Questions on vaccinations

mdoherty mdoherty at atlas.niaid.nih.gov
Tue Jan 20 12:41:05 EST 1998


In article <34c076de.9650871 at news.innet.be>, nospam at innet.be (G. Van
Nuffel) wrote:

> On Wed, 14 Jan 1998 11:15:29 -0500, mdoherty at atlas.niaid.nih.gov
> (mdoherty) wrote:
> 
> To reply by E-mail, replace nospam by gvnuffel. 
> 
> Hi Mark,
> 
> After reading your posting, I suspect you are an immunologist.

Guilty as charged  :-)

Just to answer your questions..

> After 12 months prednisolone taking (will be 0 mg end March '98, it
> took the med's 3 months to diagnose the disease), starting from 48 mg
> , 32 mg ,16 mg down to 3 mg now (16 to 3 in about 8 months), how do
> you consider the risk her body will still remember it was "breaking
> down" her veins mistaking some cell(s) (proteins ?) from them for
> invaders ?

The short answer is yes - but fortunately, things are not quite as dire as
that makes it sound. Prednisolone stops the symptoms by "turning down" the
immune response generally.  In an autoimmune disease, the stimulus (in this
case, probably some component of endothelial cells) will still be there, so
immune cells reactive with those components will probably be retained. 
However, most individuals have some autoimmune cells in circulation - and
the body has mechanisms for keeping them under control.  What happens in a
case of triggered autoimmune response is that these cells are sufficiently
stimulated to break free of this control.  By damping the response back
down with prednisolone, your doctor is trying to decrease the numbers and
activity of the autoimmune cells to the point where your wife's normal
control mechanisms can regain control - and normally that's what happens.

> >The second (or third, or fourth etc) time,
> >the response is faster and stronger - and often the disease is wiped out
> >before it can cause you any significant illness. 
> 
> Is this also possible with polyarteritis nodosa ? 
> When end March the prednisolone taking (should) will be stopped, we
> hope there will be no retake of the disease because the MD's are
> thinking to use chemo in that case. 
> My wife, being a nurse, doesn't like the idea of chemo at all. She
> knows the risks and side effect very well !

I hope very much that's the case, too.  As you are both well aware,
chemotherapy is a last - or next to last - resort, because the side effects
are often pretty drastic.  Unfortunately, there is no way to tell in
advance whether the prednisolone treatment will be all that is required -
often it is.

> >Subunit vaccines.
> 
> Like the (latest) hepatitis B vaccine from SKB ?

Yes.  Since the subunit vaccines are more specifically targeted, the
chances of a cross-reaction leading to autoimmunity are much smaller.  Of
course "much smaller" still doesn't mean zero.  Because of the way the
immune system works, I doubt *any* effective vaccine could be completely
safe in all people.

> >Still, some vaccines CAN induce side effects - sometimes very serious - in
> >people.  Remember that a vaccine works by mimicking - in a reduced way - a
> >disease, and people vary a lot in their response to disease.  
> 
> But in the case of the hepatitis B shot, the producent knows "nothing"
> about the possibility of the vaccine triggering polyarteritis nodosa.

Here it is important that whoever is producing the vaccine should know that
you have this side effect and and that you think it may be connected to the
vaccination.  Without this we will never get the best picture on how safe a
vaccine is.

> Far from willing to help "curing" it or any other positive response.
> The MD treating her has sended the producent a complete case report
> but they seem to try to hold things off by asking more questions.
> There were already cases (reported) in the past, so MD's do not want
> to keep spending time answering questions when the producent seems to
> do nothing with the answers. So, first trying to cure the patient and
> maybe answering the questions later, they react.
> Don't the producents have to keep some records of and do some research
> on the reported cases ?

Before any vaccine is allowed to be sold in the EU, it has to pass three
satges of testing.  The first stage is simply to ensure that the vaccine is
safe, and normally involves several hundred volunteers.  The next two
stages test both safety and effectiveness and normally involves hundreds or
thousands of patients.  That means that they can say "we gave this vaccine
to 5 thousand people and nobody got any significant side effects - but it
would miss a side effect that occurred one in 10,000, or 1 in a  million. 
That technically is defined as safe, but it's not much comfort if you are
that 1 in 10,000 person.

> How is it possible they still "do not know" about this risk ?
> Only vascullitis is mentioned in the product insert, but that's just a
> symptom of polyarteritis nodosa, not the autoimmune disease itself.

It is possible that either this particular side effect is so uncommon that
it has escaped notice until now - in which case it is important that the
company *is* notified about it.  Alternatively, it is possible that they do
know but are trying to avoid admitting it in case they have a legal
liability.  It's sad that this could happen, but unfortunately it does,
whenever businesses are involved in healthcare.  Again - that makes it
important that you get as much documented about this as possible, so that
if you are entitled to compensation, you do not miss out.

I wish you all the very best,

Mark Doherty



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