specific post-licensure surveillance systems to monitor and study AEs after vaccination, such as the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink, and the Clinical Immunization Safety Assessment Project, each with its unique set of strengths and limitations, provide a harmonized and supportive approach to meet several of these barriers.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Penina Haber
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Farez MF, Correale J, Armstrong MJ, Rae-Grant A, Gloss D, Donley D, Holler-Managan Y, Kachuck NJ, Jeffery D, Beilman M, Gronseth G, Michelson D, Lee E, Cox J, Getchius T, Sejvar J, Narayanaswami P. Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis. Neurology 2019; 93:584-594. [DOI: 10.1212/wnl.0000000000008157] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/18/2019] [Indexed: 12/26/2022] Open
Abstract
ObjectiveTo update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS).MethodsThe panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended.Major recommendations (Level B except where indicated)Clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions. Clinicians should recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications and weigh local vaccine-preventable disease risks when counseling patients. Clinicians should recommend that patients with MS receive the influenza vaccination annually. Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4–6 weeks before initiating patients' ISIM therapy. Clinicians must screen for infections according to PI before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in PI (Level A) and should consult specialists regarding treating patients who screen positive for latent infection. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies. Clinicians should delay vaccinating people with MS who are experiencing a relapse.
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Zrzavy T, Kollaritsch H, Rommer PS, Boxberger N, Loebermann M, Wimmer I, Winkelmann A, Zettl UK. Vaccination in Multiple Sclerosis: Friend or Foe? Front Immunol 2019; 10:1883. [PMID: 31440255 PMCID: PMC6693409 DOI: 10.3389/fimmu.2019.01883] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous systems (CNS). Disease-modifying treatments (including immunosuppressive treatments) have shown positive effects on the disease course, but are associated with systemic consequences on the immune system and may increase the risk of infections and alter vaccine efficiency. Therefore, vaccination of MS patients is of major interest. Over the last years, vaccine hesitancy has steadily grown especially in Western countries, partly due to fear of sequelae arising from vaccination, especially neurological disorders. The interaction of vaccination and MS has been discussed for decades. In this review, we highlight the immunology of vaccination, provide a review of literature and discuss the clinical consideration of MS, vaccination and immunosuppression. In conclusion, there is consensus that MS cannot be caused by vaccines, neither by inactivated nor by live vaccines. However, particular attention should be paid to two aspects: First, in immunocompromised patients, live vaccines may lead to a stronger immune reaction with signs of the disease against which the patients have been vaccinated, albeit in weakened form. Second, protection provided by vaccination should be controlled in patients who have been vaccinated while receiving immunomodulatory or immunosuppressive treatment. In conclusion, there is evidence that systemic infections can worsen MS, thus vaccination will lower the risk of relapses by reducing the risk of infections. Therefore, vaccination should be in general recommended to MS patients.
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Affiliation(s)
- Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Herwig Kollaritsch
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Paulus S. Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Nina Boxberger
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Micha Loebermann
- Department of Tropical Medicine and Infectious Diseases, University of Rostock, Rostock, Germany
| | - Isabella Wimmer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Uwe K. Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
- Department of Neurology, University of Rostock, Rostock, Germany
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Hapfelmeier A, Gasperi C, Donnachie E, Hemmer B. A large case-control study on vaccination as risk factor for multiple sclerosis. Neurology 2019; 93:e908-e916. [DOI: 10.1212/wnl.0000000000008012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/29/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate the hypothesis that vaccination is a risk factor for multiple sclerosis (MS) by use of German ambulatory claims data in a case-control study.MethodsUsing the ambulatory claims data of the Bavarian Association of Statutory Health Insurance Physicians covering 2005–2017, logistic regression models were used to assess the relation between MS (n = 12,262) and vaccinations in the 5 years before first diagnosis. Participants newly diagnosed with Crohn disease (n = 19,296) or psoriasis (n = 112,292) and participants with no history of these autoimmune diseases (n = 79,185) served as controls.ResultsThe odds of MS were lower in participants with a recorded vaccination (odds ratio [OR] 0.870, p < 0.001 vs participants without autoimmune disease; OR 0.919, p < 0.001 vs participants with Crohn disease; OR 0.973, p = 0.177 vs participants with psoriasis). Lower odds were most pronounced for vaccinations against influenza and tick-borne encephalitis. These effects were consistently observed for different time frames, control cohorts, and definitions of the MS cohort. Effect sizes increased toward the time of first diagnosis.ConclusionsResults of the present study do not reveal vaccination to be a risk factor for MS. On the contrary, they consistently suggest that vaccination is associated with a lower likelihood of being diagnosed with MS within the next 5 years. Whether this is a protective effect needs to be addressed by future studies.
