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Vaccines and Optic Neuritis: Consequence or Coincidence?

Justyna Roszkiewicz, Yehuda Shoenfeld

A mosaic of various inflammatory diseases associated with the administration of vaccines has been reported in the literature. Optic Neuritis (ON), a primary inflammation of the optic nerve, serves as an prominent piece of it, presenting the features of autoimmune phenomena including Treg/Th17 cell imbalance and the abundance of proinflammatory cytokines. A PubMed search revealed 48 cases of vaccination-related ON, from which 32 were reports as isolated ON, 9 occurred as the first symptom of neuromyelitis optica spectrum diseases (NMOSD) and 6 were inscribed in clinical course of Acute Disseminated Encephalomyelitis (ADEM). In Vaccine Adverse Effects Reporting System (VAERS) 537 reports of ON were identified, the vast majority of them was isolated (n=284), followed by ON preceding multiple sclerosis (n=99), ADEM (n=30) and NMOSD (n=20). Influenza vaccine was the leading cause of isolated ON, hepatitis B vaccine (HBV) was mostly associated with diseases entailing further demyelination, such as multiple sclerosis. Moreover, the time interval between vaccine delivery and symptoms of ON occurrences was shorter in cases of isolated-ON in comparison to ON-MS and ON-NMOSD. This time gap was also considerably longer after vaccines enriched with aluminum adjuvant. This article presents the thorough analysis of vaccination related ON cases and focuses on the possible pathomechanism of this autoimmune interplay, including the impact of adjuvants and the mechanism of molecular mimicry.