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                                 Vaccination section -Autoimmune diseases

Update: Vaccine Side Effects, part-2

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Adverse Events

In the United States, surveillance of adverse reactions indicated a possible association between GBS and receipt of the first dose of plasma-derived hepatitis B vaccine (CDC,

Based on reports to the Vaccine Adverse Events Reporting System (VAERS), the estimated incidence rate of anaphylaxis among vaccine recipients is low (i.e., approximately one event per 600,000 vaccine doses distributed). Two of these adverse events occurred in children (CDC, unpublished data). , this adverse event can be fatal; in addition, hepatitis B vaccine can -- in rare instances -- cause a life-threatening hypersensitivity reaction in some persons (5). Therefore, subsequent vaccination with hepatitis B vaccine is contraindicated for persons who have previously had an anaphylactic response to a dose of this vaccine.

As hepatitis B vaccine is introduced for routine vaccination of infants, surveillance for vaccine-associated adverse events will continue to be an important part of the program despite the current record of safety. Any adverse event suspected to be associated with hepatitis B vaccination should be reported to VAERS. VAERS forms can be obtained by calling (800) 822-7967.

POLIOMYELITIS PREVENTION

Precautions and Contraindications Pregnancy

Although no conclusive evidence documents the adverse effects of OPV or inactivated poliovirus vaccine (IPV) in pregnant women and their developing fetuses, vaccination of pregnant women should be avoided. However, if immediate protection against poliomyelitis is necessary, OPV or IPV can be given.

Immunodeficiency

Persons who have congenitally acquired immune-deficiency diseases (e.g., combined immunodeficiency, hypogammaglobulinemia, and agammaglobulinemia) should not be given OPV because of their substantially increased risk for vaccine-associated disease. Furthermore, persons who have altered immune status resulting from acquired conditions (e.g., human immunodeficiency virus {HIV} infection, leukemia, lymphoma, or generalized malignancy) or who have immune systems compromised by therapy (e.g., treatment with corticosteroids, alkylating drugs, antimetabolites, or radiation) should not receive OPV because of the theoretical risk for paralytic disease.

IPV -- and not OPV -- should be used to vaccinate immunodeficient persons and their household contacts. Many immunosuppressed persons are already immune to polioviruses because of previous vaccination or exposure to wild-type virus when they were immunocompetent. Although such persons should not receive OPV, their risk for paralytic disease may be less than that of persons who have congenitally acquired immunodeficiency. Although a protective immune response to IPV in the immunodeficient patient cannot be ensured, the vaccine is safe and some protection may result from its administration. If a household contact of an immunodeficient person is vaccinated inadvertently with OPV, the OPV recipient should avoid close physical contact with the immunodeficient person for approximately 4-6 weeks after vaccination (i.e., during the period of maximum excretion of vaccine virus).

Adverse Reactions OPV

In rare instances, administration of OPV has been associated with paralytic poliomyelitis in healthy recipients and their contacts. Very rarely, OPV has caused fatal paralytic poliomyelitis in immunocompromised persons (5). Other than efforts for identifying persons with immune-deficiency conditions, no procedures are currently available to identify persons likely to experience such adverse reactions. Although the risk of vaccine-associated paralysis is extremely small for vaccinees and their susceptible, close, personal contacts, they should be informed of this risk.

Available data do not indicate a measurable increased risk for GBS after receipt of OPV. Initial reports (at the time of IOM review) of two studies conducted in Finland suggested that OPV might cause GBS. These studies identified an apparent increased incidence of GBS that was temporally associated with mass OPV vaccination of children and adults who had previously received IPV (15,16). Since the IOM review, a reanalysis of the data derived from the studies conducted in Finland and an analysis of an observational study conducted in the United States have not demonstrated a causal relationship between OPV and GBS in infants (17).

Because OPV contains trace amounts of streptomycin, bacitracin, and neomycin, its use is contraindicated in persons who have previously had an anaphylactic reaction to OPV or to these antibiotics.

IPV

No serious side effects of currently available IPV have been documented. Since IPV contains trace amounts of streptomycin and neomycin, there is a possibility of hypersensitivity reactions in individuals sensitive to these antibiotics.

MEASLES PREVENTION

Side Effects and Adverse Reactions

More than 240 million doses of measles vaccine were distributed in the United States from 1963 through 1993. The vaccine has an excellent record of safety. From 5% to 15% of vaccinees may develop a temperature of greater than or equal to 103 F ( greater than or equal to 39.4 C) beginning 5-12 days after vaccination and usually lasting several days (19).  Central nervous system (CNS) conditions, including encephalitis and encephalopathy, have been reported with a frequency of less than three per million doses administered.

Personal and Family History of Convulsions

As with the administration of any agent that can produce fever, some children may have a febrile seizure. Although children with a personal or family history of seizures are at increased risk for developing idiopathic epilepsy, febrile seizures following vaccinations do not in themselves increase the probability of subsequent epilepsy or other neurologic disorders. Most convulsions following measles vaccination are simple febrile seizures, and they affect children without known risk factors.

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