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From the Division of Neurology, Maimonides Medical Center (Dr. Miller and Ms. Morgante) and the State University of New York-Health Science Center at Brooklyn (Dr. Miller), Brooklyn NY; Division of Neurology, Mt. Auburn Hospital (Dr. Buchwald and Ms. Nutile), Cambridge, MA; Department of Neurology, State University of New York (Drs. Coyle and Krupp and Ms. Doscher), Stony Brook, NY; Department of Neurology, Thomas Jefferson University (Drs. Lublin, Knobler, Kelley and Ms. Trantas, Philadelphia, PA); Multiple Sclerosis Care Center, St. Agnes Medical Center, (Drs. Smith and LaRocca and Ms. Lopez), White Plains, NY.
Supported by the National Multiple Sclerosis Society, New York, New York.
Presented in part at the 47th Annual Meeting of the American Academy of Neurology, Seattle, WA, May 1995.
Received December 6, 1995. Accepted in final form July 16, 1996.
Address correspondence and reprint requests to Dr. A. Miller, Division of Neurology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219.
Article abstract-We determined the effect of influenza vaccine in patients with relapsing/remitting MS. Considerable controversy surrounds the question of whether to administer influenza vaccines to MS patients. Prevention of a febrile viral illness is clearly desirable in MS, and previous studies suggest that immunization is safe. Despite this, many clinicians avoid vaccination because they fear precipitating an MS exacerbation. We conducted a multicenter, prospective, randomized, double-blind trial of influenza immunization in patients with relapsing/remitting MS. In the autumn of 1993, 104 patients at five MS centers received either standard influenza vaccine or placebo. Patients were followed for 6 months for evaluation of neurologic status and the occurrence of influenza. Influenza was operationally defined as fever >or=to 38 degrees C in the presence of coryza, cough, or sore throat at a time when the disease was present in the community. Attacks were defined in the standard manner, requiring objective change in the examination. Patients were examined at 4 weeks and 6 months after inoculation and were contacted by telephone at 1 week and 3 months. They were also examined at times of possible attacks but not when they were sick with flu-like illness. Three vaccine patients and two placebo patients experienced attacks within 28 days of vaccine (no significant difference). Exacerbation rates in the first month for both groups were equal to or less than expected from published series. The two groups showed no difference in attack rate or disease progression over 6 months. Influenza immunization in MS patients is neither associated with an increased exacerbation rate in the postvaccination period nor a change in disease course over the subsequent 6 months.
NEUROLOGY 1997;48: 312-314
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