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Immunization and MS

A summary of published evidence and recommendations

*See the Appendix on page 1843 for a list of Immunization Panel of the Multiple Sclerosis Council for Clinical Practice Guidelines’ members.
From the Duke Center for Clinical Health Policy Research (Dr. Matchar), Duke University Medical Center, Durham, NC.

Address correspondence and reprint requests to Therapeutics and Technology Assessment, American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.

Objective: To review the risk of MS exacerbations after infectious episodes potentially preventable by vaccination, and the risks and benefits of immunizing patients with MS.

Methods: The authors searched MEDLINE (1966 to January 2001; U.S. National Library of Medicine, Bethesda, MD), HealthSTAR, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database (Cinahl Information Systems, Glendale, CA) for English-language articles. Each study was summarized and rated for quality of evidence. Then feasible data were pooled and analyzed in meta-analysis.

Results: The risk of contracting common infectious diseases in patients with MS is not well established. There is strong evidence for an increased risk of MS exacerbations during weeks around an infectious episode. There is strong evidence against an increased risk of MS exacerbation after influenza immunization. There is no evidence that hepatitis B, varicella, tetanus, or Bacille Calmette–Guerin vaccines increase the risk of MS exacerbations. Insufficient evidence was found for other vaccines.

Conclusions: Evidence supports 1) strategies to minimize the risk of acquiring infectious diseases that may trigger exacerbations of MS; and 2) the safety of using influenza, hepatitis B, varicella, tetanus, and Bacille Calmette–Guerin (BCG) vaccines in patients with MS.

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