DMDs may influence flu vaccine response in MS patients

[doublevision1]

Immunotherapies influence the influenza vaccination response in multiple sclerosis patients: an explorative study

Henning K Olberg1
Rebecca J Cox2,3,4
Jane K Nostbakken2,3
Jan H Aarseth5,6
Christian A Vedeler1,6,7
Kjell-Morten Myhr5,6,8
1Department of Neurology, Haukeland University Hospital, Bergen, Norway
2Department of Research and Development, Haukeland University Hospital, Bergen, Norway
3Influenza Centre, Department of Clinical Science, University of Bergen, Norway
4KG Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Norway
5Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
6KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Norway
7Department of Clinical Medicine, University of Bergen, Norway
8Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
Henning Kristian Olberg, Section of Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Jonas Lies Vei 61, Bergen 5021, Norway. Email: [email protected]


Abstract

Background: The immunogenicity of influenza vaccines in MS patients undergoing immunomodulatory treatment is not well studied.

Objectives: This explorative study investigated the influence of immunomodulatory treatment on MS patients receiving pandemic H1N1 (swine flu) vaccination in 2009 and seasonal influenza vaccination in 2010.

Methods: We investigated the immune response to pandemic H1N1 vaccination among 113 MS patients and 216 controls during the pandemic of 2009. We also investigated the serological response to seasonal influenza vaccination (2010 – 2011 season) among 49 vaccinated and 62 non-vaccinated MS patients, versus 73 controls. We evaluated these vaccine responses by haemagglutination inhibition assay.

Results: MS patients receiving immunomodulatory treatment had reduced protection (27.4%), compared to controls (43.5%) (p = 0.006), after pandemic H1N1 vaccination (2009). The rates of protection were not influenced by interferon beta treatment (44.4% protected), but were reduced among patients receiving glatiramer acetate (21.6%), natalizumab (23.5%), and mitoxantrone (0.0%). A similar pattern emerged after MS patients received a seasonal influenza vaccination in 2010.

Conclusions: These findings suggest that MS patients receiving immunomodulatory therapies other than interferon beta should be considered for a vaccine response analysis and perhaps be offered a second dose of the vaccine, in cases of insufficient protection.


http://msj.sagepub.com/content/early/2014/01/16/1352458513513970.abstract?papetoc

[kwarendorf]

My doc advises against them. Looks like I may not be missing much :-)

[HVAC]

That makes sense. My chemo makes it less likely the vaccine will work for me. I get it anyway.

Alex

[PeninaD]

My daughter's doc said only not to let her, or anyone in the household have the live virus vaccine.  As she has had the flu vaccine every year for the last 10 years, she has had multiple doses of H1N1 to date...interesting, as I brought this up to the team treating her, and they said that the memory cells would not be effected, so that she would still be able to mount a defense.

[essdipity]

We've discussed flu vaccines a lot here. Some do it, some don't. I'm in the do it camp.

But pretty much everyone (everyone's doctor too) agrees that the live virus in flu mist vaccine is absolutely a no. The shots contain dead virus.

ess

[PeninaD]

I should say, all her docs insisted that she, and everyone in the household should get the flu shot, just to make sure it was not one of the live versions.

[sllowe]

Some protection is better than none I say. It's the complications to the flu that can kill.

But, wonder if these percentages would change with the high dose flu vaccine.

[calamfred]

Hubby, myself, and myv mom all get the flu shot every year.

Husband's Neuro and Endo Drs both say get the vaccine, just not the live version, which we wouldn't take that one anyway.

What's funny (I guess) is that I only started taking the flu shot the last 3-4 years...after we were both diagnosed with auto immune diseases...AND I work in the medical field, yet all those years prior never wanted to get the flu shot...go figure...

C

[SarahL2491]

I thought the flu vaccine was a dead virus, not a live one.  I know the shingles vaccine is a live one and it gave me 3 days of heck.  I talked to my walk in clinic doc the other day and she said it was up to me and since I have never had the flu in my life, I told her I wasn't messing with a good thing!

But I think there are those of us in each camp on this one.  The hospital I used to work at did not enforce the flu vaccine, the other one did, but probably both do now.

[calamfred]

Forgot to add that I still sometimes wonder what the immune effect really is taking the flu shot for instance, for those of us with auto immune disorders...

My husband was on allergy shots (3 shots every week, for severe seasonal allergies) for several years prior to being diagnosed with the Addison's. And 2 years after that dx, along comes the MS dx...I have wondered what correlation, if any there may be to the allergy shots. His Neuro as well as Endo and I have discussed this, and they both actually said it couldn't be ruled out something such as allergy shots could "trigger" in a genetically predisposed person.

Our son also was on allergy shots. About a year and a half in, he started having some odd reactions..and this was on a maintenance/stable dose regarding the allergy shots. Around this time, hubby had received the MS diagnosis. I told our son I was concerned, and after speaking with the Drs, he stopped the allergy shots.

Yes, I know I have OCD, so let me go ahead and put that out here...lol

But, honestly since it's not really known how a disease process gets "activated", and studies show it can be a combo of genetics and an environmental trigger, I seriously think why chance it? Especially when taking Zyrtec, Claritin, Benadryl, etc. is so much easier than dealing with severe autoimmune diseases.

