Tuesday, October 23, 2012

Reversible blindness in bilateral optic neruritis associated with nasal flu vaccine

Flu vaccines would be fine for everyone to take each year if the benefit exceeded the risk plus cost.  The cost in a drug store to be vaccinated is about $25.  No benefit can be demonstrated in those over 65 or in younger children, where 90% of flu deaths occur.  (See several posts from earlier this week for more details.)  In teens and healthy adults the vaccine probably stops some cases of flu.  But the side effect below, although a known potential vaccine side effect, is not measured after flu vaccinations to see how common it is, despite its devastating effect.

Thus we have some evidence that flu vaccine causes an excess of 1-5 cases per million vaccinated, but we have no idea how many excess optic neuritis cases occur.  Nor do we have rates for other illnesses caused by flu vaccine.

Reversible blindness in bilateral optic neruritis associated with nasal flu vaccine.

Crawford CGrazko MBRaymond WR 4thRivers BAMunson PD.
Various case reports have shown possible associations between optic neuritis and different vaccines. Some of the vaccines include influenza, hepatitis B and anthrax
To present evidence for a causal relationship between optic neuritis and Live Attenuated Influenza Vaccine (LAIV), administered as nasal flu vaccine.
Case Report. In a 13-year-old male with bilateral optic neuritis, detailed clinical history, neuro-ophthalmologic examination, magnetic resonance imaging, stereo-disc photos, visual field testing, ocular coherence tomography, blood tests and cerebral spinal fluid analysis were performed.
Exam findings on presentation: BCVA: 20/CF OD; 20/LP OS. Positive relative afferent pupil defect OD. Unremarkable anterior segment and posterior segment exam. No papillitis or papilledema. Global visual field defect OU based on Humphrey 30-2. MRI: diffuse enlargement of Optic Chiasm with inflammation of distal optic nerves bilateral. Blood cultures and CSF were negative. Patient received 3 divided doses of methyl prednisone with mild improvement of vision upon hospital discharge and marked improvement of vision at 2 month follow up.
In this child, no infectious, vascular, granulomatous, viral or immune-related cause of optic neuritis was identified. This case provides compelling evidence that supports the nasal flu vaccination as a cause of optic neuritis.

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