Consequence or coincidence? The occurrence, pathogenesis and significance of autoimmune manifestations after viral vaccines

Background: Viruses and virus-induced lymphokines may have an important role in the pathogenesis of autoimmunity (Schattner A. Clin Immunol Immunopathol; 1994). The occurrence and significance of autoimmune manifestations after the administration of viral vaccines remain controversial. Methods: Medline search of all relevant publications from 1966 through June 2004 with special emphasis on search of each individual autoimmune manifestation and vaccination, as well as specifically searching each viral vaccine for all potential autoimmune syndromes reported. All relevant publications were retrieved and critically analyzed. Results: The most frequently reported autoimmune manifestations for the various vaccinations, were: hepatitis A virus (HAV) - none; hepatitis B virus (HBV) - rheumatoid arthritis, reactive arthritis, vasculitis, encephalitis, neuropathy, thrombocytopenia; measles, mumps and rubella vaccine (MMR) - acute arthritis or arthralgia, chronic arthritis, thrombocytopenia; influenza - Guillain-Barre syndrome (GBS), vasculitis; polio - GBS; varicella - mainly neurological syndromes. Even these 'frequent' associations relate to a relatively small number of patients. Whenever controlled studies of autoimmunity following viral vaccines were undertaken, no evidence of an association was found. Conclusions: Very few patients may develop some autoimmune diseases following viral vaccination (in particular - arthropathy, vasculitis, neurological dysfunction and thrombocytopenia). For the overwhelming majority of people, vaccines are safe and no evidence linking viral vaccines with type I diabetes, multiple sclerosis (MS) or inflammatory bowel disease can be found. (c) 2005 Elsevier Ltd. All rights reserved.