DMEK and the Influenza (Flu) Vaccine

Fall weather is upon us and along with it comes an unwelcome guest--flu season. According to the Centers for Disease Control (CDC), influenza viruses typically circulate widely in the United States annually, from the late fall through the early spring. Since it takes a few weeks for the body to build antibodies to fight the virus, so it is advisable to receive the vaccine in early Fall.
Although most people with influenza will recover, influenza can cause serious illness and death, particularly among older adults, very young children, pregnant women, and those with certain chronic medical conditions. You can review FAQs of the 2017-2018 Flu Season on the CDC website
For cornea transplant recipients, the vaccine does not harm the graft. The problem is that the vaccine stimulates the immune system which can recognize the graft as foreign material and try to eliminate it just as it would an infection. According to Dr. Francis Price, getting the flu would cause a stronger immune response than the vaccine alone, which does not contain a live virus. In summary, having a cornea transplant is not a reason to avoid receiving the flu vaccine.
If you have had a DMEK cornea transplant, in previous years you have may been told to increase your steriod dosing two days before your flu vaccine and 14 days after. Since DMEK is relatively new, it was unknown if the vaccine could harm the transplant so the increased dosing provided additional protection as your immune system responds to the vaccine.
At the Cornea Research Foundation of America, our continued and active tracking of long-term cornea transplant outcomes has now shown that if you have had DMEK and are otherwise healthy, you may now continue to take steroid drops as prescribed with no increased dosing prior to or after the influenza vaccine. "We are excited to show that longitudinal tracking of transplant outcomes continues to reveal new discoveries and benefits for post-operative DMEK recipients," said Marianne Price, executive director of the Foundation.
If you are planning to have DMEK this fall, Dr. Price and Dr. Feng advise waiting 30 days after your surgery to receive the influenza vaccine.
You need to continue with the increased steroid dosing regimen (two days before and 2 weeks after) if you had a:
  • DMEK and are no longer taking steroids for any number of reasons
  • DSEK transplant
  • Penetrating Keratoplasty (full-thickness transplant)
  • Anterior Lamellar Keratoplasty (transplant of the front portion of the cornea)
Increased dosing is recommended for transplant types other than DMEK due to the higher risk of rejection. Our research has shown continued rejection risk of less than 1% with DMEK. If you have questions about the flu vaccine or are unsure of your transplant type, please speak to your primary care physician or ophthalmolgist.
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