The Impacts of Influenza Infection and Vaccination on Exacerbation of Myasthenia Gravis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Purpose Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. Methods Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38°C accompanied by a cough and/or a sore throat. Results Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). Conclusions The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
Abstract
Background and Purpose Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. Methods Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38°C accompanied by a cough and/or a sore throat. Results Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). Conclusions The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
참고문헌 (18)
- Wendell LC, "Myasthenic crisis", Neurohospitalist, 1, pp.16~22 (2011)
- Kalita J, "Predictors of outcome of myasthenic crisis", Neurol Sci, 35, pp.1109~1114 (2014)
- Grohskopf LA, "Prevention and control of seasonal influenza with vaccines", MMWR Recomm Rep, 65, pp.1~54 (2016)
- Agmon-Levin N, "Influenza vaccine and autoimmunity", Isr Med Assoc J, 11, pp.183~185 (2009)
- MartÍn Arias LH, "Guillain-Barré syndrome and influenza vaccines: a meta-analysis", Vaccine, 33, pp.3773~3778 (2015)
- Vellozzi C, "Guillain-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence", Clin Infect Dis, 58, pp.1149~1155 (2014)
- McNicholas N, "Relapse risk in patients with multiple sclerosis after H1N1 vaccination, with or without seasonal influenza vaccination", J Neurol, 258, pp.1545~1547 (2011)
- Zinman L, "Safety of influenza vaccination in patients with myasthenia gravis: a population-based study", Muscle Nerve, 40, pp.947~951 (2009)
- Auriel E, "Safety of influenza and H1N1vaccinations in patients with myasthenia gravis, and patient compliance", Muscle Nerve, 43, pp.893~894 (2011)
- Hong YH, "Prognosis of ocular myasthenia in Korea: a retrospective multicenter analysis of 202 patients", J Neurol Sci, 273, pp.10~14 (2008)
- Cho S, "Correlation between national influenza surveillance data and google trends in South Korea", PLoS One, 8, pp.e81422~ (2013)
- Flannery B, "Early estimates of seasonal influenza vaccine effectiveness-United States, January 2015", MMWR Morb Mortal Wkly Rep, 64, pp.10~15 (2015)
- 유소연, "독감 예방접종군과 미접종군 간의 독감의사질병 발생 차이 비교", Journal of korean biological nursing science, 18(2), pp.110~117 (2016), 기초간호학회
- 송준영, "Immunogenicity and Safety of Trivalent Inactivated Influenza Vaccine: A Randomized, Double-Blind, Multi-Center, Phase 3 Clinical Trial in a Vaccine-Limited Country", Journal of Korean Medical Science, 26(2), pp.191~195 (2011), 대한의학회
- Taylor C, "Same influenza vaccination strategies but different outcomes across US cities?", Int J Infect Dis, 14, pp.e792~e795 (2010)
- "Influenza vaccines", Wkly Epidemiol Rec, 80, pp.279~287 (2005)
- Esposito S, "Vaccination recommendations for patients with neuromuscular disease", Vaccine, 32, pp.5893~5900 (2014)
- Choi WS, "Suboptimal effectiveness of the 2011-2012 seasonal influenza vaccine in adult Korean populations", PLoS One, 10, pp.e0098716~ (2015)