J Clin Neurol.  2017 Oct;13(4):325-330. 10.3988/jcn.2017.13.4.325.

The Impacts of Influenza Infection and Vaccination on Exacerbation of Myasthenia Gravis

• Seok HY
• Shin HY
• Kim JK
• Kim BJ
• Oh J
• Suh BC
• Kim SY
• Kang SY
• Ahn SW
• Bae JS
• Kim BJ

• KMID: 2392127
• DOI: http://doi.org/10.3988/jcn.2017.13.4.325

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℃ 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.

Keyword

myasthenia gravis; influenza; vaccination; safety; exacerbation

MeSH Terms

Autoimmune Diseases
Common Cold
Cough
Fever
Follow-Up Studies
Humans
Influenza Vaccines
Influenza, Human*
Male
Muscle Weakness
Myasthenia Gravis*
Pharyngitis
Vaccination*
Influenza Vaccines

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