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Post Vaccination Optic Neuritis: Observations From the SARS-CoV-2 Pandemic

103 Pages Posted: 28 Jul 2021

See all articles by Lidia Martinez Alvarez

Lidia Martinez Alvarez

Barking, Havering and Redbridge University Hospitals NHS Trust - Birmingham and Midland Eye Centre

Yan Ning Neo

Government of the United Kingdom - Moorfields Eye Hospital

Indran Davagnanam

Government of the United Kingdom - Moorfields Eye Hospital; University College Hospital

Michael Ashenhurst

Government of the United Kingdom - Moorfields Eye Hospital; University of Calgary

James Acheson

Government of the United Kingdom - Moorfields Eye Hospital

Ahmed Abdel-Hay

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Daniah Alshowaeir

King Saud University - College of Medicine

Mashair Bakheet

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Oscar Balaguer

Hospital Vall d’Hebron

Ruchika Batra

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Tasanee Braithwaite

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham; Government of the United Kingdom - Ophthalmology Department

Fion Bremner

University College London - National Hospital for Neurology and Neurosurgery

Zelie Britton

University College London - National Hospital for Neurology and Neurosurgery

Wallace Brownlee

University College London - National Hospital for Neurology and Neurosurgery

Ailbhe Burke

Government of the United Kingdom - Moorfields Eye Hospital

Anna Camós Carreras

Hospital Clínic de Barcelona - Institut Clínic de Oftalmología

Fiona Costello

University of Calgary - Clinical Neurosciences and Surgery

Sarah Coulette

Hospital Foundation Adolphe De Rothschild

Nieves De Las Rivas Ramirez

Hospital de la Serranía de Ronda

Romain Deschamps

Hospital Foundation Adolphe De Rothschild

Clare Fraser

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Lorna Galleguillos

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Hector Fernandez Jimenez Ortiz

Hospital Universitario de Fuenlabrada

Jose Flores-Rivera

Hospital de la Serranía de Ronda

Caroline Froment Tilikete

Hospices Civils de Lyon - Service of Neurocognition and Neuro-Ophthalmology

Jose Manuel Guajardo

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Zhaleh Khaleeli

University College London - National Hospital for Neurology and Neurosurgery

Pierre Lardeux

Hospices Civils de Lyon - Service of Neurocognition and Neuro-Ophthalmology

Lisa Lagrou

University College London - National Hospital for Neurology and Neurosurgery

Ruth Martín

University College London - National Hospital for Neurology and Neurosurgery

Dalia Meira

University College London - National Hospital for Neurology and Neurosurgery

Katherine Miszkiel

University College London - National Hospital for Neurology and Neurosurgery

Silvia Muñoz

Bellvitge University Hospital

Victoria Nowak

University College London - National Hospital for Neurology and Neurosurgery

Lola Ogunbowale

Government of the United Kingdom - Moorfields Eye Hospital

Eoin O’Sullivan

King's College London - King's College Hospital Foundation Trust

Friedemann Paul

Charité Universitätsmedizin Berlin - Experimental and Clinical Research Center and NeuroCure Clinical Research Center

Alfonso J. Rodriguez-Morales

Technological University of Pereira; Fundación Universitaria Autónoma de Las Americas - Grupo de Investigación Biomedicina

Bernardo Sanchez Dalmau

Hospital Universitari Vall d'Hebron of Barcelona

Federico Sadun

Rome Eye Hospital

Aksel Siva

Istanbul University Cerrahpaşa - Cerrahpasa School of Medicine

Muriel Spörri

Government of the United Kingdom - Moorfields Eye Hospital

Martin Stangel

Hannover Medical School - Clinical Neuroimmunology and Neurochemistry

Kurt-Wolfram Sühs

Hannover Medical School - Clinical Neuroimmunology and Neurochemistry

Anand Trip

University College London - National Hospital for Neurology and Neurosurgery

Ahmed T. Toosy

University College London - UCL Queen Square Institute of Neurology; Government of the United Kingdom - Moorfields Eye Hospital

Melih Tutuncu

Istanbul University Cerrahpaşa - Cerrahpasa School of Medicine

Mike Wattjes

Hannover Medical School - Clinical Neuroimmunology and Neurochemistry

John Woolmore

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham

Sui H. Wong

Government of the United Kingdom - Moorfields Eye Hospital

Jasmin Zvorničanin

Tuzla University Clinical Center

Franz Marie Cruz

University of the Philippines, Manila - College of Medicine

Axel Petzold

NHS Foundation Trust - NIHR Biomedical Research Centre; Government of the United Kingdom - Moorfields Eye Hospital

More...

