Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

Abstract

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

COVID-19 in teriflunomide-treated patients with multiple sclerosis: A case report and literature review

“…Along similar lines, some concern exists for vaccination of PwMS against SARS-CoV-2. However, most of COVID-19 candidates are non-live vaccines ( Jeyanathan et al., 2020 ), thus they could be administered with reasonable safety to people treated with DMTs too ( Riva et al., 2020 ).…”

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

“…So far, mRNA vaccines have been approved and used in oncology and for Ebola and Zika immunisation. It may be anticipated that the rules and safety of COVID-19 vaccines should be similar to those for seasonal influenza inactivated vaccines [6]. In the case of mRNA-based vaccines, there is no associated risk of developing an active infection.…”

COVID-19 with no antibody response in a multiple sclerosis patient treated with cladribine: Implication for vaccination program?

“…Data regarding the efficacy of vaccinations in patients treated with cladribine are still lacking ( Riva et al., 2020 ). Studies are needed to test the response to vaccines at different timepoints after cladribine administration.…”

“…Studies are needed to test the response to vaccines at different timepoints after cladribine administration. These studies should take into account also cell-mediated immune response that is not routinely tested and may be preserved in these patients ( Riva et al., 2020 ). Current guidelines do not provide indications regarding the timing of inactivated vaccine administration in DMD-treated patients ( Riva et al., 2020 ).…”

“…These studies should take into account also cell-mediated immune response that is not routinely tested and may be preserved in these patients ( Riva et al., 2020 ). Current guidelines do not provide indications regarding the timing of inactivated vaccine administration in DMD-treated patients ( Riva et al., 2020 ). Considering lymphocyte-depleting DMD, however, a blunted antibody response to vaccination has been observed in the first six months after alemtuzumab treatment ( McCarthy et al., 2013 ).…”