Maureen A Mealy1, Lawrence J Cook2, Florence Pache3, Diego L Velez4, Nadja Borisow3, Daniel Becker5, Jorge A Jimenez Arango4, Friedemann Paul3, Michael Levy6. 1. Department of Neurology, Johns Hopkins University School of Medicine, 600N. Wolfe St. Pathology 627 Baltimore, MD 21287, USA. Electronic address: mmealy1@jhmi.edu. 2. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. 3. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center and Department of Neurology, Berlin, Germany, and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany. 4. Department of Neurology, Neuroclinica, Medellín, CO, USA. 5. Department of Neurology, Johns Hopkins University School of Medicine, 600N. Wolfe St. Pathology 627 Baltimore, MD 21287, USA; International Neurorehabilitation Institute, Lutherville, MD, USA. 6. Department of Neurology, Johns Hopkins University School of Medicine, 600N. Wolfe St. Pathology 627 Baltimore, MD 21287, USA.
Abstract
BACKGROUND: It is unknown if vaccines cause non-specific immune activation in patients with neuromyelitis optica spectrum disorder and no consensus on the use of vaccines exists for this population. We investigated the temporal association of vaccinations with relapses in patients with neuromyelitis optica spectrum disorder. METHODS: This is a multi-center retrospective analysis of patients with neuromyelitis optica spectrum disorder for whom immunization history and clinical records from disease onset were available. Ninety patients who met 2015 diagnostic criteria received a total of 211 vaccinations and experienced 340 relapses over a median disease course of 6.6 years. The likelihood of a relapse occurring within 30, 60, and 90 days of a vaccine was compared to the likelihood of a relapse occurring within each time point of a randomly generated date. We also compared the relapse rate between patients who received any vaccination(s) after disease onset to those who did not. RESULTS: We identified seven patients with neuromyelitis optica spectrum disorder who relapsed within 30 days of a vaccination, six between 31 and 60 days, and four who relapsed between 61 and 90 days. The rate of vaccine-associated relapses within 30, 60, and 90 days was significantly higher than the likelihood of a relapse spontaneously occurring within each of the given time frames (p = 0.034, 0.01, 0.016, respectively) among patients who were not on preventive immunotherapy only. Among those who were on immunotherapy to prevent relapses, there was no significant association of relapse with vaccines. Additionally, among patients on immunotherapy, the annualized relapse rate of those who received routine vaccinations was significantly lower than in unvaccinated patients. CONCLUSION: The evidence suggests that there may be a risk of vaccination-associated relapses among untreated neuromyelitis optica spectrum disorder patients, however immunosuppressive therapy at time of vaccine may abort the risk; this suggests that the patients who are treated with preventive immune suppression and receive routine vaccinations for common infections may fare better. Further prospective studies are necessary to verify these findings.
BACKGROUND: It is unknown if vaccines cause non-specific immune activation in patients with neuromyelitis optica spectrum disorder and no consensus on the use of vaccines exists for this population. We investigated the temporal association of vaccinations with relapses in patients with neuromyelitis optica spectrum disorder. METHODS: This is a multi-center retrospective analysis of patients with neuromyelitis optica spectrum disorder for whom immunization history and clinical records from disease onset were available. Ninety patients who met 2015 diagnostic criteria received a total of 211 vaccinations and experienced 340 relapses over a median disease course of 6.6 years. The likelihood of a relapse occurring within 30, 60, and 90 days of a vaccine was compared to the likelihood of a relapse occurring within each time point of a randomly generated date. We also compared the relapse rate between patients who received any vaccination(s) after disease onset to those who did not. RESULTS: We identified seven patients with neuromyelitis optica spectrum disorder who relapsed within 30 days of a vaccination, six between 31 and 60 days, and four who relapsed between 61 and 90 days. The rate of vaccine-associated relapses within 30, 60, and 90 days was significantly higher than the likelihood of a relapse spontaneously occurring within each of the given time frames (p = 0.034, 0.01, 0.016, respectively) among patients who were not on preventive immunotherapy only. Among those who were on immunotherapy to prevent relapses, there was no significant association of relapse with vaccines. Additionally, among patients on immunotherapy, the annualized relapse rate of those who received routine vaccinations was significantly lower than in unvaccinated patients. CONCLUSION: The evidence suggests that there may be a risk of vaccination-associated relapses among untreated neuromyelitis optica spectrum disorderpatients, however immunosuppressive therapy at time of vaccine may abort the risk; this suggests that the patients who are treated with preventive immune suppression and receive routine vaccinations for common infections may fare better. Further prospective studies are necessary to verify these findings.
Authors: Neha Kumar; Kelsey Graven; Nancy I Joseph; John Johnson; Scott Fulton; Robert Hostoffer; Hesham Abboud Journal: Int J MS Care Date: 2020 Mar-Apr
Authors: Ahmad A Ballout; Anna Babaie; Michael Kolesnik; Jian Yi Li; Natasha Hameed; Glenn Waldman; Frasat Chaudhry; Sami Saba; Asaff Harel; Souhel Najjar Journal: Front Neurol Date: 2022-02-24 Impact factor: 4.003