Abstract

Background: Vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first approved on the 8th of December 2020. Though safe and effective, very rare side effects continue to be identified as global vaccination advances. They do not necessarily leave “a signal” in public registries if the incidence remains below previously reported total incidence levels. Optic neuritis (ON) is a rare but recognised adverse event after immunisation. The risk of post-vaccination ON and visual outcome in the context of global vaccination efforts against SARS-CoV-2 are not known. 

Methods: A global report on 73 deep-phenotyped individuals with post-SARS-CoV-2 vaccination ON observed in 15 of 55 countries with designated experts between 14 February to 18 July 2021. Statistical analyses were performed on type of vaccine, number of jabs, time to onset of ON, demographics, clinical features and treatment. Paraclinical data included immunological testing for autoantibodies against myelin oligodendrocyte glycoprotein (MOG) and aquaporin-4, magnetic resonance imaging (MRI) of the brain and orbits, retinal optical coherence tomography (OCT). The primary outcome was the visual acuity (VA). 

Findings: The characteristics of the 69 individuals included, differed from pre-COVID whole population-based incidence studies in frequency of bilateral presentation, age distribution and radiological features more commonly found in immune-mediated ON. Most events (67%) occurred after vaccination with AstraZeneca, followed by Pfizer-BioNTech (26%) and Sinovac (7%). In 56 this was after the first and in 13 after the second jab with the same vaccine. Autoantibodies against MOG were present in 15 and not detected for aquaporin-4. The condition was steroid responsive in most (58/62), requiring plasma exchange in a few (5) with spontaneous recovery in the remainder (7). The incidence was highest in the UK (0.036 per 100,000 persons) where vaccination commenced earliest. Importantly, the pattern of presentation in time lagged about 1-5 weeks behind the pattern of national age group vaccination. The median VA at presentation was logMAR 1.0 and recovered to 0.0. 

Interpretation: Post-SARS-CoV-2 vaccination ON is an extremely rare adverse event with generally good outcome of visual function. The global incidence of post-vaccination ON (0.0017 per 100,000 persons) is lower than for ON (3.74 per 100,000 persons in the UK). A causal relationship is plausible, but the overall risk benefit balance is in favour of SARS-CoV-2 vaccination.

Funding Information: None.

Declaration of Interests: None.

Ethics Approval Statement: Reporting of patients was approved by the Institutional Research Board at Moorfields Eye Hospital (study number CaRS_24).

Suggested Citation

Alvarez, Lidia Martinez and Ning Neo, Yan and Davagnanam, Indran and Ashenhurst, Michael and Acheson, James and Abdel-Hay, Ahmed and Alshowaeir, Daniah and Bakheet, Mashair and Balaguer, Oscar and Batra, Ruchika and Braithwaite, Tasanee and Braithwaite, Tasanee and Bremner, Fion and Britton, Zelie and Brownlee, Wallace and Burke, Ailbhe and Carreras, Anna Camós and Costello, Fiona and Coulette, Sarah and De Las Rivas Ramirez, Nieves and Deschamps, Romain and Fraser, Clare and Galleguillos, Lorna and Jimenez Ortiz, Hector Fernandez and Flores-Rivera, Jose and Tilikete, Caroline Froment and Guajardo, Jose Manuel and Khaleeli, Zhaleh and Lardeux, Pierre and Lagrou, Lisa and Martín, Ruth and Meira, Dalia and Miszkiel, Katherine and Muñoz, Silvia and Nowak, Victoria and Ogunbowale, Lola and O’Sullivan, Eoin and Paul, Friedemann and Rodriguez-Morales, Alfonso J. and Rodriguez-Morales, Alfonso J. and Sanchez Dalmau, Bernardo and Sadun, Federico and Siva, Aksel and Spörri, Muriel and Stangel, Martin and Sühs, Kurt-Wolfram and Trip, Anand and Toosy, Ahmed T. and Toosy, Ahmed T. and Tutuncu, Melih and Wattjes, Mike and Woolmore, John and Wong, Sui H. and Zvorničanin, Jasmin and Cruz, Franz Marie and Petzold, Axel and Petzold, Axel, Post Vaccination Optic Neuritis: Observations From the SARS-CoV-2 Pandemic. Available at SSRN: https://ssrn.com/abstract=3889990 or http://dx.doi.org/10.2139/ssrn.3889990

Lidia Martinez Alvarez

Barking, Havering and Redbridge University Hospitals NHS Trust - Birmingham and Midland Eye Centre ( email )

Birmingham
United Kingdom

Yan Ning Neo

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

Indran Davagnanam

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

University College Hospital

Ibadan
Nigeria

Michael Ashenhurst

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

University of Calgary

University Drive
Calgary, T2N 1N4
Canada

James Acheson

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

Ahmed Abdel-Hay

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham ( email )

