Neuromyelitis optica (NMO) was initially thought be an aggressive subtype of multiple sclerosis (MS), but evidence suggests the majority of NMO phenotypes are rather due to autoimmunity against aquaporin 4 (AQP4).(e1,e2) Infection preceding a first attack of NMO may occur in up to 30% of seropositive cases, although no specific agent has been identified(1, e3); similarly, NMO may follow immunization but causality has not been established.(2, e4,e5) Association of infection or vaccination and autoimmunity is well described in other neuroinflammatory conditions such as Guillain-Barré syndrome (GBS) and acute disseminated encephalomyelitis.(e6,e7) Endogenous human proteins share sequence homology with microbial antigens, implicating molecular mimicry as the putative mechanism for immunologic crossreactivity and thus autoimmunity.
[Show abstract][Hide abstract] ABSTRACT: The human papilloma virus (HPV) vaccines were introduced to reduce the incidence of cervical cancer. The bivalent vaccine is effective against HPV-16, -18, -31, -33 and -45 while the quadrivalent vaccine is effective against HPV-16, 18, 31, 6 and 11 types. The immunisation, recommended for adolescent females, has led to high vaccine coverage in many countries. Along with the introduction of the HPV vaccines, several cases of onset or exacerbations of autoimmune diseases following the vaccine shot have been reported in the literature and pharmacovigilance databases, triggering concerns about its safety. This vaccination programme, however, has been introduced in a population that is at high risk for the onset of autoimmune diseases, making it difficult to assess the role of HPV vaccine in these cases and no conclusive studies have been reported thus far. We have thus analysed and reviewed comprehensively all case reports and studies dealing with either the onset of an autoimmune disease in vaccinated subject or the safety in patients with autoimmune diseases to define the role of the HPV vaccines in these diseases and hence its safety. A solid evidence of causal relationship was provided in few cases in the examined studies, and the risk vs. benefit of vaccination is still to be solved. The on-going vigilance for the safety of this vaccine remains thus of paramount importance.
Margaret E. Walker-Caulfield, Yong Guo, Renee K. Johnson, Christina B. McCarthy, Patrick D. Fitz-Gibbon, Claudia F. Lucchinetti, Charles L. Howe
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