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44
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Lebrun C, Vukusic S. Immunization and multiple sclerosis: Recommendations from the French multiple sclerosis society. Mult Scler Relat Disord 2019; 31:173-188. [DOI: 10.1016/j.msard.2019.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
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45
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Lebrun C, Vukusic S, Abadie V, Achour C, Ader F, Alchaar H, Alkhedr A, Andreux F, Androdias G, Arjmand R, Audoin B, Audry D, Aufauvre D, Autreaux C, Ayrignac X, Bailbe M, Benazet M, Bensa C, Bensmail D, Berger E, Bernady P, Bertagna Y, Biotti D, Blanchard-Dauphin A, Bonenfant J, Bonnan M, Bonnemain B, Borgel F, Botelho-Nevers E, Boucly S, Bourre B, Boutière C, Branger P, Brassat D, Bresch S, Breuil V, Brochet B, Brugeilles H, Bugnon P, Cabre P, Camdessanché JP, Carra-Dalière C, Casez O, Chamouard JM, Chassande B, Chataignier P, Chbicheb M, Chenet A, Ciron J, Clavelou P, Cohen M, Colamarino R, Collongues N, Coman I, Corail PR, Courtois S, Coustans M, Creange A, Creisson E, Daluzeau N, Davenas C, De Seze J, Debouverie M, Depaz R, Derache N, Divio L, Douay X, Dulau C, Durand-Dubief F, Edan G, Elias Z, Fagniez O, Faucher M, Faucheux JM, Fournier M, Gagneux-Brunon A, Gaida P, Galli P, Gallien P, Gaudelus J, Gault D, Gayou A, Genevray M, Gentil A, Gere J, Gignoux L, Giroux M, Givron P, Gout O, Grimaud J, Guennoc AM, Hadhoum N, Hautecoeur P, Heinzlef O, Jaeger M, Jeannin S, Kremer L, Kwiatkowski A, Labauge P, Labeyrie C, Lachaud S, Laffont I, Lanctin-Garcia C, Lannoy J, Lanotte L, Laplaud D, Latombe D, Lauxerois M, Le Page E, Lebrun-Frenay C, Lejeune P, Lejoyeux P, Lemonnier B, Leray E, Loche CM, Louapre C, Lubetzki C, Maarouf A, Mada B, Magy L, Maillart E, Manchon E, Marignier R, Marque P, Mathey G, Maurousset A, Mekies C, Merienne M, Michel L, Milor AM, Moisset X, Montcuquet A, Moreau T, Morel N, Moussa M, Naudillon JP, Normand M, Olive P, Ouallet JC, Outteryck O, Pacault C, Papeix C, Patry I, Peaureaux D, Pelletier J, Pichon B, Pittion S, Planque E, Pouget MC, Pourcher V, Radot C, Robert I, Rocher F, Ruet A, Ruet A, Saint-Val C, Salle JY, Salmon A, Sartori E, Schaeffer S, Stankhof B, Taithe F, Thouvenot E, Tizon C, Tourbah A, Tourniaire P, Vaillant M, Vermersch P, Vidil S, Wahab A, Warter MH, Wiertlewski S, Wiplosz B, Wittwer B, Zaenker C, Zephir H. Immunization and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Rev Neurol (Paris) 2019; 175:341-357. [DOI: 10.1016/j.neurol.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 03/31/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
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Hepatitis B vaccination and central demyelination - History, description and observed/expected analyses of 624 cases reported to the French pharmacovigilance over a 20-year period. Vaccine 2019; 37:2142-2148. [PMID: 30851966 DOI: 10.1016/j.vaccine.2019.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Confidence in vaccines is essential for achieving targeted immunization coverage. The current skepticism about vaccine safety feeds on controversies such as the suspicion about a link between hepatitis B (HB) vaccination and central demyelination (CD) after the massive HB immunization campaign in France in 1994-2000. This study assesses the robustness of this signal by analysing all validated cases reported in 1980-2000 and by conducting observed-to-expected (OE) comparisons. METHODS After characterizing case profiles, reporting rates per 1,000,000 vaccine doses sold