Evidence Update: Vaccination and Autoimmune Disease

One of the potential adverse effects of vaccination is the triggering of autoimmune diseases in susceptible individuals. There is some evidence in humans, for example, that the routine MMR vaccine (which prevents measles, mumps, and rubella) can trigger an autoimmine disease, called ITP, which destroys platelets and reduces a patient’s ability to form normal blood clots. The evidence suggests this occurs in roughly 1-3 children for every 100,000 MMR vaccinations.

While this is a real and serious risk, it is important to note that not only are the diseases prevented by this vaccine a much greater risk, but it turns out that these disease can also cause ITP and at a much higher rate than the vaccine (1 child out of every 3,000-6,000 cases). Therefore, the benefit of vaccination is clearly greater than the risk in this case.

There is, as always, far less data to determine what, if any, risk of autoimmune disease there is in vaccination of dogs and cats. Both ITP and IMHA, another autoimmune disease involving destruction of red blood cells, occur in dogs, and these have been reported to follow vaccination. However, the relevant research literature is sparse, flawed, and inconsistent. The bottom line from my previous review of the literature was this:

Bottom Line

  • Little evidence vaccination causes IMHA/ITP
  • No consistent temporal association
  • Data are weak
  • Overwhelming majority of vaccinated animals do not develop these diseases
  • Infection can be a greater risk for IMHA/ITP than vaccination
  • Don’t vaccinate more than necessary
  • Don’t vaccinate less than necessary
  • Don’t avoid vaccination out of fear of IMHA/ITP

A small piece of additional evidence was recently presented at the American College of Veterinary Internal Medicine (ACVIM) 2017 Forum.

Moon, AKB. Veir, J. Vaccination Behavior and Adverse Events in Dogs Treated for Primary Immune-Mediated Hemolytic Anemia (Abstract HM17) ACVIM Forum, National Harbor, MD, 2017.

This study surveyed the owners and veterinarians of dogs who had been diagnosed with IMHA. Such dogs are frequently not vaccinated once they recover from the disease because of concerns that vaccination might trigger a relapse. This is often done even when there is no specific reason to think vaccination triggered the initial episode. It is a reasonable precaution, but since it is not clear that vaccination actually is a risk factor for ITP or IMHA, it is possible that these dogs are being left vulnerable to infectious diseases unnecessarily.

In this small study, survey results were available for 44 dogs. There were several relevant findings:

  1. The average time from most recent vaccination to the initial onset of IMHA was 351 days. Such a long period makes it unlikely that vaccination was a major trigger for IMHA in many of these dogs. It still might have been in the subset who were vaccinated closer in time to the onset of their illness. This study found no such temporal relationship, but a different study design would be necesary to confirm that.Previous studies have found only a small proportion of IMHA cases received vaccinations in the 2-4 weeks before the onset of their illness, and most found no difference in recent vaccination rates between dogs who developed these diseases and comparison dogs who did not. So far, the overall data suggests that vaccination is rarely a proximal trigger for these autoimmune disease, though whether they play a role as an overall risk factor isn’t known.
  2. About half of the dogs had not been vaccinated since their IMHA diagnosis. This is consistent with the common practice of many vets to eschew vaccination in dogs who have had a history of autoimmune disease. However, about half of these dogs did receive vaccines after their diagnosis, and almost all of these were rabies vaccines. This is likely because rabies vaccination is legally required in most of the U.S. and exceptions are not always allowed for dogs with a history of autoimmune disease.Only 2 of the 21 dogs who were vaccinated following their IMHA had any reported adverse reaction. These two reactions were typical of the acute hypersensitivity reaction seen with vaccination. No relapse of IMHA or other autoimmune disease was reported in the vaccinated dogs. This suggests that such dogs may not be more sensitive to vaccination than other dogs, though again the size and methodology of this study is not adequate to demonstrate that with any certainty.
  3. Though this is just a small bit of data, it does fit into the larger context of existing evidence in dogs, and the much more comprehensive evidence in humans, suggesting that vaccines play an extremely small role, if any, in triggering such autoimmune diseases, While caution is warranted, and certainly unnecessary vaccination should be avoided on principle, there is no justification for extreme and confident claims that vaccines are a major cause of these autoimmune diseases in our pets or that what risk may exist outweighs the benefits of appropriate vaccination.
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58 Responses to Evidence Update: Vaccination and Autoimmune Disease

  1. Ruth says:

    My beautiful, healthy (7) year old lab received his annual shots Sept 27. He had never had an reactions. He received the rabies, DHLPP, Flu and Bordotella vaccines. Two days later he became confused, another day or two he began to trip going up the steps, the next day he was having trouble walking up the hill on our morning walk, the next day he would just look into his water bowl and did not know how to drink, he then began walking like a drunk person, he then did not know how to eat, he then started non stop pacing. We doctored with him every day for a month until we could see that our soul dog Ollie would never be the same in this life time and that he could not handle anymore. We lost him on October 24 almost one month after his shots. We are grieving in a huge way and questioning what went wrong. Are the shots to blame, did this healthy beauty have an underlying condition, was his time just up? We know that we will never know for sure what happened to him, but we would appreciate your thoughts.

  2. skeptvet says:

    I’m so sorry you had to go through this. Unfortunately, when hundreds of thousands of dogs get vaccinated regularly, the chances are that some who are going to get sick for other reasons will happen to do so following a vaccine. The way that we try to tell if the vaccines are a cause or a coincidence is with studies that look at many dogs who get sick with particular diseases and see if the number who gets sick within a certain time after vaccination is higher than the number who don’t get sick following vaccines. So far, we have not found any pattern for any particular disease that suggests the timing of vaccination is anything more than a coincidence. I don’t know what happened with Ollie or why, but there isn’t any reason to think the timing of vaccines was anything other than a coincidence.

