Vaccinations and the Risk of Relapse in Multiple Sclerosis

Confavreux, Christian; Suissa, Samy; Saddier, Patricia; Bourdès, Valérie; Vukusic, Sandra

doi:10.1056/nejm200102013440501

Cited by 444 publications

(195 citation statements)

References 36 publications

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“…24,28 However, these were underpowered to demonstrate rare events, nor did they document less serious events that may have prompted outpatient physician visits. Randomized controlled trials and observational studies in multiple sclerosis 29,30 and rheumatoid arthritis 31 also did not demonstrate increased risk of disease flare after immunization. The primary advantage of the current study is its large numbers of included children with IBD and its ability to assess the full spectrum of health system utilization.…”

Section: Figurementioning

confidence: 91%

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

et al. 2013

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OBJECTIVE: Influenza immunization is recommended for children with IBD, however safety concerns may limit uptake. This study assessed whether immunization was associated with adverse events in IBD patients using a population-based database of children with IBD. METHODS: All children <19 years diagnosed with IBD in Ontario, Canada between 1999–2009 were identified using health administrative data, and matched to non-IBD controls. Self-controlled case series (SCCS) analyses determined health services event rates (outpatient visits, hospitalizations and emergency visits) in any 2-week risk period to 180 days post-immunization compared to a no-risk control period. Relative incidence (RI) was calculated for overall and IBD-related events and rates were compared between IBD cases and controls using relative incidence ratios (RIR). RESULTS: A total of 4916 IBD patients were matched to 21 686 controls. IBD patients were more likely to have received immunization than controls (25.3% vs 13.2%, P < .001). No increased event rates existed in IBD cases during risk periods (pooled RI 0.95, 95% CI 0.84–1.07), including hospitalizations and emergency visits. There was a slightly higher event rate in IBD cases versus controls for days 3–14 (RIR 1.60, 95% CI 1.05–2.44, P = .03). IBD-related visit rates were lower in risk periods compared to control period (pooled RI 0.81, 95% CI 0.68–0.96). CONCLUSIONS: There was no increase in health services use in the post-vaccine risk period in IBD patients, and there was evidence for a protective effect of influenza immunization against IBD-related health services use. Influenza immunization is safe in children with IBD and should be encouraged to improve poor coverage rates.

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Section: Figurementioning

confidence: 91%

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

et al. 2013

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“…About 200 cases of CNS demyelinating disorders within 2 months after HBV vaccination were reported to the French pharmacovigilance system [72] and 2 years later, the French government suspended routine immunization of preadolescents in schools [73]. However, these studies were criticized for methodological limitations, including methods used for case ascertainment and control selection, the validation of vaccination status, and limited statistical power, since the findings of two large-scale studies have shown no significant association between HBV vaccination and the MS occurrence [74,75], but different opinions have also been formulated. For instance, an unpublished study showed by the Bcapture-recapture^method that the real number of MS cases linked to HBV vaccine was 2-2.5 higher than the officially registered number in the French pharmacology.…”

Section: Hbv Vaccine and Multiple Sclerosismentioning

confidence: 99%

Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon?

et al. 2017

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Autoimmune diseases, including multiple sclerosis and type 1 diabetes mellitus, affect about 5% of the worldwide population. In the last decade, reports have accumulated on various autoimmune disorders, such as idiopathic thrombocytopenia purpura, myopericarditis, primary ovarian failure, and systemic lupus erythematosus (SLE), following vaccination. In this review, we discuss the possible underlying mechanisms of autoimmune reactions following vaccinations and review cases of autoimmune diseases that have been correlated with vaccination. Molecular mimicry and bystander activation are reported as possible mechanisms by which vaccines can cause autoimmune reactions. The individuals who might be susceptible to develop these reactions could be especially not only those with previous post-vaccination phenomena and those with allergies but also in individuals who are prone to develop autoimmune diseases, such as those with a family history of autoimmunity or with known autoantibodies, and the genetic predisposed individuals.Further research is encouraged into the direct associations between vaccines and autoimmune conditions, and the biological mechanisms behind them.

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“…For example, a provider may believe that a given vaccination was likely responsible for a temporally related exacerbation of multiple sclerosis (MS), but input from neurologic consultants could reassure the practitioner that MS exacerbations are common and that multiple studies have not supported their increased risk after vaccination [48]. Also, panel experts can clarify the most likely diagnosis, such as the fixed-drug reaction to aluminum in Case 2 and provide appropriate recommendations regarding future immunization options.…”

Section: Discussionmentioning

confidence: 99%

Overview of the Clinical Consult Case Review of adverse events following immunization: Clinical Immunization Safety Assessment (CISA) network 2004–2009

Williams

Klein

Halsey

et al. 2011

Vaccine

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Vaccinations and the Risk of Relapse in Multiple Sclerosis

Abstract: Vaccination does not appear to increase the short-term risk of relapse in multiple sclerosis.

Cited by 444 publications

References 36 publications

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon?

Overview of the Clinical Consult Case Review of adverse events following immunization: Clinical Immunization Safety Assessment (CISA) network 2004–2009

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