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Influenza Vaccine Is Recommended for Autoimmune Neuromuscular Diseases

AUSTIN, TX—Most neurologists surveyed said they would recommend an influenza vaccine for patients with autoimmune neuromuscular diseases, such as myasthenia gravis (MG) or chronic inflammatory demyelinating polyneuropathy (CIDP), researchers reported here at the annual meeting of the American Association of Neuromuscular & Electrodiagnostic Medicine.

About 82.7 percent of the neurologists who responded to the online questionnaires said they would recommend influenza vaccines to their patients with MG, and 59.1 percent indicated they would recommend the influenza vaccine for patients with a history of CIDP. But less than half—42.7 percent—of the 184 respondents said they would recommend the influenza vaccine for patients with Guillain–Barré syndrome (GBS), Tess Litchman, a fourth-year medical student at Yale University, reported.

In the survey, neurologists said they observed disease exacerbations among 1.5 percent of patients with MG who were vaccinated; 3.7 percent of the CIDP patients, and 8.7 percent of the GBS patients. The higher percentage of GBS patients who had disease activation within six weeks of receiving the influenza vaccination was statistically significant (p< 0.001), Litchman said.

"This survey demonstrates that clearer guidelines and education from a professional academic neurology society is an unmet need and would be helpful to better inform the neurology community about the possible risks and benefits of immunization in MG, CIDP, and GBS patients," Litchman suggested.

She noted that existing guidelines on influenza vaccination from the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices suggest that all patients with MG and CIDP should be vaccinated, as well as GBS patients who did not develop the disease after receiving an influenza vaccine in the past.

Commenting on the study, Sarah Jones, MD, assistant professor of neurology at the University of Virginia in Charlottesville, told Neurology Today At the Meetings that she basically follows the recommendations outlined by the CDC, and that the results of the survey should be viewed with caution.

"There is pretty good evidence that folks with myasthenia gravis, even when they are on medication, have a pretty robust response that is equal to peers that are not on immunosuppressive medicine and healthy control subjects, and the literature indicates that vaccines are considered safe and do not result in exacerbation of myasthenia gravis."

She added that she would follow CDC guidance that recommends not administering the vaccine to GBS syndrome patients who had developed GBS after receiving influenza vaccination in the past.

"I would recommend vaccinating all other GBS patients and those with MG and CIDP.  I do think the benefit of the vaccine outweighs the potential risk."

Litchman disclosed no relevant relationships with the industry. Dr. Jones disclosed relevant relationships with Argenx and Orphazyme.

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