Measles Vaccines Reactions - OPTIC NEURITIS

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OPTIC NEURITIS
Clinical Description
Patients with optic neuritis present with unilateral or bilateral
impairment of vision. This process can be transient, with full recovery
following, or the loss of vision can be permanent. In most instances the
underlying pathogenesis is demyelination involving the optic nerve. Chapter
3 contains a more detailed discussion of optic neuritis. No
population-based incidence rates were identified.

History of Suspected Association
Measles virus and measles vaccine have long been studied for their ability
to cause demyelinating disorders. The committee was charged with
investigating a possible causal relation between only measles vaccine and
optic neuritis.

Evidence for Association
Biologic Plausibility
Chapter 3 contains a description of the general biologic plausibility for a
role for vaccines, particularly live viral vaccines, in causing
demyelinating disorders. There are no data bearing on the biologic
plausibility that measles vaccine specifically can cause optic neuritis.

Case Reports, Case Series, and Uncontrolled Observational Studies
There are several reports of optic neuritis following measles vaccination.
A 6-year-old boy developed bilateral optic neuritis 18 days after an
injection of MMR. He was treated with corticosteroids and experienced a
complete resolution after several weeks (Kazarian and Gager, 1978).
Marshall et al. (1985) described a 16-month-old girl who experienced an
acute loss of vision 16 days after an injection of MMR. Two days earlier
she felt warm to the touch and developed a cough, conjunctivitis, and a
generalized maculopapular rash. Examination revealed diffuse
chorioretinitis and papilledema, which ultimately evolved into a "salt and
pepper" pattern. Seven months later she improved, but she had macular
scarring. Riikonen (1989) described 18 children with optic neuritis
following infection, vaccination, or both. Of those 18, 10 went on to
develop multiple sclerosis. Six of these children had been vaccinated
between 3 days and 1 month before the onset of optic neuritis, but none had
received measles vaccine during that time period. All 18 of the children
were reported to have received measles vaccine (unspecified) between 12 and
18 months of age; the age of onset of optic neuritis ranged from 5 years 2
months to 14 years 10 months.

Controlled Observational Studies
None.

Controlled Clinical Trials
None.

Causality Argument
There is demonstrated biologic plausibility of a causal relation between
optic neuritis and measles vaccine, in that measles virus is associated
with demyelinating disorders. The number of reported cases is too small and
the data contained within the reports are too equivocal to support a
positive association between measles vaccine and optic neuritis. As
discussed in Chapter 3, optic neuritis can result from many causes and is
frequently associated with multiple sclerosis.

Conclusion
The evidence is inadequate to accept or reject a causal relation between
measles vaccine and optic neuritis.