[CIS PIDD] [cis-pidd] Vaccinations following immunosuppression in NMDA receptor encephalitis

[CIS-PIDD]

Hi all,

We would appreciate your input regarding resuming immunizations in patients with autoimmune encephalitis.

We have a 5 year old child with NMDA-R encephalitis now improving and nearly back to baseline although requiring anti-epileptic medication for infrequent seizures.

The patient presented 5 months ago and was managed with high dose IVIG x 3 doses, pulse steroids (weaned 2 months ago), and a single dose of Rituximab. They are on low dose MMF presently.  T and B cell subsets done one month ago showed no B cells.

He is due for his 4-6 year immunizations (DTaP-IPV and MMR-V) and the admitting service was wondering how to proceed. Current recommendations suggest waiting 11 months after high dose IVIG for live vaccines and 6+ months after Rituximab for inactivated vaccines. However we were unsure whether there were special considerations for NMDA receptor encephalitis given the theoretical risk of immune system activation leading to recurrence of symptoms.

We found a case study suggesting an association (see below), but wondered whether anyone had experience with resuming vaccinations in this particular patient population?

Any input would be appreciated!


Dr. Victoria Cook PGY-4
Allergy and Clinical Immunology
University of British Columbia
41-01536


J Neurol.<http://www.ncbi.nlm.nih.gov/pubmed/20878418#> 2011 Mar;258(3):500-1. doi: 10.1007/s00415-010-5757-3. Epub 2010 Sep 30.
Anti-NMDA receptor encephalitis after TdaP-IPV booster vaccination: cause or coincidence?
Hofmann C<http://www.ncbi.nlm.nih.gov/pubmed/?term=Hofmann%20C%5BAuthor%5D&cauthor=true&cauthor_uid=20878418>, Baur MO<http://www.ncbi.nlm.nih.gov/pubmed/?term=Baur%20MO%5BAuthor%5D&cauthor=true&cauthor_uid=20878418>, Schroten H<http://www.ncbi.nlm.nih.gov/pubmed/?term=Schroten%20H%5BAuthor%5D&cauthor=true&cauthor_uid=20878418>.

PMID:
20878418
[PubMed - indexed for MEDLINE]









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