Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder

Maureen A. Mealy, Lawrence J. Cook, Florence Pache, Diego L. Velez, Nadja Borisow, Daniel Becker, Jorge A.Jimenez Arango, Friedemann Paul, Michael Levy

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)78-82
Number of pages5
JournalMultiple Sclerosis and Related Disorders
Volume23
DOIs
StatePublished - Jul 1 2018

Fingerprint

Neuromyelitis Optica
Vaccines
Recurrence
Vaccination
Immunotherapy
Immunosuppressive Agents
Immunization

Keywords

  • Aquaporin 4
  • Immunotherapy
  • Neuromyelitis optica
  • Risk factors
  • Vaccines

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder. / Mealy, Maureen A.; Cook, Lawrence J.; Pache, Florence; Velez, Diego L.; Borisow, Nadja; Becker, Daniel; Arango, Jorge A.Jimenez; Paul, Friedemann; Levy, Michael.

In: Multiple Sclerosis and Related Disorders, Vol. 23, 01.07.2018, p. 78-82.

Research output: Contribution to journalArticle

Mealy, MA, Cook, LJ, Pache, F, Velez, DL, Borisow, N, Becker, D, Arango, JAJ, Paul, F & Levy, M 2018, 'Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder', Multiple Sclerosis and Related Disorders, vol. 23, pp. 78-82. https://doi.org/10.1016/j.msard.2018.05.003
Mealy, Maureen A. ; Cook, Lawrence J. ; Pache, Florence ; Velez, Diego L. ; Borisow, Nadja ; Becker, Daniel ; Arango, Jorge A.Jimenez ; Paul, Friedemann ; Levy, Michael. / Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder. In: Multiple Sclerosis and Related Disorders. 2018 ; Vol. 23. pp. 78-82.
@article{171cb4eec6044e8cbd232fbb82ee9628,
title = "Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder",
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.",
keywords = "Aquaporin 4, Immunotherapy, Neuromyelitis optica, Risk factors, Vaccines",
author = "Mealy, {Maureen A.} and Cook, {Lawrence J.} and Florence Pache and Velez, {Diego L.} and Nadja Borisow and Daniel Becker and Arango, {Jorge A.Jimenez} and Friedemann Paul and Michael Levy",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.msard.2018.05.003",
language = "English (US)",
volume = "23",
pages = "78--82",
journal = "Multiple Sclerosis and Related Disorders",
issn = "2211-0348",
publisher = "Elsevier",

}

TY - JOUR

T1 - Vaccines and the association with relapses in patients with neuromyelitis optica spectrum disorder

AU - Mealy, Maureen A.

AU - Cook, Lawrence J.

AU - Pache, Florence

AU - Velez, Diego L.

AU - Borisow, Nadja

AU - Becker, Daniel

AU - Arango, Jorge A.Jimenez

AU - Paul, Friedemann

AU - Levy, Michael

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Aquaporin 4

KW - Immunotherapy

KW - Neuromyelitis optica

KW - Risk factors

KW - Vaccines

UR - http://www.scopus.com/inward/record.url?scp=85047260342&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047260342&partnerID=8YFLogxK

U2 - 10.1016/j.msard.2018.05.003

DO - 10.1016/j.msard.2018.05.003

M3 - Article

C2 - 29783157

AN - SCOPUS:85047260342

VL - 23

SP - 78

EP - 82

JO - Multiple Sclerosis and Related Disorders

JF - Multiple Sclerosis and Related Disorders

SN - 2211-0348

ER -