Hepatitis B Vaccination Should Be Avoided in Patients With Risk of CNS Disease

WESTPORT, Aug 04 (Reuters Health) - French researchers report eight cases in which patients developed central nervous system inflammation and demyelinating disease less than 10 weeks after receiving a hepatitis B vaccination.

The results of MRI suggested acute disseminated encephalomyelitis, according to a multicenter team led by Dr. A. Tourbah, of Hopital de la Salpetriere in Paris. However, over a mean follow-up period of 18 months "...clinical follow-up, repeated MRI, or both showed the persistence of inflammatory activity, which makes this encephalitis more suggestive of MS than of acute disseminated encephalomyelitis," the team writes.

Two patients had a family history of multiple sclerosis, according to the report. A few years earlier, a third patient had experienced sensitive symptoms compatible with a Lhermitte sign.

The risk of CNS inflammation after hepatitis B vaccination is unknown, according to the researchers. They note, in their paper in the second July issue of Neurology, that epidemiologic studies under way in Europe and the United States may help resolve the question.

"In the absence of an immediate answer, it would seem reasonable to treat these patients as having MS and, as a precautionary measure, to avoid hepatitis B vaccination in patients with a personal or familial history of symptoms suggestive of an inflammatory or demyelinating disease of the CNS."

Neurology 1999;53:396-401.