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Eye (Lond). Nov 2012; 26(11): 1498.
Published online Aug 10, 2012. doi:  10.1038/eye.2012.146
PMCID: PMC3496087
A case of post-vaccination optic neuritis: coincidence or causative?
S Sudarshan,1* E H Z Huang,2 P L Lim,3 Y S Leo,4 and S A Lim4
1Yong Loo Lin School of Medicine, Singapore
2Singapore National Eye Centre, Singapore
3Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
4Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
*E-mail: seshasudarshan/at/gmail.com
We wish to address our article ‘Retrobulbar optic neuritis after Hepatitis A vaccination in a HIV-infected patient',1 in which we suggested a temporal association between Hepatitis A vaccination and optic neuritis. The patient's subsequent progress is shown in Figure 1. As our patient sero-converted after the first dose, he did not receive further Hepatitis A or other vaccinations during the follow-up period.
Figure 1
Figure 1
Timeline of events of patient.
He was diagnosed with multiple sclerosis (MS), 3 years after the occurrence of optic neuritis. We now feel that the initial two events are more likely coincidental than causative.
Since our earlier article, case reports continue to suggest an association between vaccination and optic neuritis.2, 3 Larger studies, however, are still unable to establish a definite link. Besides those mentioned previously, Liang et al4 recently reported the occurrence of three cases of optic neuritis in the post-marketing surveillance of 89.6 million doses of Influenza A (H1N1) vaccine in China, between September 2009 and March 2010, and concluded that there was no observable pattern of adverse events after the administration of influenza A (H1N1) vaccine. One caveat of this study is the passive reporting of adverse events making underreporting likely. Despite this, the incidence of optic neuritis (post-vaccination) is 0.003 cases per 100 000 doses, much lower than the rate of 0.89 per 100 000 for optic neuritis in Singaporean Chinese.5
On longer follow-up of this patient, it appears that the two events are more likely coincidental. We feel that patients who develop post-vaccination optic neuritis should be followed up as they may develop demyelinating syndromes years later.
Notes
The authors declare no conflict of interest.
  • Huang EH, Lim SA, Lim PL, Leo YS. Retrobulbar optic neuritis after Hepatitis A vaccination in a HIV-infected patient. Eye. 2009;23 (12:2267–2271. [PubMed]
  • Sutton I, Lahoria R, Tan I, Clouston P, Barnett M. CNS demyelination and quadrivalent HPV vaccination. Mult Scler. 2009;15 (1:116–119. [PubMed]
  • Jo DH, Kim SJ, Chae JH, Yu YS. The clinical characteristics of optic neuritis in Korean children. Korean J Ophthalmol. 2011;25 (2:116–120. [PMC free article] [PubMed]
  • Liang XF, Li L, Liu DW, Li KL, Wu WD, Zhu BP, et al. Safety of influenza A (H1N1) vaccine in postmarketing surveillance in China N Engl J Med 2011. 364(7638–647.647Erratum in: N Engl J Med 2011; 364(15): 1481. [PubMed]
  • Lim SA, Wong WL, Fu E, Goh KY, Seah A, Tan C, et al. The incidence of neuro-ophthalmic diseases in Singapore: a prospective study in public hospitals. Ophthalmic Epidemiol. 2009;16 (2:65–73. [PubMed]
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