Citations of eye/optic problems and vaccines
Citations

[You give vitamin A depleting vaccines for a disease (measles) that blinds the vitamin A deficient. See: Nutritional medicine for measles]

"When the live viral measles vaccine is given, it depletes the children of their existing supply of Vitamin A."--Mary Megson MD

"We all know that the vaccinating of the children of Japan against small-pox— a disgraceful mass medication spree engineered by our conquering army’s medical doctors—resulted in putting eye-glasses on fully 50% of the race that Admiral Perry—back in 1870—reported to have the "finest eyesight of any nation in the world." --TM Schippell ND

Albitar S, et al.     Bilateral retrobulbar optic neuritis with hepatitis B vaccination. Nephrol Dial Transplant. 1997 Oct;12(10):2169-70. No abstract available.PMID: 9351086; UI: 98012356.

Baglivo E, et al.      Multiple evanescent white dot syndrome after hepatitis B vaccine. Am J Ophthalmol. 1996 Sep;122(3):431-2. PMID: 8794720; UI: 96387180.
Berkman N.  [A case of segmentary unilateral occlusion of the central retinal vein following hepatitis B vaccination]. Presse Med. 1997 Apr 26;26(14):670. French. No abstract available.PMID: 9180888; UI: 97324783.
Bienfang DC, et al.    Ocular abnormalities after influenza immunization. Arch Ophthalmol. 1977 Sep;95(9):1649. No abstract available.PMID: 561590; UI: 77266169.

Brezin A, et al.    Visual loss and eosinophilia after recombinant hepatitis B vaccine. Lancet. 1993 Aug 28;342(8870):563-4. No abstract available.PMID: 8102709; UI: 93360669.

Fong KS, et al.  Multiple evanescent white dot syndrome--an uncommon cause for an enlarged blind spot. Ann Acad Med Singapore. 1996 Nov;25(6):866-8. Review. PMID: 9055018; UI: 97207761.
Granel B, et al. [Occlusion of the central retinal vein after vaccination against viral hepatitis B with recombinant vaccines. 4 cases]. Presse Med. 1997 Feb 1;26(2):62-5. French. PMID: 9082411; UI: 97226577.       
Hull TP, et al.     Optic neuritis after influenza vaccination. Am J Ophthalmol. 1997 Nov;124(5):703-4. PMID: 9372734; UI: 98040003.

Helies P, et al.    [Oculo-palpebral complication of vaccination. Review of the literature]. J Fr Ophtalmol. 1994;17(1):62-6. Review. French. PMID: 8176177; UI: 94230905.
Kazarian EL, et al.     Optic neuritis complicating measles, mumps, and rubella vaccination. Am J Ophthalmol. 1978 Oct;86(4):544-7. PMID: 707601; UI: 79039497.

Kawasaki A, et al.    Bilateral anterior ischemic optic neuropathy following influenza vaccination. J Neuroophthalmol. 1998 Mar;18(1):56-9. PMID: 9532544; UI: 98193723.

Kline L, Margulies SL, Oh SJ. Optic neuritis and myelitis following rubella vaccination. Arch Neurol 1982;39:443-4.
Milkowski S.   [Ocular complications following influenza]. Wiad Lek. 1971 Jan 15;24(2):103-8. Polish. No abstract available.PMID: 5100901; UI: 71109124.

McKibbin M, et al.    Bilateral optic neuritis after hepatitis A. J Neurol Neurosurg Psychiatry. 1995 Apr;58(4):508. No abstract available.PMID:  7738570; UI: 95256879.       

Ray CL, et al.    Bilateral optic neuropathy associated with influenza vaccination. J Neuroophthalmol. 1996 Sep;16(3):182-4. PMID: 8865010; UI: 97018394      

Voigt U, Baum U, Behrendt W, Hegemann S, Terborg C, Strobel J.  [Neuritis of the optic nerve after vaccinations against hepatitis A, hepatitis B and yellow fever] Klin Monatsbl Augenheilkd. 2001 Oct;218(10):688-90. German.PMID: 11706386 [PubMed - indexed for MEDLINE]

Schuil J, van de Putte EM, Zwaan CM, Koole FD, Meire FM.  Retinopathy following measles, mumps, and rubella vaccination in an immuno-incompetent girl.Int Ophthalmol. 1998;22(6):345-7.PMID: 10937849 [PubMed - indexed for MEDLINE]

Solomon A, et al.     Bilateral simultaneous corneal graft rejection after influenza vaccination. Am J Ophthalmol. 1996 Jun;121(6):708-9. PMID: 8644815; UI: 96243666.

Solomon A, et al.   Adverse ocular effects following influenza vaccination. Eye. 1999 Jun;13 (Pt 3A):381-2. No abstract available.[MEDLINE record in process]PMID: 10624444; UI: 20089570.

Stevenson VL, et al. Optic neuritis following measles/rubella vaccination in two 13-year-old children. Br J Ophthalmol. 1996 Dec;80(12):1110-1. No abstract available.PMID: 9059281; UI: 97212425.

Kawasaki A, et al.    Bilateral anterior ischemic optic neuropathy following influenza vaccination. J Neuroophthalmol. 1998 Mar;18(1):56-9. PMID: 9532544; UI: 98193723.

Simultaneous administration of hepatitis B and polio vaccines associated
with bilateral optic neuritis

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EDITOR,-Immunisation against hepatitis B is recommended when there is an
increased risk of contracting the virus because of lifestyle, occupation, or
factors such as close contact with a case. Immunisation against
poliomyelitis is routinely given to infants in the UK with reinforcement
during childhood and then again in the teenage years. For those individuals
at continued risk of infection, further reinforcing doses are given every 10
years.

