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Immunologic Research

, Volume 60, Issue 2–3, pp 376–383 | Cite as

Chronic fatigue syndrome and fibromyalgia following immunization with the hepatitis B vaccine: another angle of the ‘autoimmune (auto-inflammatory) syndrome induced by adjuvants’ (ASIA)

  • Nancy Agmon-Levin
  • Yaron Zafrir
  • Shaye Kivity
  • Ari Balofsky
  • Howard Amital
  • Yehuda ShoenfeldEmail author
PATHOGENESIS AND THERAPY IN AUTOIMMUNE DISEASES

Abstract

The objectives of this study were to gather information regarding demographic and clinical characteristics of patients diagnosed with either fibromyalgia (FM) or chronic fatigue (CFS) following hepatitis B vaccination (HBVv) and furthermore to apply the recently suggested criteria of autoimmune (auto-inflammatory) syndromes induced by adjuvants (ASIA), in the aim of identifying common characteristics that may suggest an association between fibromyalgia, chronic fatigue and HBV vaccination. Medical records of 19 patients with CFS and/or fibromyalgia following HBVv immunization were analyzed. All of which were immunized during 1990–2008 in different centers in the USA. All medical records were evaluated for demographics, medical history, the number of vaccine doses, as well as immediate and long term post-immunization adverse events and clinical manifestations. In addition, available blood tests, imaging results, treatments and outcomes were analyzed. ASIA criteria were applied to all patients. The mean age of patients was 28.6 ± 11 years, of which 68.4 % were females. 21.05 % had either personal or familial background of autoimmune disease. The mean latency period from the last dose of HBVv to onset of symptoms was 38.6 ± 79.4 days, ranging from days to a year. Eight (42.1 %) patients continued with the immunization program despite experiencing adverse events. Manifestations that were commonly reported included neurological manifestations (84.2 %), musculoskeletal (78.9 %), psychiatric (63.1 %), fatigue (63.1 %), gastrointestinal complains (58 %) and mucocutaneous manifestations (36.8 %). Autoantibodies were detected in 71 % of patients tested. All patients fulfilled the ASIA criteria. This study suggests that in some cases CFS and FM can be temporally related to immunization, as part of ASIA syndrome. The appearance of adverse event during immunization, the presence of autoimmune susceptibility and higher titers of autoantibodies all can be suggested as risk factors. ASIA criteria were fulfilled in all patients eluding the plausible link between ASIA and CFS/FM.

Keywords

Autoimmune (auto-inflammatory) syndromes induced by adjuvants (ASIA) Vaccines Autoimmunity Hepatitis B vaccine Fibromyalgia Chronic fatigue syndrome 

Notes

Conflict of interest

Prof. Yehuda Shoenfeld has served as an expert witness in cases involving adverse vaccine reactions in the no-fault U.S. National Vaccine Injury Compensation Program. All other authors have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Nancy Agmon-Levin
    • 1
    • 2
  • Yaron Zafrir
    • 1
  • Shaye Kivity
    • 1
    • 2
    • 3
  • Ari Balofsky
    • 1
  • Howard Amital
    • 2
    • 4
  • Yehuda Shoenfeld
    • 1
    • 5
    Email author
  1. 1.The Zabludowicz Center for Autoimmune DiseasesChaim Sheba Medical CenterTel-HashomerIsrael
  2. 2.Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  3. 3.The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013Sheba Medical CenterTel-HashomerIsrael
  4. 4.Department of Medicine BSheba Medical CenterTel-HashomerIsrael
  5. 5.Sackler Faculty of Medicine, Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune DiseasesTel-Aviv UniversityTel AvivIsrael

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