were computed for the period and per year. OE comparisons were conducted by using individual-based and person-year approaches and were stratified by gender. FINDING A total of 624CD cases including 422 incident cases of multiple sclerosis (MS) were reported over 20 years. Women accounted for 73.2% (n = 457). Mean age was 29.8 years (SD = 11.1). Incidence of events peaked in 1995-1996 and 1997, these years accounting for 59.8% (n = 373) of cases. Events were mainly reported after booster doses (46.3%, n = 289). The overall reporting rate was 6.5 per 1,000,000 doses sold. The OE analyses produced inconclusive results, the number of observed cases remaining below the expected number. CONCLUSIONS The complete disjunction between target and joint populations in the 1990s French HB immunization campaign created an unpreceded situation with ∼26 million of adults exposed at the age of MS onset. Two findings are noteworthy: the non-random distribution of reports according to the rank of vaccination or years of survey, and the fact that the number of reports sometimes approached the baseline incidence of MS, irrespective of underreporting. While the nature of the link remains unclear, our results are not consistent with a strong association between HB vaccine and MS. Current recommendations targeting newborns with a possible catch-up of at-risk adults should remain the preferred strategy in low-endemic countries.
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Mouchet J, Bégaud B. Central Demyelinating Diseases after Vaccination Against Hepatitis B Virus: A Disproportionality Analysis within the VAERS Database. Drug Saf 2018; 41:767-774. [PMID: 29560597 DOI: 10.1007/s40264-018-0652-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hepatitis B (HB) vaccination programs were set up worldwide in the early 1990s. Despite their major focus on reducing the burden of HB infection, they have seldom achieved the targeted population coverage in most countries, including the USA, with around 24.5% of adults being vaccinated against HB. Among proposed reasons for this is the persisting doubt about a possible link between HB vaccination and the occurrence of cases of multiple sclerosis (MS). OBJECTIVE Our objective was to evaluate a potential safety signal between MS and HB vaccination. We conducted a disproportionality analysis (DPA) using the cases reported to the Vaccine Adverse Event Reporting System (VAERS). METHODS We calculated the proportional reporting rate (PRR) and reporting odds ratio (ROR) of MS having occurred within the 120 days following HB immunization in adults aged 19-49 years when compared with other vaccines using the reports recorded in the VAERS database. Both ratios were estimated globally and then according to the origin of reports (USA vs. non-USA). We then performed a sensitivity analysis using a broader category of demyelinating events. FINDINGS MS cases following HB vaccination were more likely to originate from outside the USA and to be reported before 2000 than those associated with other immunizations. All computed ratios were found to be statistically significant, with PRRs ranging from 3.48 to 5.56 and RORs ranging from 3.48 to 5.62. When considering the geographical origin, similar RORs were obtained for both US and non-US cases. CONCLUSION In VAERS, MS cases were up to five times more likely to be reported after an HB vaccination than after any other vaccination. Since DPA is mainly suited for hypothesis generation, further studies evaluating the nature of the link between MS and HB vaccination would be of considerable importance.
