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Flu Shots and Myasthenia Gravis
Absract & Commentary
By Michael Rubin, MD, Professor of Clinical Neurology, Weill Cornell Medical College. Dr. Rubin reports no financial relationships relevant to this field of study.
Synopsis: Seasonal flu and H1N1 vaccines are safe for patients with myasthenia gravis and should be administered.
Source: Auriel E, et al. Safety of influenza and H1N1 vaccinations in patients with myasthenia gravis, and patient compliance. Muscle Nerve 2011;43:May. Accepted manuscript online: 25 FEB 2011DOI: 10.1002/mus.22077.
Is it safe to vaccinate myasthenia gravis patients against the flu, or is there a tangible risk of myasthenic worsening? During the winter of 2009-10, the Ministry of Health of the Israeli government recommended that citizens with chronic conditions be vaccinated against both H1N1 and seasonal influenza virus. A subgroup of patients with myasthenia within this population served as the nucleus for this analysis.
Among 74 patients with myasthenia gravis followed in outpatient neuroimmunology clinics at Sourasky Medical Center and Sheba Medical Center in Tel Aviv, Israel, patient questionnaires were completed during a clinic visit or telephone interview to determine whether they had received either the seasonal influenza or H1N1 vaccine, or both during the winter of 2009-10. If no vaccination was received, the patient was asked to explain why, and, if vaccination was performed, information was obtained regarding adverse effects, particularly worsening of myasthenia.
Seasonal influenza flu vaccination was given to 38 myasthenia patients (51.4%) and H1N1 vaccine to 24 (32.4%), with 20 patients (27%) receiving both. No adverse events occurred among those who underwent seasonal influenza flu vaccination, but following H1N1 vaccine, three patients experienced adverse effects, one each with facial palsy (six weeks following vaccination), acute bronchitis (a few days after vaccination), and fever. No patient in either group reported worsening of myasthenia. Among those who declined vaccination, fear of adverse effects was cited most often, including myasthenic (31.5%) and non-myasthenic concerns (42.6%), with 14.8% (n = 8) being advised by their physician to abstain from the program. Seasonal influenza flu and H1N1 vaccination appears to be safe for patients with myasthenia.
Vaccines may be composed of whole killed organisms, live attenuated virus, components of the organism or their denatured toxin, or may be created as a conjugate vaccine by covalently attaching a polysaccharide antigen to a protein carrier. The last, which includes those for Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis, cannot produce the natural disease but provokes an immune response that is directed against the antigen and hence is protective against the disease. Neurological complications post-vaccination, although rare, are among the most serious, and, although a causal relation may be difficult to prove, include encephalitis, meningitis, Parkinsonism, seizures, stroke, transverse myelitis, and Guillain-Barre syndrome. Neurological complications have been reported following a host of vaccines, including measles-rubella, varicella, influenza, hepatitis A and B, rabies, meningococcal, pneumococcal, H. flu, and diphtheria–tetanus–pertussis.1 Among patients with immune-mediated disease, stimulating the immune system by vaccination raises the concern that the underlying disease will be similarly incited. Risk of developing the disease must be weighed against risk of vaccination. For myasthenics, seasonal influenza flu and H1N1 vaccination appears to be safe.
1. Miravalle A, et al. Neurological complications following vaccinations. Neurol Res 2010;32:285-292.