Do Vaccines Cause Optic Neuritis or Neuromyelitis Optica?

Conclusion | Epidemiological Evidence | Proposed Biological Mechanism | Archives | References


Vaccines currently routinely recommended to the general population in the U.S.* have not been shown to cause optic neuritis or neuromyelitis optica (NMO).

Epidemiological Evidence

The 2012 report by the Institute of Medicine (IOM) [1], now called the National Academy of Medicine (NAM), described two studies assessing optic neuritis and MMR, influenza, hepatitis B, diphtheria and tetanus vaccines [2, 3], but these studies did not provide convincing evidence due to a lack of validity and precision. The IOM found no relevant studies of quality in the literature assessing optic neuritis and pertussis vaccine or NMO and MMR, influenza, hepatitis B or HPV vaccines [1].

Studies published since the 2012 IOM report have not found evidence of an association between vaccination and optic neuritis. A prospective cohort study of 189,629 females receiving quadrivalent HPV vaccine (Gardasil) in California did not find a statistically significant association with optic neuritis [4]. A Vaccine Safety Datalink study found no cases of optic neuritis in over 200,000 pregnant women within 42 days after receiving trivalent inactivated influenza vaccine [5].

Proposed Biological Mechanism

Anti-phosphatidylcholine antibodies have been suggested as a potential cause of optic neuritis [6]. A highly specific immunoglobulin G autoantibody that targets aquaporin-4 is present in up to 80% of patients with NMO [7, 8]. One possible mechanism for this is molecular mimicry, which refers to the possibility that similar epitopes shared between self-peptides and foreign peptides (introduced via infection or immunization) inadvertently cause the activation of autoreactive T or B cells, leading to autoimmunity. Another possible mechanism is activation of the complement system, in which a cascade of proteolysis and successive release of cytokines functions to amplify the immune response but can damage host cells if not properly regulated. Other mechanisms that could contribute to optic neuritis or NMO include formation of immune complexes, as well as direct or persistent viral infection. Natural infection with wild-type measles, mumps or rubella viruses has been associated with optic neuritis, albeit very rarely [1].

The 2012 IOM report described two cases of optic neuritis after MMR [9, 10], two cases of optic neuritis after influenza vaccine showing a reoccurrence of symptoms after vaccine rechallenge [11, 12], and one case of NMO after rubella vaccine [13]; however, even when considering knowledge about the aforementioned natural infections, the IOM concluded that this mechanistic evidence was weak. The IOM also concluded that there was no mechanistic evidence for an association between optic neuritis and hepatitis B, diphtheria, tetanus or pertussis vaccines, or between NMO and influenza, hepatitis B, HPV, measles or mumps vaccines [1].


1. Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
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3. Payne DC, Rose CE, Jr., Kerrison J, Aranas A, Duderstadt S, McNeil MM. Anthrax vaccination and risk of optic neuritis in the United States military, 1998-2003. Arch Neurol 2006;63:871-5.
4. Chao C, Klein NP, Velicer CM, et al. Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. J Intern Med 2012;271:193-203.
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6. Korematsu S, Miyahara H, Kakita A, Izumi T. Elevated serum anti-phosphatidylcholine IgG antibodies in patients with influenza vaccination-associated optic neuritis. Vaccine 2014;32:6345-8.
7. Jarius S, Wildemann B, Paul F. Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clin Exp Immunol 2014;176:149-64.
8. Wingerchuk DM, Weinshenker BG. Neuromyelitis optica (Devic's syndrome). Handbook of clinical neurology 2014;122:581-99.
9. Riikonen RS. Retinal vasculitis caused by rubella. Neuropediatrics 1995;26:174-6.
10. Stevenson VL, Acheson JF, Ball J, Plant GT. Optic neuritis following measles/rubella vaccination in two 13-year-old children. Br J Ophthalmol 1996;80:1110-1.
11. Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P. Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine 2009;27:2114-20.
12. Hull TP, Bates JH. Optic neuritis after influenza vaccination. Am J Ophthalmol 1997;124:703-4.
13. Kline LB, Margulies SL, Oh SJ. Optic neuritis and myelitis following rubella vaccination. Arch Neurol 1982;39:443-4.