Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis

Farez, Mauricio; Correale, Jorge

doi:10.1001/archneurol.2011.131

Cited by 88 publications

(76 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent report concerned seven patients with multiple sclerosis who had a 12.8-fold higher relapse rate following 17D vaccination compared to the pre-immunization period, enlarging plaque size on MRI, and increases in myelin basic protein and biomarkers of inflammation/immune activation [30]. This could be due to nonspecific immune activation, consistent with the large array of genes turned on during the early response to 17D virus [31,32], but requires clinical confirmation.…”

Section: Neurologic Adverse Eventsmentioning

confidence: 98%

Review of the risks and benefits of yellow fever vaccination including some new analyses

Monath

2012

Expert Review of Vaccines

126

View full text Add to dashboard Cite

The live, attenuated yellow fever (YF) 17D vaccine provides highly effective and durable immunity and is widely used for travelers to and residents of endemic areas of South America and Africa. Neurotropic and viscerotropic serious adverse events associated with these vaccines occur rarely, but YF 17D vaccine-associated viscerotropic disease (YEL-AVD) is notable for its lethality. There appear to be two distinct patterns of risk for YEL-AVD: the first in younger persons, particularly women, with defects in innate immunity, in whom the case-fatality rate is higher; and the second in elderly persons, particularly men with age-related immune senescence and a lower case-fatality rate. From 1990 to the present, the number of cases (n = 31) and deaths (n = 12) from YEL-AVD in travelers has exceeded the reports of YF (n = 6) acquired by natural infection, raising the question whether the risk of vaccination exceeds the benefit in travelers. To provide some guidance on this point, the rate of vaccine-related injury is compared with the rate of naturally acquired disease in a new analysis that estimates the immunologically susceptible denominator population in YF endemic and epidemic areas. For many years, the risk of vaccine-related illness and death was similar to the risk of illness and death from natural infection with YF in South America. Africa posed a substantially higher estimated risk of wild-type YF than vaccine-related injury. Multiple factors should be considered in making decisions about YF vaccination, including specific destination, season of the year, local evidence for YF transmission, likelihood of exposure to vector mosquitoes and individual risk factors for YEL-AVD, with the goal of increasing vaccine coverage for travel to high-risk areas and reducing unnecessary vaccination. Prospects for future, safer vaccines are also described.

show abstract

Section: Neurologic Adverse Eventsmentioning

confidence: 98%

Review of the risks and benefits of yellow fever vaccination including some new analyses

Monath

2012

Expert Review of Vaccines

126

View full text Add to dashboard Cite

show abstract

“…The majority of studies investigating relapse incidence in patients undergoing vaccinations against influenza (including the H1N1 subtype), hepatitis B and tetanus did not demonstrate any associations [65][66][67][68] . The relationship between attenuated vaccines (such as the vaccine against yellow fever) and relapse risk warrants further investigation [69] . Episodes of infectious diseases were invariably associated with higher risk of relapses [70][71][72][73][74][75] .…”

Section: Individual Risk Factors and Predictorsmentioning

confidence: 99%

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Kalinčík

2015

Neuroepidemiology

138

View full text Add to dashboard Cite

Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies.

show abstract

“…The general impression (except for vaccination against yellow fever) is that vaccinations in MS and ON appear safe, neither increasing the risk of development of these diseases nor relapses during MS. However, based on the potentially increased risk of relapses after yellow fever vaccination seen in one study of only 7 patients with relapsing-remitting MS, it is in daily practice recommended to avoid live vaccines, for example against yellow fever, during and in particular shortly after the dosing of secondor third-line treatment of MS 6 . This may limit the patients travelling to risk areas of the relevant infection.…”

Section: Resultsmentioning

confidence: 99%

Vaccines and multiple sclerosis

Frederiksen

Mailand

2017

Acta Neurol Scand

View full text Add to dashboard Cite

Funding information TevaAn association between certain vaccinations and onset or relapse of multiple sclerosis (MS) has been debated. Based on PubMed, we made a thorough literature review and included all relevant studies, 51 on MS and 15 on optic neuritis (ON). Case studies were excluded. With the exception of a live vaccine against yellow fever, vaccinations appear safe in untreated patients with MS and ON. However, most studies were underpowered, and small risks cannot be excluded. One study of BCG vaccination after the first demyelinating event showed even a reduced risk of developing MS. Further studies are needed to fully exclude a causal association. The objective of this review is to investigate the following:• The potential role of vaccines as a predisposing factor for the development of MS or ON.• Influence of vaccines on the risk of relapses in MS.• Beneficial and damaging effect of vaccines on patients with MS or ON.Caveat: The relation between vaccination and various diseasemodifying drugs used in MS is outside the scope of this comprehensive review. | METHODSA complete literature review based on PubMed and search criteria with major MeSH words MS, vaccines, vaccination and immunization and relevant subheadings was performed. The abstract of each individual article was screened to detect relevant studies, and the reference list of all relevant articles was screened for additional studies.The resulting articles were then sorted after type leading to 51 included relevant papers. Case reports were omitted. 5Similar search strategy (replacing MS with ON) was later performed for ON. The same procedure as above resulted in the inclusion of 13 research articles and 2 reviews. Thirty-one case reports were excluded. | RESULTSA detailed description of the analyses of the 51 included papers on vaccines and MS, including statistical analyses, is given elsewhere, including a table with a thorough description of each study.

show abstract

Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis

Cited by 88 publications

References 19 publications

Review of the risks and benefits of yellow fever vaccination including some new analyses

Review of the risks and benefits of yellow fever vaccination including some new analyses

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Vaccines and multiple sclerosis

Contact Info

Product

Resources

About