Vaccination in Multiple Sclerosis: Friend or Foe?

Abstract

Multiple sclerosis (MS) is a debilitating disease of the central nervous systems (CNS). Disease-modifying treatments (including immunosuppressive treatments) have shown positive effects on the disease course, but are associated with systemic consequences on the immune system and may increase the risk of infections and alter vaccine efficiency. Therefore, vaccination of MS patients is of major interest. Over the last years, vaccine hesitancy has steadily grown especially in Western countries, partly due to fear of sequelae arising from vaccination, especially neurological disorders. The interaction of vaccination and MS has been discussed for decades. In this review, we highlight the immunology of vaccination, provide a review of literature and discuss the clinical consideration of MS, vaccination and immunosuppression. In conclusion, there is consensus that MS cannot be caused by vaccines, neither by inactivated nor by live vaccines. However, particular attention should be paid to two aspects: First, in immunocompromised patients, live vaccines may lead to a stronger immune reaction with signs of the disease against which the patients have been vaccinated, albeit in weakened form. Second, protection provided by vaccination should be controlled in patients who have been vaccinated while receiving immunomodulatory or immunosuppressive treatment. In conclusion, there is evidence that systemic infections can worsen MS, thus vaccination will lower the risk of relapses by reducing the risk of infections. Therefore, vaccination should be in general recommended to MS patients.

Vaccination in multiple sclerosis ‑ Challenging practices (Review)

“…There are no special contraindications for vaccination for patients with MS, the only exception regards live-attenuated vaccines, the consensus being that they are contraindicated for MS patients who receive immunosuppressing or immunomodulating treatment unless the risk of infection is high (19). In VZV negative patients treated with fingolimod, varicella vaccine can be taken into consideration, since complications from the natural infection may outweigh the risk of postvaccination adverse reactions (16). MS relapses are not a contraindication, but a reason to delay vaccination until remission (19).…”

“…Teriflunomide is recommended to avoid live vaccines during treatment and 6 months after stopping the treatment (59). The recommendations for prescribing alemtuzumab advise against the administration of live vaccines 6 weeks before, during, and after recent treatment (16). The producer of ocrelizumab recommends against the administration of live vaccines 4 weeks before beginning treatment, respectively 2 weeks for other types of vaccines, during and after treatment, until B cell depletion has occurred (60).…”

Impfungen gegen Infektionskrankheiten bei Multipler Sklerose

“…Lange waren Impfungen unter einer DMT bei MS nicht im Fokus klinischer Untersuchungen [6,15]. Das Thema stellte sich in seiner ganzen Relevanz dar, als 2 junge Patienten im Rahmen der Zulassungsstudie TRANSFORMS unter Fingolimod-Therapie an einer Varizella-bzw.…”

“…Diese "Kontamination" mit Myelinantigenen induzierte eine spezifische Immunreaktion als Nebenwirkung der Rabies-Immunisierung, die sich phänomenologisch wie eine akute MS oder eine akute disseminierte Enzephalomyelitis (ADEM) manifestieren konnte. Auch aus späteren Kasuistiken oder Fall serien, in denen eine potenzielle MS-Symptomatik nach einer Impfung aufgetreten zu sein schien, lässt sich auf der Grundlage unseres heutigen immunologischen Wissens in den meisten Fällen kein plausibler kausaler Zusammenhang ableiten [5][6][7][8]. Eine systematische Übersichtsarbeit und Metaanalyse fand 2011 keine Veränderung des MS-Risikos nach Impfung gegen Tuberkulose (Bacillus Calmette-Guérin, BCG), Hepatitis-B, Influenza, Masern-Mumps-Röteln, Polio oder Typhus [9].…”

Tick-borne encephalitis vaccination in multiple sclerosis

“…Immunocompromised patients may mount a lower immune response and also exhibit a more rapid antibody decline after vaccination. 5 Special consideration must be given to adequate immune protection against vaccine-preventable diseases before and during immunomodulatory therapy of MS. 6 The aim of this study was to evaluate the safety and immunogenicity of licensed TBE vaccines in MS.…”