1. Home>
2. Specialties>
3. Neurology>
4. Summary and Comment

No Significant Risk to Vaccination in MS

Multiple sclerosis (MS) is considered an autoimmune disease of the CNS related to genetic and environmental factors. According to the autoimmune paradigm, myelin-reactive Th1-type T cells are triggered in the periphery by infectious agents and migrate to the CNS, where they initiate the disease. Th1-type T cells secrete interferon-, and when MS patients in one study were given interferon-, exacerbations occurred. Viruses also trigger interferon- secretion, and MS relapses have been shown to be associated with upper respiratory viral infections. Interferon-ß, widely used in treating MS, decreases interferon- secretion. Thus, not surprisingly, physicians have been cautious about recommending vaccines to MS patients for fear of triggering a relapse in an already primed immune system. Nonetheless, despite anecdotal reports of vaccination-induced or vaccination-exacerbated MS, carefully controlled studies and surveys have not shown increased risk.

Confavreux and colleagues obtained the vaccination histories of MS patients in the European Database for Multiple Sclerosis who had suffered at least one relapse. They found that the administration of vaccines (including those against diphtheria-tetanus, tetanus, hepatitis B, and influenza) did not increase patients' short-term risk for MS relapse. Ascherio and colleagues used data from the Nurses' Health Study to examine the association between hepatitis B vaccination and development of MS. Vaccination records confirmed that the age-adjusted relative risk for MS was not affected by hepatitis B vaccination.

Comment: These results, taken together with earlier studies, should comfort physicians confronting the question of vaccination in MS patients. All evidence suggests there is no contraindication to hepatitis B, influenza, or tetanus vaccination in MS. As more is learned about MS and its subtypes, it is becoming theoretically possible that vaccination may not be recommended for a subgroup of patients or for a particular vaccine. Further, it is becoming theoretically possible that certain vaccines may be recommended therapeutically if they are found to modulate the immune system in a manner beneficial to MS patients.

— HL Weiner

Howard L. Weiner, MD, is Robert L. Kroc Professor of Neurology, Harvard Medical School, and Director, Multiple Sclerosis Center, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA.

Published in Journal Watch Neurology March 8, 2001

Citation(s):

Confavreux C et al. Vaccinations and the risk of relapse in multiple sclerosis. N Engl J Med 2001 Feb 1 344 319-326.

• Original article (Subscription may be required)
• Medline abstract (Free)

Ascherio A et al. Hepatitis B vaccination and the risk of multiple sclerosis. N Engl J Med 2001 Feb 1 344 327-332.

• Original article (Subscription may be required)
• Medline abstract (Free)