Recently Dr. Mamatha Pasnoor, MD, FAAN, University of Kansas Medical Center graciously addressed Vaccines and Myasthenia Gravis during one of our webinars. Here is a recap for those who may have missed it or just was the SparkNotes. You can also view the webinar here.
What are Vaccines?
Vaccines reduce risk of getting a disease by working with your body’s natural defenses to build protections.
There are four different types of vaccines.
Live-attenuated Vaccines: Use a weakened form of the germ.
Inactivated Vaccines: Use killed versions of the germ.
Messenger RNA Vaccines: Make proteins to trigger an immune response.
Subunit, Recombinant, Polysaccharide, & Conjugate Vaccines: Use specific pieces of the germ.
Are Vaccines Safe?
Yes, but always speak with your medical team before deciding on when and which vaccines to get. There are a variety of manufacturers that produce the same vaccine. If you have had a reaction to a vaccine in the past, it may have been caused by something used by the manufacturer and not the vaccine itself. If you have had exacerbations after receiving a vaccine in the past, you may ask your medical team what precautions you should take. Your medical team my suggest one manufacture or type of vaccine over another.
There are always exceptions to the rule, you will find these outliers in every study. You will also find data that shows a greater percentage of patients who did not receive a vaccine, caught the virus, and had exacerbations, while those patients that received the vaccine were less likely to show exacerbations or had none at all.
Do Vaccines Cause MG Exacerbation?
There is little data on the relationship between Vaccines and Exacerbation of MG. Remember that MG is considered a rare disease. So, although we don’t have much data comparing MG and different vaccines, we can look at how patients with similar diseases have reacted and make some generalizations. With the information we have, we can conclude that most vaccines do not cause exacerbation. The type of vaccine that is most likely to cause exacerbation is a vaccine that contains live viruses.
Live-attenuated vaccines use a weakened form of the germ that causes the disease. They create a long-lasting immune response, which can last a lifetime. The U.S. Department of Health and Human Services suggest that those with weakened immune systems should consult with their medical providers.
Common live vaccines are:
o Measles o Chicken pox
o Mumps o Smallpox
o Rubella o Yellow fever
o Rotavirus
Do Vaccines Cause New Onset MG?
There has been a very small percent of the population that reported cases of onset MG within 6 weeks of receiving a vaccine. The incident rate of MG after vaccinations was 2.1 per year, based on a study from 1990 to 2017. This 2.1per year is similar to the percent of the general population that become diagnosed with MG yearly. With that correlation, it could be suggested that the vaccine triggered their MG and did not cause it.
Conclusion
In conclusion, vaccinations are an essential part of management of neuro-immunological diseases. Although they should be avoided during relapse or exacerbation periods of neuroimmunology disease due to the purpose of vaccines and how they work. Your current treatments should also be considered when planning to receive a vaccine.
Optimal Timing of Vaccine Suggestions:
IVIg: Vaccinate 2 weeks before or 2 weeks after IVIg. If you are on a IVIg 4-week schedule, its suggested to vaccinate between your IVIg treatments.
Rituximab: If completing 2 shots, it is suggested to schedule your vaccine 4 weeks prior to your first shot or 4 weeks after your last shot. If completing a 6-month cycle, it is suggested to vaccinate midway between cycles.
Eculizumba/Plasma Exchange: Vaccinate at your midpoint between treatments.
FcRn Antagonism: Vaccinate between treatment cycles.
Oral Therapies: Vaccinate at any time.
As always, consult with your medical team prior to any decisions on vaccination.
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