    All the best.

  3. Ruth says:

    Thank you for responding. We have felt that there must have been an underlying condition that we had no idea about, even though his blood work was perfect and x Rays. His RBC plummeted from 7.68 to 5.37 one week after the shots. Wouldn’t that imply autoimmune involvement?

    I also worried about the quantity of immunizations at once. What is your opinion to that?

    Thanks for your help.

  4. Barry Herrero says:

    So sorry to hear your story. My 10 year old healthy soul mate dog got a rabies booster and developed auto immune anemia and died three months after the vaccine. She did not have any condition that would have caused the disease. The vaccine killed my beloved soulmate. I will never give my dogs rabies boosters.

  5. hannah says:

    I had the same coincidence with my beautiful retriever. He got his shots, along with a wellness exam in November at the vet we went to for years. The vet exclaimed how healthy he was and vitals were all good. Within two days, he slowed down and progressed to inability to eat. Within two months, he was dead. After multiple blood tests with platelets plummeting from normal range to “2” and severe anemia, his diagnosis was ITP. My intuition tells me he should still be here if I hadn’t gotten his annual vaccinations after age five. I fully understand the benefit of vaccinations and am the furthest in beliefs from any “anti-vaxer” out there.

  6. skeptvet says:

    Yes, I understand why such experiences, as painful as they are, can be so compelling. All I can say is that we vaccines may be a trigger for ITP, but so can many other things that we don’t see. The vast majority of ITP cases haven’t had vaccines recently, so we know there are. many other triggers. And, as you say, vaccines do a great deal of good. The sad reality is that even if vaccines prevent far more suffering than they cause, and they most certainly do, we can’t guarantee they won’t cause problems in some rare individuals. I still think that you made the right choice based on the best evidence.

  7. VK says:

    We have two black lab sisters we adopted as puppies from the humane society around 2008. In 2011, one of our labs developed IMHA (her immune system attacked red blood cells resulting in extreme anemia). What we went through with her was awful!! The prednasone made her back like raw hamburger (I have pictures of her back, the specialty vet had never seen anything like it and took pictures, I covered my dog with a winter jacket when I took her to the vet so people wouldn’t get grossed out in the waiting room, instead they would comment on her pretty jacket), we did a blood transfusion, I tried nursing her back to health, daily, for months and months. At one point early on, before the blood transfusion, we were going to put her down but my college-aged son insisted we didn’t, that she was tough and would survive.

    We spent thousands and thousands of dollars through this ordeal to try to help her survive. Luckily, she survived but has her life-long residual battle wounds of a hard time walking, weak hind muscles that makes it hard for her to get up or go up stairs, thick welts of scar tissue on her back (the thick fur grew back and luckily hides it) but she is happy and we’re happy to see her happy. I call her our “lucky-to-be-alive dog”. When we take her to the park and see her prancing around carrying her ball in her mouth, we are so very happy for her.

    Would I go through all of this again? Probably not. We don’t have the financial means to do it all over again nor do I have the energy or stamina to go through that again so I would probably have to let the dog go. However, we’ve met other people who have spent thousands of dollars to try to save their dogs too and at the time, when you’re in the whirlwind, you just say yes and yes to what the vets say they could try. And once you try one thing, like a blood transfusion, and it helps but doesn’t “fully” recover the dog, then you think well maybe a second blood transfusion will do it, and you end up in a cycle of attempts that pile up into a lot of money. I’m not faulting the vets in any way, it’s just the emotional events that occur that makes a person so blurred about what to do. And one vet was very realistic with us, cautioning us about the possibilities and even suggested it was maybe time to put her down. The vets really were awesome as we went through this process but we had to go to a specialty vet because the scope of our dog’s disease was far beyond what our regular vet was capable or equipped to handle.

    So what does my story have to do with this article? It really makes me question whether the immunization is what caused the IMHA vs a tick bite or other possibilities. We will never know unless there’s a way to test her blood now for specific antibodies or whatever they would test her for.

    Also, we have NOT immunized her at all since she recovered back in 2015 per our vet’s recommendations. In fact, we just had a long, serious discussion with our vet yesterday again about whether we should give her the rabies vaccination because we take our dog to the dog park, and our vet (and us of course) is still extremely apprehensive to vaccinate her. Why? Because it could kill her.

    And if our dog would accidentally cause an open wound on someone, like scratched a person’s arm with her tooth or something and broke skin, they could insist our dog get tested for rabies. How do you test a dog for rabies? You have to kill them.

    So we’re faced with a choice of 1) letting our dog live out her life (she’s almost 11 yrs old now) or 2) giving her a rabies vaccine that could kill her and may never have been needed in the first place for the likely short couple of years she has left. And if we choose option 2 and she dies, all the effort and money we spent to save her in the first place is negated.

    And while I never gave a second thought to our other black lab who has been fine, now after reading the responses above and this article, it concerns me whether our other black lab who just got her vaccines yesterday could develop IMHA. Ugh!

  8. L says:

    Your dog has an autoimmune disorder. Just ask your vet to sign a waver for the rabies vaccine.
    It basically says that your dog cannot have the rabies vaccine due to a medical condition.
    I would give up the dog park and keep the dog on leash whenever outside.

    “I have examined the animal above and determined that, in my professional opinion, there is considerable risk of harm to the animal from the administration of a rabies vaccine as required by law”
    You can present this when you take your dog for emergency care, some town halls accept it and allow you to license your dog.

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