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Daniah Alshowaeir

King Saud University - College of Medicine ( email )

Saudi Arabia

Mashair Bakheet

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham ( email )

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Oscar Balaguer

Hospital Vall d’Hebron ( email )

Barcelona
Spain

Ruchika Batra

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham ( email )

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Tasanee Braithwaite

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham ( email )

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Government of the United Kingdom - Ophthalmology Department ( email )

162 City Road
London
United Kingdom

Fion Bremner

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Zelie Britton

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Wallace Brownlee

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Ailbhe Burke

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

Anna Camós Carreras

Hospital Clínic de Barcelona - Institut Clínic de Oftalmología ( email )

Barcelona
Spain

Fiona Costello

University of Calgary - Clinical Neurosciences and Surgery ( email )

Calgary
Canada

Sarah Coulette

Hospital Foundation Adolphe De Rothschild

29 Rue Manin
Paris
France

Nieves De Las Rivas Ramirez

Hospital de la Serranía de Ronda ( email )

Malaga
Spain

Romain Deschamps

Hospital Foundation Adolphe De Rothschild

29 Rue Manin
Paris
France

Clare Fraser

Facultad de Medicina Clínica Alemana Universidad del Desarrollo ( email )

Santiago de Chile
Chile

Lorna Galleguillos

Facultad de Medicina Clínica Alemana Universidad del Desarrollo ( email )

Santiago de Chile
Chile

Hector Fernandez Jimenez Ortiz

Hospital Universitario de Fuenlabrada ( email )

Madrid
Spain

Jose Flores-Rivera

Hospital de la Serranía de Ronda ( email )

Malaga
Spain

Caroline Froment Tilikete

Hospices Civils de Lyon - Service of Neurocognition and Neuro-Ophthalmology ( email )

France

Jose Manuel Guajardo

Facultad de Medicina Clínica Alemana Universidad del Desarrollo ( email )

Santiago de Chile
Chile

Zhaleh Khaleeli

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Pierre Lardeux

Hospices Civils de Lyon - Service of Neurocognition and Neuro-Ophthalmology ( email )

France

Lisa Lagrou

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Ruth Martín

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Dalia Meira

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Katherine Miszkiel

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Silvia Muñoz

Bellvitge University Hospital ( email )

Catalonia
Spain

Victoria Nowak

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Lola Ogunbowale

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

Eoin O’Sullivan

King's College London - King's College Hospital Foundation Trust

Bessemer Road
London, SE5 9PJ
United Kingdom

Friedemann Paul

Charité Universitätsmedizin Berlin - Experimental and Clinical Research Center and NeuroCure Clinical Research Center ( email )

Berlin
Germany

Alfonso J. Rodriguez-Morales

Fundación Universitaria Autónoma de Las Americas - Grupo de Investigación Biomedicina ( email )

Pereira, Risaralda
Colombia

Technological University of Pereira

Mexico

Bernardo Sanchez Dalmau

Hospital Universitari Vall d'Hebron of Barcelona ( email )

Barcelona
Spain

Federico Sadun

Rome Eye Hospital ( email )

Rome
Italy

Aksel Siva

Istanbul University Cerrahpaşa - Cerrahpasa School of Medicine ( email )

Istanbul
Turkey

Muriel Spörri

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

Martin Stangel

Hannover Medical School - Clinical Neuroimmunology and Neurochemistry ( email )

Hannover, 30625
Germany

Kurt-Wolfram Sühs

Hannover Medical School - Clinical Neuroimmunology and Neurochemistry ( email )

Hannover, 30625
Germany

Anand Trip

University College London - National Hospital for Neurology and Neurosurgery ( email )

London
United Kingdom

Ahmed T. Toosy

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

University College London - UCL Queen Square Institute of Neurology

Queen Square
London
United Kingdom

Melih Tutuncu

Istanbul University Cerrahpaşa - Cerrahpasa School of Medicine ( email )

Istanbul
Turkey

Mike Wattjes

Hannover Medical School - Clinical Neuroimmunology and Neurochemistry ( email )

Hannover, 30625
Germany

John Woolmore

Government of the United Kingdom - Queen Elizabeth Hospital Birmingham ( email )

Mindelsohn Way
Birmingham, B15 2TH
United Kingdom

Sui H. Wong

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

Jasmin Zvorničanin

Tuzla University Clinical Center ( email )

Tuzla
Bosnia and Herzegovina

Franz Marie Cruz

University of the Philippines, Manila - College of Medicine ( email )

Manila
Philippines

Axel Petzold (Contact Author)

NHS Foundation Trust - NIHR Biomedical Research Centre ( email )

London
United Kingdom

Government of the United Kingdom - Moorfields Eye Hospital ( email )

162 City Road
London
United Kingdom

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