Both are commonly used vaccines and serious adverse reactions are extremely
rare. We describe a case of severe bilateral, progressive optic neuritis
occurring 1 week after vaccination against hepatitis B and poliomyelitis.

CASE REPORT

A 44 year old female health worker presented with gradual reduction of
vision in both eyes associated with retrobulbar discomfort exacerbated by
ocular movement, 7 days after vaccination against hepatitis B and
poliomyelitis. Ophthalmological findings revealed visual acuities of 6/18
right eye, 6/12 left eye associated with bilateral optic nerve swelling.
Within the next 48 hours the visual acuities dropped to perception of light
in both eyes with absent direct and indirect pupillary light responses. This
was despite commencement of therapy with intravenous methylprednisolone.
Systemic examination revealed no other abnormalities. All haematological and
biochemical investigations were normal and no infective cause was isolated.
Computed tomograph imaging was normal and there was no evidence of
demyelination on magnetic resonance imaging. Cerebrospinal fluid (CSF)
examination revealed no abnormality either biochemically, after culture, or
on electrophoresis. In addition, CSF pressure was within normal limits.
Visually evoked potentials revealed absent responses. Despite 5 days of
intravenous methylprednisolone (1 g per day) followed by a slow tapering of
oral prednisolone (1 mg/kg/day) her vision remained poor (counting fingers
at 1 metre in both eyes) after 3 months.

COMMENT

The recombinant hepatitis B vaccine has been associated with a diverse range
of isolated adverse reactions but ocular complications are exceedingly rare.
Granel et al attributed four cases of central retinal vein occlusion in
patients under 50 years of age to the vaccine,1 and associations with
multiple evanescent white dot syndrome (MEWDS)2 and acute posterior
multifocal placoid pigment epitheliopathy (APMPPE)3 have been described.
Various related neurological and systemic features of an autoimmune nature
have been reported including CNS demyelination.4 Bilateral optic neuritis
occurs occasionally in acute hepatitis B infection.5 6

Vaccines derived from live attenuated viruses such as the trivalent oral
polio vaccine can cause direct viral infections of the central nervous
system.7 The incidence of vaccine derived paralytic poliomyelitis is
reported as being one in three million in recipients of the vaccine or their
close contacts.7 The vaccine has also been linked to some cases of
Guillain-- Barre syndrome7 but ocular complications have not been reported.

Others such as the trivalent measles, mumps, and rubella (MMR) vaccines and
the monovalent rubella vaccine,9 have also been associated with bilateral
optic neuritis.

The exact mechanisms behind neurological complications following vaccination
are unknown but various hypotheses exist including immune complex mediated
demyelination or neurotoxicity, antigenic mimicry between the stimulating
vaccine derived antigen and normal or altered host tissue proteins,
immediate hypersensitivity reactions, and stimulation of a pathogenic
lymphocytic response.

Adverse neurological reactions generally occur 1-3 weeks following
vaccination which supports the claim that vaccination was the aetiological
factor in this case. To the best of our knowledge, this is the first report
of this complication with either of the two individual vaccines. The fact
that there are many case reports describing a diverse variety of systemic
reactions of an autoimmune nature associated with both vaccines also adds to
the claim. Those cases of optic neuritis attributed to other vaccines and to
post infectious optic neuritis generally did better with corticosteroid
therapy than in our case but high dose corticosteroids are generally
considered to be the treatment of choice in these rare but potentially
devastating complications.

1 Granel B, Disdier P, Devin F, et al. Occlusion of the central retinal vein
after vaccination against viral hepatitis B with recombinant vaccines. 4
cases. Press Med 1997;26:62-5.

2 Baglivo E, Safran AB, Borruat FX. Multiple evanescent white dot syndrome
after hepatitis B vaccine. Am J Ophthalmol 1996;122:431 2.

3 Brezin AP, Massin-Korobelnik P, Boudin M, et al. Acute posterior
multifocal placoid pigment epitheliopathy after hepatitis B vaccine. Arch
Ophthalmol 1995;113:297-300.

4 Kaplanski G, Retornaz F, Durand J, et al Central nervous system
demyelination after vaccination against hepatitis B and HLA haplotype. J
Neurol Neurosurg Psychiatry 1995;58:758-9.

5 Galli M, Morelli R, Casellato A, et al. Retrobulbar optic neuritis in a
patient with acute type B hepatitis. Neurol Sci 1986;72:195-200.

6 Achiron LR. Postinfectious hepatitis B optic neuritis. Optom Vis Sci
1994;71:53-6.

7 Fenichel GM. Neurological complications of immunization. Ann Neurol
1982;12:119-27.

8 Stevenson VL, Acheson JF, Ball J, et al. Optic neuritis following
measles/rubella vaccination in two 13-year-old children. Br J Ophthalmol
1996; 80:1110-11.

9 Kline L, Margulies SL, Oh SJ. Optic neuritis and myelitis following
rubella vaccination. Arch Neurol 1982;39:443-4.

OWEN STEWART

BERNARD CHANG

JOHN BRADBURY

Department of Ophthalmology, Bradford Royal Infirmary, Bradford, West
Yorkshire

Correspondence to: Mr Owen Stewart, Department of Ophthalmology, St James's
University Hospital, Leeds, West Yorkshire, LS9 7TF.

Accepted for publication 18 May 1999
British Journal of Ophthalmology
Date:  10/01/1999
Owen Stewart; Bernard Chang; John Bradbury

Children with adverse effects from Hepatitis B vaccine

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