Immunization in Patients With Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system characterized by inflammatory demyelination and some axonal damage. An overactive or dysfunctional immune response to self-antigen is believed to be the pathogenic mechanism and therefore the treatment of MS often involves immunosuppressive therapy. Because of altered immune function in patients with MS, questions arise about risk of infections in this population and the safety and efficacy of common immunizations. The risk of MS exacerbation with common infections and safety and efficacy of immunization are reviewed along with the available guidelines for use of vaccines in patients with MS.

Vaccination in Multiple Sclerosis: Friend or Foe?

“…Theoretically, an increased immune response against different types of vaccines, such as live attenuated viruses, inactive attenuated viruses, or portions of bacteria and viruses, could trigger increased immune response to self-antigens (45, 58, 96), but an increased risk for MS itself or increased relapse rates after vaccination have not been show (with exception for YF) in case-control studies (7). There is, however, evidence that infections can trigger relapses in MS (96–104), which is why vaccination of MS patients should be pursued in order to reduce the risk of infections. To assure the best vaccination success, immunization and immunosuppressive treatments have to be well timed.…”

Vaccination and autoimmunity: Influenza vaccination and association with multiple sclerosis

“…measles and varicella), inactive viruses (e.g. seasonal influenza and hepatitis A), or portions of viruses or bacteria [e.g., hepatitis B, human papiloma virus (HPV), and pneumococcus] vaccines, that have been included among the environmental factors, might also induce an aberrant immune response against self-antigens 82 . Many common infections are known to induce a transient rise in autoantibody production.…”

Specific aspects of modern life for people with multiple sclerosis: considerations for the practitioner

“…However, readministration of the vaccines is recommended, once immune competence has been restored [Cahill et al 2010]. The use of live attenuated vaccines may carry a risk of infections and complications in patients receiving immunosuppressants, including steroids, and should therefore be avoided [Cahill et al 2010]. While live attenuated vaccines are considered safe for patients receiving an immunomodulator such as glatiramer acetate or interferon [Goldman et al 2006], physicians should refer to specific guidelines before administering vaccines in patients with MS. For the more recently approved agents (natalizumab, fingolimod and teriflunomide), there are relatively few data on the concomitant use of live attenuated vaccines and current guidance is summarized here.…”

“…However, a study published by DeStefano and colleagues indicated that vaccinations for influenza, hepatitis B, tetanus, measles and rubella are safe for patients with MS and are not associated with an increased risk of the development of MS or optic neuritis [DeStefano et al 2003]. A study by Cahill and colleagues recommends that patients with MS, and their physicians, should consider, unless there are specific contraindications, the influenza vaccine as a safe and effective prophylactic option in advance of the influenza season [Cahill et al 2010]. The live attenuated influenza virus vaccine (nasal), however, is not recommended for people with MS [National Multiple Sclerosis Society, 2013a].…”

“…Inactivated vaccines are generally considered safe for patients with MS, including those who are taking interferon, glatiramer acetate, mitoxantrone or natalizumab. However, readministration of the vaccines is recommended, once immune competence has been restored [Cahill et al 2010]. The use of live attenuated vaccines may carry a risk of infections and complications in patients receiving immunosuppressants, including steroids, and should therefore be avoided [Cahill et al 2010].…”