Page 101 - GTM-2-3

Global Translational Medicine Autoimmune diseases after vaccination

Kawasaki disease, neutropenia, and GBS (Table S1). In or exclusion of reported adverse events would perturb
the case of influenza, there is a possibility of slight epitope the accuracy of VAERS in representing the immunized
molecular mimicry, which may be more pronounced for populations. By comparing the relative proportions of
specific influenza strain protein(s) included within yearly adverse events with large clinical trial datasets, we can
vaccines. However, for other vaccines, the associations with detect possible perturbations in the VAERS dataset.
GBS might align more with the hypothesis of bystander
or polyclonal activation, and the likelihood of epitope 4.7. Study recommendations
molecular mimicry appears lower. In addition to the PNC The risks associated with developing autoimmune diseases
vaccine (0.43%), 6VAX-F (diphtheria and tetanus toxoids following vaccinations may be mitigated through the
and acellular pertussis absorbed + inactivated poliovirus + following measures: (i) Evaluating alternative vaccine and
hepatitis B + Haemophilus B conjugate vaccine) (1.78%), therapeutic platforms to either avoid or minimize the use
RV (rotavirus vaccine) (0.83%), MENB (meningococcal of mRNA and adenoviral platforms, and (ii) increasing the
group B, rDNA absorbed vaccine) (0.69%), and HIBV time between mRNA vaccine doses to 4 weeks or longer,
(Haemophilus influenzae Type B vaccine) (0.23%) vaccines and perhaps (iii) removing aluminum adjuvants and
exhibit significant temporal onset associations with adverse mercury excipients from vaccines.
events related to Kawasaki disease (Table S3). Despite
the unknown etiology of Kawasaki disease, the observed 5. Conclusion
associations with multiple vaccines represent unexpected Autoimmune diseases appear to be triggered by specific
observations. One proposed hypothesis suggests that vaccines in some vaccinees (COVID-19 vaccine: alopecia,
high-titer antibodies capable of activating mast cells may Bell’s palsy, chronic fatigue syndrome, CRPS, GBS,
play a key role in the etiology of Kawasaki disease [52,53] . Henoch-Schonlein purpura, ITP, myositis, multiple
It is plausible that immunizations for these vaccines may sclerosis, narcolepsy, optic neuritis, POTS, rheumatoid
activate mast cells due to the high titers of immunization- arthritis, systemic lupus erythematosus, and Type 1
stimulated antibodies binding to vaccine antigens. diabetes mellitus. Influenza vaccine: GBS [already known].
Consequently, therapeutic approaches targeting activated HEP vaccine: Alopecia, chronic fatigue syndrome,
mast cells may hold promise for patients experiencing GBS, multiple sclerosis, optic neuritis, systemic lupus
vaccine-associated Kawasaki disease [52,53] . erythematosus, and vasculitis. HPV vaccine: alopecia,
4.5. Patients with pre-existing autoimmune diseases chronic fatigue syndrome, CRPS, GBS, multiple sclerosis,
narcolepsy, optic neuritis, POTS, and systemic lupus
Immunosuppressed individuals and those with erythematosus. PNC vaccine: GBS, Kawasaki disease, and
autoimmune diseases are advised to consult with licensed neutropenia. Vericella-zoster vaccine: Bell’s palsy, GBS,
medical professional regarding suitable vaccine candidates. and rheumatoid arthritis. Refer to Table S2. The study
It is important to note that live-attenuated vaccines reveals specific temporal onset correlations of ADAEs for
are not recommended for patients with autoimmune multiple vaccines (Figures 1 and 2, Table S1). Both mRNA
inflammatory rheumatic diseases, especially those who are and adenoviral COVID-19 vaccine platforms appear
immunosuppressed . In the work of Frasca et al. , there to non-specifically increase the occurrence of ADAEs
[54]
[55]
is a debate concerning the necessity of COVID-19 vaccines associated with multiple autoimmune diseases (Table S1).
for individuals with autoimmune diseases as well as for the Increasing the time between initial COVID-19 mRNA shots
general population. It is worth highlighting that impaired to at least 4 weeks is likely to mitigate the observed increase
immunogenicity to COVID-19 vaccines has been reported in ADAEs for tozinameran (Figure 3). It is important to
in individuals with autoimmune systemic diseases , note that increased non-specific ADAEs are not observed
[56]
although there have been reports of vaccine efficacy in for all other vaccines. These well-established platforms may
[57]
patients with autoimmune hepatitis . In the consideration offer safer alternatives for COVID-19 vaccination with
of candidate treatments, relevant information needs to be respect to ADAEs. HEP and HPV vaccines, on the other
provided to ensure that informed consent requirements hand, appear to induce specific patterns of ADAEs, with
have been met while carefully weighing the risks against aluminum being a common adjuvant to both vaccines. The
the benefits. removal of aluminum adjuvants from HPV vaccines, HEP
vaccines, and potentially other vaccines may reduce the
4.6. Study limitations
frequency of ADAEs. Adhering to the principle of informed
This study is based on adverse events reported to the VAERS consent and the disclosure of information, it is advisable
database, which are considered a subset of all adverse to provide ADAE risk notifications for COVID-19, HPV,
events experienced by vaccinees. Any reporting biases HEP, and other vaccines.

Volume 2 Issue 3 (2023) 8 https://doi.org/10.36922/gtm.1455