Abstract Details

Title Systematic Review Investigating Relationship Between Neuromyelitis Optica Spectrum Disorder (NMOSD) and Vaccination

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-003

Objective

To systematically review existing data regarding the relationship between neuromyelitis optica spectrum disorder (NMOSD) and vaccination.

Background Most patients with NMOSD harbor an antibody against aquaporin-4 (AQP4-IgG) that can be detected in serum years in advance of clinical disease expression. Factors responsible for triggering NMOSD onset or individual attacks are not well understood. Vaccinations have been implicated as triggers of idiopathic transverse myelitis and other monophasic CNS inflammatory syndromes but their relationship to NMOSD onset and relapse is unclear.

Design/Methods PubMed and MEDLINE databases were searched using the following terms: “neuromyelitis optica”, “Devic’s disease”, “Devic’s syndrome”, “vaccine”, “vaccination”, and “immunization” and limited to English language publications. We included articles that described patients meeting 2006 or 2015 NMO/NMOSD diagnostic criteria and either disease onset or relapse occurring 2-42 days post-vaccination.

Results Data was abstracted from 6 articles (1 retrospective review, 5 individual case reports) describing a total of 15 patients with vaccine-NMOSD activity relationships. Ten of 15 (67%) were AQP4-IgG seropositive. Four (80%) of AQP4-IgG seronegative and 4 (40%) AQP4-IgG seropositive patients experienced their first-ever attack after a vaccine. Attack types included optic neuritis (n=8), myelitis (n=12) and area postrema syndrome (n=2). Attacks were multiregional (e.g. optic neuritis and myelitis) in 4/5 (80%) of AQP4-IgG seronegative but only 1/10 (10%) seropositive patients. Implicated vaccines included influenza, tetanus and diphtheria (Td), tetanus, diphtheria, and pertussis (Tdap), human papilloma virus, pneumococcal, hepatitis A, hepatitis B, typhoid, yellow fever, and Japanese encephalitis vaccines.

Conclusions

NMOSD can arise de novo or relapse post-vaccination but current data are limited in number and quality. A greater proportion of first-event attacks and multiregional attacks in AQP4-IgG seronegative patients requires further study. This systematic review highlights the need for use of standard exposure-event methodology for conducting epidemiologic studies of NMOSD when addressing questions of vaccine-associated risks.

Authors/Disclosures
Aimen Vanood, MD (Mayo Clinic Arizona) PRESENTER	Dr. Vanood has nothing to disclose.
Dean M. Wingerchuk, MD, FAAN (Mayo Clinic)	Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Meyer Squibb. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abcuro. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters Kluwers.

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