Also with hubby and I both having autoimmune diseases, the chances our son may have some type of autoimmune issue goes up, too. Frankly that is a BIG thing that hubby and I pray does NOT happen.
So, otc allergy meds and boxes of Kleenex make great gifts for our son! Haha

Regards,
C

[essdipity]

Sarah, there are 2 types of flu vaccine. The mist (oral, I'm pretty sure) is made of live virus, the shot of dead virus.

Calamfred, I don't think there's any proof one way or the other about allergy shots and autoimmune triggers, so it's really just speculation. Sometimes, though, stuff gets very real indeed, my allergies, for instance. They have gotten so bad year round-- pollen, mould, feathers and dust (the last of which I have plenty of!)--that my allergist has approved triple doses of the OTC products. Apparently there's only one prescription antihistamine pill left on the market, which I have, and it really dries my mouth out, etc.

I may well have to start the shots soon, not that I want to. I've known quite a few people who have gotten them for 18 months or 2 years and they haven't worked, plus it's a real pain to have to go in so often, and then sit there afterwards to make sure there isn't a bad reaction.

But we do what we have to do, and hope for the best. I'm such an outlier in terms of most medications and their effects and side effects that I've stopped trying to predict anything.

ess

[Lulu54]

sort of off topic- as I waited in line to check out at the grocery where I had just picked up a prescription for my current crud I have (runny nose, cough, etc.) the cashier was talking to the woman ahead of me, who she knows through their children.  They talked a lot- believe me I was irritated because I felt bad and just wanted to check out and go home.  

One of their last topics was the flu vaccine and they both declared they don't get it and they never will let their children get it, either.  

I couldn't resist and as I was checking out, I said that she should be thankful I just have a virus and not the flu to spread to her.  That I have had the flu and believe it is important for the protection of the herd - the people who can get them, should to help prevent its spread.  

What came next from her stunned me - she thanked me for getting the vaccine and said she belives it is important for people to get it, but it just wasn't going to be her.  And then she added that is why she keeps a bottle of antibacterial hand gel at her register.   go figure.....

[essdipity]

It takes all kinds, I guess.

[Lulu54]

i meant I have had the flu vaccine -  

Also, for this research, I wonder if their serum test is commercially available at a reasonable cost so it could be used to check if our vaccine was effective or if we need a second dose.

[karryon55]

I have had the yearly flu vax for as long as I can remember. I'm not to have any live vaccines though. I got to have the Phuemonia vax as well this year but it lasts 5 years apparently.

Karry.

[calamfred]

essdipity, I hear you on meds and averse reactions to many of them!

As far as allergy shots, our son actually took his 1st round of them from ages 5-8, we took him to a pediatric allergist in another state, they would in turn mail the serum to our son's pediatrician and once a week we would take our son to get his shot.

My husband took his round of shots several years after that, by that time we had an allergy specialist here in our town. After one is on the shots and gets to a maintenance dose, you have the option to do your own shots at home. Dr also rx'd an Epi-pen. We did this with my husband. Our son also saw this allergy dr and started on shots again, too

So, I guess my take on it is for my hubby, his allergies are much better, but now he has Addison's, MS, hypothyroidism, high blood pressure. I can't say whether the shots helped his allergies, or not. Just like I can't say if they had anything to do with the Polyendocrinopathy and MS "switched to active". I don't attribute the shots at all to the hbp, and he had that prior anyway.

For our son, his allergies don't seem any different. And even though there is no specific fact as to what actually "triggers" autoimmune diseases to become active, after research, and speaking to our drs, we decided it wasn't worth taking a chance as far as him continuing on with the shots. Especially with his "wonderful" (said with eye roll) genetics and the odd reactions he and my husband both experienced with the shots...not in the beginning of getting them, but well into the process and on maintenance doses.

We had a dr comment that he thinks we are all just a "Murphy's Law" family...I tend to agree...

Regards,
C

[calamfred]

I wonder if that cashier has had a bout with the flu? As I said prior, I used to not get the flu vaccine either...It's not only my family's compromised immunities that changed my mind.

I had the flu a few times throughout my life. But the year before I started getting the flu shot I got the worst case of flu I had ever had. I never had it turn into bronchitis, but that year it did..that did it for me. Flu shot for me from then on. And as you say, "protection for the herd".

Regards,
C

[sllowe]

Lu - Glad she thanked you - Ironically, I was reading up about the high dose last week for another reason, and in that same write-up was about "herd" immunity. Herd immunity is when the majority of people get the flu shot, therefore minimizing the chances of those around them.

You very much deserved the "thanks." We all do. So, in the end, even if people choose not to get it - and I do understand the reasoning of some, at least those of us who do, contribute to lowering the odds of getting it for ourselves, and others! Whoop Whoop! Good for all ;)

[Lulu54]

I did ask her if she had ever had the flu and she said, oh yeah, several times. I'm pretty sure she has not had influenza multiple times and is still passing up the vaccine.  A lot of people confuse being ill with a 3-5 day virus with the flu - they are entirely two different things.

A very good explanation, complete with charts, explains herd immunity at

http://en.wikipedia.org/wiki/Herd_immunity

thanks again, DV, for sharing this research.  

[calamfred]

Good info on herd immunity, Lulu.
Thanks for the research info, too DV.

C