Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis

Abstract

ObjectiveTo update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS).MethodsThe panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended.Major recommendations (Level B except where indicated)Clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions. Clinicians should recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications and weigh local vaccine-preventable disease risks when counseling patients. Clinicians should recommend that patients with MS receive the influenza vaccination annually. Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4–6 weeks before initiating patients' ISIM therapy. Clinicians must screen for infections according to PI before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in PI (Level A) and should consult specialists regarding treating patients who screen positive for latent infection. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies. Clinicians should delay vaccinating people with MS who are experiencing a relapse.

Safety and efficacy of COVID-19 vaccines in multiple sclerosis patients

“…No safety data are currently available for MV-014-210. According to the American Academy of Neurology's (AAN) 2019 guidelines regarding vaccination and MS, live-attenuated vaccines should not generally be recommended to MS patients taking DMTs and those who recently used DMTs, given possible risks of infection associated with immunosuppressed patients ( Farez et al, 2019 ). Indeed, package inserts of many DMTs advise against live vaccination during and shortly before treatment.…”

“…However, these guidelines also state that clinicians may recommend live-attenuated vaccines for MS patients taking DMTs if non-live vaccines are unavailable and the risk of infection is high ( Farez et al, 2019 ). Given the number of non-live vaccines already approved and/or in late-stage trials, the use of live-attenuated COVID-19 vaccines in MS patients is not recommended, especially for those on cell-depleting DMTS.…”

Fulminant MS Reactivation Following Combined Fingolimod Cessation and Yellow Fever Vaccination

“…However, in contrast to our scenario, all seven patients received DMTs with either interferon or glatiramer acetate, suggesting a lower pre-vaccination MS disease activity. In light of the evidence gained from this study and our case report, YF vaccines are not recommended in patients with MS [8,9,10].…”

COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) in patients with multiple sclerosis: a statement by a working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society

“…Vaccines against SARS-CoV-2 have not been used in patients with autoimmune diseases, including MS. Therefore, clinical reasoning in this context should be based on the experience from other vaccines' use in MS and from the knowledge of immunology, vaccinology and virology [3][4][5]. Currently in Poland there are two COVID-19 vaccines available: Pfizer-BioNTech and Moderna.…”