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Affiliation(s)
- Julie Mouchet
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, 33000, Bordeaux, France.
| | - Bernard Bégaud
- Inserm, Bordeaux Population Health Research Centre, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, 33000, Bordeaux, France
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48
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Post Vaccinal Temporary Sensorineural Hearing Loss. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081780. [PMID: 30126227 PMCID: PMC6121486 DOI: 10.3390/ijerph15081780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/02/2018] [Accepted: 08/17/2018] [Indexed: 11/17/2022]
Abstract
In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event.
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Elwood JM, Ameratunga R. Autoimmune diseases after hepatitis B immunization in adults: Literature review and meta-analysis, with reference to 'autoimmune/autoinflammatory syndrome induced by adjuvants' (ASIA). Vaccine 2018; 36:5796-5802. [PMID: 30100071 DOI: 10.1016/j.vaccine.2018.07.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To assess if hepatitis B vaccination in adults is causally associated with autoimmune diseases. Such causation has been claimed based mainly on case reports and uncontrolled studies, and a syndrome 'Autoimmune/autoinflammatory Disorder Induced by Adjuvants' (ASIA) has been claimed to be linked to immunization, particularly hepatitis B vaccination. METHODS Review of peer-reviewed literature from January 1990 to March 2017 identifying controlled studies with documented incidence of autoimmune diseases occurring after hepatitis B vaccinations in adults. From 1297 studies identified, 259 were further assessed and 49 reviewed further; 19 relevant papers reporting 21 results are reviewed here, and 14 results included in a meta-analysis. RESULTS Overall no association between hepatitis B vaccination and the onset of autoimmune diseases was seen. The overall odds ratio was 1.06, with 95% confidence limits of 0.93-1.21, with non-significant heterogeneity. Only one study showed a significant excess risk between hepatitis B immunisation and autoimmune disease. CONCLUSIONS Despite multiple case reports, there is no reliable scientific evidence of autoimmune diseases being caused by hepatitis B vaccinations.
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Affiliation(s)
- J Mark Elwood
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Rohan Ameratunga
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland 1010, New Zealand
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50
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Segal Y, Shoenfeld Y. Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction. Cell Mol Immunol 2018; 15:586-594. [PMID: 29503439 PMCID: PMC6078966 DOI: 10.1038/cmi.2017.151] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/11/2017] [Accepted: 11/11/2017] [Indexed: 12/20/2022] Open
Abstract
Since the early 1800s vaccines have saved numerous lives by preventing lethal infections. However, during the past two decades, there has been growing awareness of possible adverse events associated with vaccinations, cultivating heated debates and leading to significant fluctuations in vaccination rates. It is therefore pertinent for the scientific community to seriously address public concern of adverse effects of vaccines to regain public trust in these important medical interventions. Such adverse reactions to vaccines may be viewed as a result of the interaction between susceptibility of the vaccinated subject and various vaccine components. Among the implicated mechanisms for these reactions is molecular mimicry. Molecular mimicry refers to a significant similarity between certain pathogenic elements contained in the vaccine and specific human proteins. This similarity may lead to immune crossreactivity, wherein the reaction of the immune system towards the pathogenic antigens may harm the similar human proteins, essentially causing autoimmune disease. In this review, we address the concept of molecular mimicry and its application in explaining post vaccination autoimmune phenomena. We further review the principal examples of the influenza, hepatitis B, and human papilloma virus vaccines, all suspected to induce autoimmunity via molecular mimicry. Finally, we refer to possible implications on the potential future development of better, safer vaccines.
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Affiliation(s)
- Yahel Segal
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, 52621, Israel
| | - Yehuda Shoenfeld
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, 52621, Israel.
- Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.
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