Review articleSystemic polyarteritis nodosa following hepatitis B vaccination
Introduction
Rheumatologic manifestations following hepatitis B (HB) vaccination have been studied and described in increasing detail in recent years [1]. Polyarteritis nodosa (PAN) is a rare, life-threatening, necrotizing vasculitis that affects medium-sized arteries and has a well-documented association with HB virus [2]. Multiple case reports have suggested a link between PAN and HB vaccination [3], [4], [5], [6], [7], [8] that may be the result of widespread immunization with this vaccine, which was introduced in the late 1980s and is the second most frequently administered vaccine in the United States [9]. It is universally recommended by the Centers for Disease Control (CDC) for infants as well as for selected high-risk adults [10].
The authors review the literature on this issue as well as a new case of PAN that appeared after receiving HB vaccination.
Section snippets
Discussion
Hepatitis B vaccination is frequently prescribed. The CDC recommends this vaccine for all individuals, but mainly for those at risk of getting this infection, such as health care professionals [10]. The vaccine most often involved with autoimmunity is the HB vaccine [11]. There is a wide spectrum of diseases and autoimmune manifestations associated with this vaccine, as shown in Table 1.
Conclusion
Although it is impossible to determine a causal effect based on only one individual case, the present case, together with the many others described in the literature and the strong temporal association observed in both the present and other studies, should alert physicians to the possibility that the development of PAN may be a rare side effect of HB vaccination. Moreover, there have been numerous instances in which the gift of immunization has proved to be a ”Trojan horse” that generated an
Learning points
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Autoimmune disorders can appear after HB vaccination.
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The vaccine most often involved with autoimmunity is HB vaccine.
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The association between HB vaccine and autoimmunity is temporal only, and no certain causality has been proven.
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The risks of HB vaccination in lupus are very small; nevertheless, it should be considered in the context of the individual's exposure risk.
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In the current literature, there are 27 descriptions of vasculitis after HB vaccine.
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Vaccination can have adverse autoimmune effects
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Vasculitis as an adverse event following immunization – Systematic literature review
2016, VaccineCitation Excerpt :The authors concluded that KD can occur in a temporal relationship with vaccination, but a causal association has not been established. “Systemic polyarteritis nodosa following hepatitis B vaccination” by de Carvalho et al. [25] in 2008. The authors concluded that vaccination may be the triggering factor for vasculitis in individuals with a genetic predisposition.
From HBV to HPV: Designing vaccines for extensive and intensive vaccination campaigns worldwide
2016, Autoimmunity ReviewsVaccines, adjuvants and autoimmunity
2015, Pharmacological ResearchCitation Excerpt :One case of polyarteritis nodosa (PAN) following the administration of Tetanus and BCG vaccine is described. All other cases of PAN in adults follow the administration of HBV vaccine [163–165]. Case reports of medium vessels vasculitis – both polyarteritis nodosa and Kawasaki disease (KD) – have also been published in pediatric patients.
Pediatric Rheumatology for the Primary Care Clinicians-Recognizing Patterns of Disease
2015, Current Problems in Pediatric and Adolescent Health CareCitation Excerpt :Children with common viral illnesses due to viruses such as parvovirus or enteroviruses may have arthritis episodes that may last days to weeks.96,97 A child who has recently received an MMR or Hepatitis B immunization may also have a transient synovitis episode.98–102 Brief idiopathic transient synovitis syndromes may occur in young children, especially in the hip (transient synovitis of the hip, observation hip), and are usually diagnosed by their relative mild clinical involvement and rapid resolution87,103,104; these hip reactive processes must be differentiated from a septic hip disease.
- 1
JF Carvalho is a recipient of grant no. BEX 2367/06-8 awarded by CAPES.
- 2
Recipient of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University.