COVID‐19 Vaccination and Autoimmune Disorders: A Scoping Review

Abstract

Background: Upon the global COVID-19 vaccination campaign, unprecedented in the history of public health, concerns have emerged regarding potential associations between vaccination and autoimmune disorders. Historical research has long identified mechanisms by which vaccines might trigger or unmask autoimmune processes. However, systematic synthesis of evidence concerning COVID-19 vaccines and autoimmunity remains limited.Objective: To review the literature on associations between COVID-19 vaccination and autoimmunity, focusing on six conditions: Graves’ disease, Hashimoto’s thyroiditis, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, and type 1 diabetes mellitus.Methods: Following a published protocol, we conducted a scoping review of studies retrieved from PubMed and the WHO COVID-19 database. Inclusion criteria required empirically verifiable clinical manifestations of autoimmune disease following COVID-19 vaccination.Results: Across 109 included studies, relapses or flares in patients with autoimmune disorders were reported in nearly 60% of studies, while about one-quarter described new-onset autoimmune disorders in persons without prior autoimmunity. Several mechanisms of action linking COVID-19 vaccination and autoimmune disorders were identified such as autoimmune inflammatory syndrome induced by adjuvants, molecular mimicry, bystander immune activation, and interactions with immunosuppressive and disease modifying therapies. Serious adverse events, though less common than mild or moderate ones, were also documented. Vaccine efficacy was claimed but empirical support was often lacking. Conclusions: This review highlights the substantial patterns of reported associations of autoimmune disorders following COVID-19 vaccination, in patients with and without prior autoimmunity. The benefits of vaccination are claimed but evidence for them is lacking. A proper evaluation of risks and benefits is needed to support vaccination recommendations given the reported associations between it and autoimmune disorders.