Highlights
- •The absolute risk of attacks occurring 30 days after vaccination is small.
- •Attacks occurred after 13 different vaccines, suggesting a broad autoimmune mechanism.
- •These attacks had a higher frequency of male and negative anti-AQP4 cases.
- •Nearly two-thirds of these attacks were an initial event of NMOSD.
Abstract
Background
Vaccination in patients with neuromyelitis optica spectrum disorders (NMOSD) is challenging
because there is a concern that vaccines can lead to clinical attacks. However, little
is known about the risk and the characteristics of attacks occurring after vaccination.
Methods
We performed a systematic review and meta-analysis using PubMed and Embase databases
to estimate a summary frequency of attacks occurring after vaccination and describe
the clinical features of theses attacks. We defined attacks occurring after vaccination
as typical NMOSD attacks that occurred up to 30 days after vaccine administration.
For the frequency of attacks occurring after vaccination, we selected observational
studies that reported the number of attacks and total number of patients that received
vaccines; for the clinical description of the attacks, case reports and case series
were also included.
Results
We included 377 participants from 5 studies to estimate the frequency of NMOSD attacks
occurring after vaccination. We found a summary frequency of of 2% (95% CI 1–4%, I2 = 0%). We evaluated 17 studies to identify that 13 different vaccines were associated
with NMOSD attacks. A higher-than-expected proportion of males, simultaneous optic
neuritis and transverse myelitis attacks, and anti-aquaporin 4 antibody negative cases
were identified in vaccine-associated attacks from 24 participants from 17 studies.
Nearly two-thirds of attacks occurring after vaccination were an initial event of
NMOSD.
Conclusion
The frequency of NMOSD attacks occurring after vaccination is low and non-specific
to different vaccine technologies. Our work reinforces the safety of vaccine recommendations
in patients with NMOSD.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Vaccines and autoimmunity.Nat. Rev. Rheumatol. 2009; 5: 648-652
- Risk factors of attacks in neuromyelitis optica spectrum disorders.J. Neuroimmunol. 2020; 343577236
- Molecular mimicry and autoimmunity.N. Engl. J. Med. 1999; 341: 2068-2074
- Newly diagnosed neuromyelitis optica spectrum disorders following vaccination: case report and systematic review.Mult. Scler. Relat. Disord. 2022; 58103414
- Post COVID-19 vaccination neuromyelitis optica spectrum disorder: case report & MRI findings.Radiol. Case Rep. 2021; 16: 3864-3867
- Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system.Arq. Neuropsiquiatr. 2021; 79: 1049-1061
- A case with new-onset neuromyelitis optica spectrum disorder following COVID-19 mRNA BNT162b2 vaccination.Neurologist. 2022; 27: 147-150
- Recurrent optic neuritis and neuromyelitis optica-IgG following first and second human papillomavirus vaccinations.Clin. Neurol. Neurosurg. 2016; 144: 126-128
- Watch out for neuromyelitis optica spectrum disorder after inactivated virus vaccination for COVID-19.Neurol. Sci. 2021; 42: 3537-3539
- A case of neuromyelitis optica spectrum disorder following seasonal influenza vaccination.Mult. Scler. Relat. Disord. 2019; 30: 110-113
- Mortality of neuromyelitis optica spectrum disorders in a Chinese population.Ann. Clin. Transl. Neurol. 2021; 8: 1471-1479
- Neuromyelitis optica associated with yellow fever vaccination.Acta Neurol. Belg. 2021; 121: 567-569
- New relapse of multiple sclerosis and neuromyelitis optica as a potential adverse event of AstraZeneca AZD1222 vaccination for COVID-19.Mult. Scler. Relat. Disord. 2022; 57103321
- MOG antibody-associated disease after vaccination with ChAdOx1 nCoV-19.Lancet Neuro. 2022; 21: 217-218
- Acute inflammatory diseases of the central nervous system after SARS-CoV-2 vaccination.Neurology - Neuroimmunol. Neuroinflammation. 2023; 10e200063
- Neuromyelitis optica after Japanese encephalitis vaccination.Eur. J. Neurol. 2011; 18: e26-e27
- Humoral response to BNT162b2-COVID-19 or CoronaVac vaccine in NMOSD and MOGAD Patients.Mult. Scler. 2021;
- Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center’s approach.Arq Neuropsiquiatr. 2022; 80: 1057-1066
- Seronegative neuromyelitis optica spectrum disorder following exposure to hepatitis B vaccination.Case Rep. Neurol. 2015; 7: 78-83
- COVID-19 and vaccination against SARS-CoV-2 in patients with neuromyelitis optica spectrum disorders.Mult. Scler. Relat. Disord. 2022; 57103320
- The spectrum of post-vaccination inflammatory CNS demyelinating syndromes.Autoimmun. Rev. 2014; 13: 215-224
- Relapse patterns in NMOSD: evidence for earlier occurrence of optic neuritis and possible seasonal variation.Front. Neurol. 2020; : 11
- COVID-19 mRNA vaccination leading to CNS inflammation: a case series.J. Neurol. 2022; 269: 1093-1106
- Reduced antibody formation after influenza vaccination in patients with neuromyelitis optica spectrum disorder treated with rituximab.Eur. J. Neurol. 2013; 20: 975-980
- Abstracts from PACTRIMS, Bali, 26-28 August 2010.Mult. Scler. 2010; 16: 1268-1298
- Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan.Brain. 2012; 135: 1834-1849
- Biphasic demyelination of the nervous system following anti-rabies vaccination.Neurol. India. 2004; 52: 106-108
- Oral presentations.Mult. Scler. 2010; 16: 7-366
- Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases.JAMA Neurol. 2014; 71: 1506-1513
- Patient-reported safety and tolerability of the COVID-19 vaccines in persons with rare neuroimmunological diseases.Mult. Scler. Relat. Disord. 2021; 55103189
- Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder.Mult. Scler. Relat. Disord. 2018; 23: 78-82
- Human papillomavirus vaccine and demyelinating diseases—A systematic review and meta-analysis.Pharmacol. Res. 2018; 132: 108-118
- Lupus and NMOSD: the blending of humoral autoimmunity.Case Rep. Rheumatol. 2020; 20208820071
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.Rev. Esp. Cardiol. 2021; 74: 790-799
- A guide to vaccinology: from basic principles to new developments.Nat. Rev. Immunol. 2021; 21: 83-100
- NMOSD triggered by yellow fever vaccination - An unusual clinical presentation with segmental painful erythema.Mult. Scler. Relat. Disord. 2017; 11: 43-44
- Spike-antibody responses to COVID-19 vaccination by demographic and clinical factors in a prospective community cohort study.Nat. Commun. 2022; 13: 5780
- Challenges and insights in immunization in patients with demyelinating diseases: a bench-to-bedside and evidence-based review.Arq. Neuropsiquiatr. 2022; 80: 173-181
- International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.Neurology. 2015; 85: 177-189
- Neuromyelitis optica spectrum disorder.N. Engl. J. Med. 2022; 387: 631-639
Article info
Publication history
Published online: May 01, 2023
Accepted:
April 30,
2023
Received in revised form:
March 25,
2023
Received:
September 28,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
