Tuscan Regional Centre of Pharmacovigilance, Interdepartmental Centre for Research in Clinical Pharmacology and Experimental Therapeutics, University of Pisa, School of Medicine and Surgery, Pisa, Italy.
Ann Pharmacother. 2011 Jan;45(1):e8. doi: 10.1345/aph.1P480. Epub 2010 Dec 28.
To describe 2 cases of autoimmune hemolytic anemia (AIHA) following the administration of MF59-adjuvanted influenza vaccine.
An 83-year-old white woman developed persistent hyperpyrexia, polyarthralgia, and lower limb hypostenia about 2 days after receiving influenza vaccine. Clinical signs and laboratory evaluations suggested AIHA. The patient was treated with high-dose corticosteroids and immunoglobulins, and her clinical condition improved. A 74-year-old white woman developed severe abdominal pain and asthenia 3 days after the administration of influenza vaccine. Clinical signs and laboratory evaluations disclosed AIHA. She was treated with corticosteroids, rehydration, and blood transfusion; however, she died about 48 hours after hospitalization.
AIHA has been rarely described following influenza vaccine administration. In the cases described here, the causal relationship between influenza vaccination and the occurrence of AIHA, assessed by means of World Health Organization criteria, was scored as probable. It has been proposed that the mechanism whereby vaccines induce autoimmune responses can be molecular mimicry, although a possible role of other vaccine constituents, with particular regard for adjuvants, such as MF59, can not be excluded. Squalene, a constituent of MF59, has been suggested as a causative agent of autoimmune reactions. However, it is not clear how and under what conditions squalene can cause immune responses.
Influenza vaccination may rarely trigger severe AIHA, shortly after vaccine administration. A mechanism of molecular mimicry is probably involved in the development of these reactions, although the possible role of adjuvants can not be excluded. Patients should be instructed to report signs and symptoms of autoimmune disorders occurring in the first weeks after administration of influenza vaccine.
描述接种 MF59 佐剂流感疫苗后发生的 2 例自身免疫性溶血性贫血（AIHA）。
一名 83 岁白人女性在接种流感疫苗后约 2 天出现持续高热、多发性关节炎和下肢无力。临床体征和实验室评估提示 AIHA。患者接受了大剂量皮质类固醇和免疫球蛋白治疗，临床状况改善。一名 74 岁白人女性在接种流感疫苗后 3 天出现严重腹痛和乏力。临床体征和实验室评估显示 AIHA。她接受了皮质类固醇、补液和输血治疗；然而，她在住院后约 48 小时死亡。
接种流感疫苗后很少描述 AIHA。在这里描述的病例中，根据世界卫生组织标准评估，流感疫苗接种与 AIHA 发生之间的因果关系被评为可能。有人提出，疫苗引起自身免疫反应的机制可能是分子模拟，尽管不能排除其他疫苗成分（特别是 MF59 等佐剂）可能发挥作用。角鲨烯是 MF59 的一种成分，被认为是自身免疫反应的致病剂。然而，角鲨烯如何以及在什么条件下引起免疫反应尚不清楚。
流感疫苗接种后可能会在疫苗接种后不久引发严重的 AIHA。可能涉及分子模拟机制，但不能排除佐剂的可能作用。应告知患者在接种流感疫苗后第一周内报告自身免疫性疾病的体征和症状。
