Vaccination and autoimmune disease: what is the evidence?

• Published in: The Lancet (British edition) Vol. 362; no. 9396; pp. 1659 - 1666
• Main Authors: Wraith, David C, Goldman, Michel, Lambert, Paul-Henri
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 15-11-2003; Lancet; Elsevier Limited
• Subjects: Antigen presentation; Antigens; Autoantigens; Autoimmune diseases; Autoimmune Diseases - etiology; Autoimmunity - immunology; Biological and medical sciences; Disease; Disease control; Environmental factors; Epidemiology. Vaccinations; Fail safe systems; General aspects; Guillain-Barre syndrome; Herpes viruses; Humans; Immune response; Immune system; Immunology; Infection - complications; Infection - immunology; Infections; Infectious diseases; Laboratories; Lymphocytes; Medical sciences; Microorganisms; Molecular Mimicry; Multiple sclerosis; Peptides; Public health; Risk; Surveillance; Vaccination - adverse effects; Vaccines; Vaccines - adverse effects; Vaccines - immunology; Viral diseases; Viral infections; Human; Immunopathology; Prevalence; Vaccination; Predisposition; Complication; Autoimmune disease; Review
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(03)14802-7

As many as one in 20 people in Europe and North America have some form of autoimmune disease. These diseases arise in genetically predisposed individuals but require an environmental trigger. Of the many potential environmental factors, infections are the most likely cause. Microbial antigens can induce cross-reactive immune responses against self-antigens, whereas infections can non-specifically enhance their presentation to the immune system. The immune system uses fail-safe mechanisms to suppress infection-associated tissue damage and thus limits autoimmune responses. The association between infection and autoimmune disease has, however, stimulated a debate as to whether such diseases might also be triggered by vaccines. Indeed there are numerous claims and counter claims relating to such a risk. Here we review the mechanisms involved in the induction of autoimmunity and assess the implications for vaccination in human beings.
Published online June 3, 2003 http://image.thelancet.com/extras/02art9340web.pdf