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

[CIS-PIDD]

Hi Victoria,

We sometimes see these kids in concert with our Neuroimmunology folks, and the position that we take is that after B-cell constitution, it should be fine to resume inactivated vaccines.  My colleagues in neurology tell me that they have not had issues with NMDAR encephalitis flares with inactivated vaccines (though I'm curious if others have had different experience).

Re the IVIG, we generally wait for at least 3 months for immunoglobulin to wash out before giving inactivated vaccines.   Post- rituxan, if B cells are still zero, I would not bank on seeing a vaccine response.

What is her serum IgG/A/M currently?

Best,
Mike


-------------------------

Michael D. Keller MD

Assistant Professor, Division of Allergy / Immunology

Center for Cancer and Immunology Research

Children's National Health System

111 Michigan Ave NW, M7745A

Washington, DC 20010

Clinic: 202.476.3016

Office: 202.476.5843

Fax: 202.476.2280

www.childrensnational.org


________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, March 16, 2016 6:19 PM
To: CIS-PIDD
Subject: [cis-pidd] Vaccinations following immunosuppression in NMDA receptor encephalitis

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.<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_20878418-23&d=CwMFAg&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=z59mEWDH8ZCipio1KCkcNNuFLVVmdMtsFOedKJDG2Rc&s=OjWD2Ly7aZ7EJpHGIP72kI6xGu5BPI4eFFaO4iSRv4I&e=> 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<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_-3Fterm-3DHofmann-2520C-255BAuthor-255D-26cauthor-3Dtrue-26cauthor-5Fuid-3D20878418&d=CwMFAg&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=z59mEWDH8ZCipio1KCkcNNuFLVVmdMtsFOedKJDG2Rc&s=rtBJBGwOkfk0s4ssxnSUIAEld4Jce9hKj_XhKAK1Rjg&e=>, Baur MO<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_-3Fterm-3DBaur-2520MO-255BAuthor-255D-26cauthor-3Dtrue-26cauthor-5Fuid-3D20878418&d=CwMFAg&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=z59mEWDH8ZCipio1KCkcNNuFLVVmdMtsFOedKJDG2Rc&s=3NPXLAjMEisr8_JLbWyduftgy094o0qgWAPokoKxFq0&e=>, Schroten H<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_-3Fterm-3DSchroten-2520H-255BAuthor-255D-26cauthor-3Dtrue-26cauthor-5Fuid-3D20878418&d=CwMFAg&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=z59mEWDH8ZCipio1KCkcNNuFLVVmdMtsFOedKJDG2Rc&s=wRBb1Dv45CXVhvsGgcuUoOPGmXYAEgZOLTC8YpziNDQ&e=>.

PMID:
20878418
[PubMed - indexed for MEDLINE]









---

You are currently subscribed to cis-pidd as: mkeller at childrensnational.org<mailto:mkeller at childrensnational.org>.

To unsubscribe click here: http://cts.dundee.net/u?id=103356975.2feedb0edc55e38c9c805588973b0280&n=T&l=cis-pidd&o=3530228<https://urldefense.proofpoint.com/v2/url?u=http-3A__cts.dundee.net_u-3Fid-3D103356975.2feedb0edc55e38c9c805588973b0280-26n-3DT-26l-3Dcis-2Dpidd-26o-3D3530228&d=CwMFAg&c=Zoipt4Nmcnjorr_6TBHi1A&r=mERX_I8PKb0Uil9coedoT1CtvFqkSey45L0vbcX0oKI&m=z59mEWDH8ZCipio1KCkcNNuFLVVmdMtsFOedKJDG2Rc&s=Zrar-_heX-bikhnMo1dn5VpcwMavFRoDckq0lCTT5Zc&e=>

(It may be necessary to cut and paste the above URL if the line is broken)

or send a blank email to leave-3530228-103356975.2feedb0edc55e38c9c805588973b0280 at lyris.dundee.net<mailto:leave-3530228-103356975.2feedb0edc55e38c9c805588973b0280 at lyris.dundee.net>

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.

---
You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://cts.dundee.net/u?id=96396833.5a9591ccd1e327fe6bc4d1543298c482&n=T&l=cis-pidd&o=3530367
or send a blank email to leave-3530367-96396833.5a9591ccd1e327fe6bc4d1543298c482 at lyris.dundee.net
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://pairlist7.pair.net/pipermail/pagid/attachments/20160317/cee3038d/attachment-0001.html>