Neurology group updates vaccine recommendations for patients with MS

Patients with multiple sclerosis (MS) should receive all recommended vaccinations, including yearly influenza shots, according to a new guideline developed by the American Academy of Neurology (AAN). The guideline, published in August in Neurology, updates AAN’s 2002 recommendations on immunization in patients with MS, including new guidance for individuals undergoing immunosuppressive or immunomodulating (ISIM) therapies.

“We reviewed all of the available evidence, and for people with MS, preventing infections through vaccine use is a key part of medical care,” said lead author Mauricio F. Farez, MD, MPH, of the FLENI Institution in Buenos Aires, Argentina, and a member of AAN, in a statement. “People with MS should feel safe and comfortable getting their recommended vaccinations.”

The updated guideline recommends that patients with MS follow all local vaccine standards, as stated by CDC, the World Health Organization, and other local regulatory bodies.

After performing a systematic review of current evidence, the expert panel found no evidence that MS increases the risk of acquiring vaccine-preventable infections or that vaccination increases MS exacerbation. Individuals with MS have at least the same risk of acquiring these infections as unvaccinated individuals without MS, and vaccination of patients with MS also contributes to herd immunity. As such, vaccination poses benefits at both an individual and population level.

Providers should recommend that patients with MS receive the influenza vaccine annually, unless a patient has known sensitivities or has had severe reactions to the vaccine. Providers should also keep in mind local disease risks when counseling individuals with MS about vaccination, as the prevalence of vaccine-preventable diseases varies by country and region.

In any case, it’s important for providers to discuss with patients the updated recommendations and current evidence for immunization in patients with MS.

ISIM therapy—including alemtuzumab, DMF, fingolimod, mitoxantrone, natalizumab, ocrelizumab, rituximab, and teriflunomide—is increasingly being used to treat MS. Treatment with these agents has been associated with severe occurrences or recurrences of vaccine-preventable infections, such as varicella zoster virus (VZV) and hepatitis B.

The guideline recommends that providers counsel patients with MS about the risks of vaccination during ISIM therapies. In addition, providers should refer to the guidance provided in the prescribing information of many ISIM agents about immunization with live vaccines during treatment.

Before prescribing or starting ISIM therapy, providers should assess the vaccination status of patients with MS. The guideline recommends vaccinating patients at least 4 to 6 weeks before initiating ISIM treatment.

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