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Relapse of polymyalgia rheumatica following adjuvanted influenza vaccine: A case-based review
Margaret F Bassendine1,2, Simon H Bridge1,3
1Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Abstract:
Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatological condition affecting individuals aged >50 years. There have been rare reports of PMR and other vasculitides developing within 3 months of influenza vaccination. Influenza is a major public health issue associated with seasonal increased mortality and intensified health care service use. Annual vaccination is the most effective intervention to prevent influenza, especially in elderly individuals. We report a severe "flare" of PMR in a 70-year-old patient after receiving the adjuvanted trivalent influenza vaccine, as recommended by the Joint Committee on Vaccination and Immunisations for this age group in the UK National Health Service in 2018-2019. The adverse event (AE) could be interpreted as the newly described autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) as both PMR and ASIA display hyperactive immune responses. Caution is warranted in the use of vaccine adjuvants in patients with PMR with pre-existing imbalance of B and T cell homeostasis. Rare AEs are important to individuals, and personalized medicine means we should move away from "one size fits all" for vaccines, as well as for therapeutics.
Insights
A severe polymyalgia rheumatica (PMR) flare occurred in a 70-year-old after an adjuvanted influenza vaccine. This rare adverse event highlights the need for personalized medicine approaches to vaccination in elderly patients.
Area of Science:
- Rheumatology
- Immunology
- Vaccinology
Background:
- Polymyalgia rheumatica (PMR) is a common inflammatory condition in individuals over 50.
- Influenza vaccination is crucial for public health, especially in the elderly.
- Rare instances of PMR and vasculitis have been reported post-influenza vaccination.
Purpose of the Study:
- To report a severe PMR flare following adjuvanted trivalent influenza vaccination.
- To discuss the potential link between PMR flares, influenza vaccines, and ASIA syndrome.
- To advocate for personalized medicine in vaccination strategies.
Main Methods:
- Case report of a 70-year-old patient experiencing a PMR flare.
- Review of literature on PMR, influenza vaccination, and ASIA syndrome.
- Analysis of the patient's adverse event in the context of vaccine adjuvants.
Main Results:
- A 70-year-old patient experienced a severe PMR flare after receiving the 2018-2019 UK NHS recommended adjuvanted trivalent influenza vaccine.
- The adverse event aligns with characteristics of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome).
- Both PMR and ASIA syndrome involve hyperactive immune responses.
Conclusions:
- Caution is advised when administering vaccine adjuvants to PMR patients with existing immune system imbalances.
- Personalized medicine approaches are necessary, moving beyond a "one size fits all" vaccination strategy.
- Individual rare adverse events are significant and warrant consideration in vaccine policy.
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