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Infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society
C Papeix1, C Donze2, C Lebrun-Frénay3
1Département de neurologie, CRCSEP-Paris, Sorbonne Université, Hôpital de la Pitié salpêtrière, AP-HP 6, Paris 75013, France.
Revue Neurologique
|July 25, 2021
Summary
Infections may trigger multiple sclerosis (MS) and its relapses. Updated infectious workup and vaccination are recommended for MS patients before and during treatment to prevent complications.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Infections are suspected triggers and promoters of multiple sclerosis (MS) relapses.
- Immune-active treatments for MS may exacerbate infections.
- This necessitates clear guidelines for infectious workup and prevention in MS patients.
Purpose of the Study:
- To establish evidence-based recommendations for managing infections in multiple sclerosis (MS).
- To provide guidance on essential infectious workup for MS patients at diagnosis and before immunotherapy initiation.
- To inform patients and healthcare professionals about infection risks and management strategies.
Main Methods:
- Systematic literature review of PubMed and university databases (1975-2020).
- Application of the RAND/UCLA formalized consensus method involving 23 experts.
- Validation of 36 recommendations by a multidisciplinary group of 63 health professionals.
Main Results:
- Minimal infectious workup, including vaccination status assessment, is recommended at MS diagnosis and during follow-up.
- Screening and preventive treatment for viral (e.g., Herpes virus, HPV, JCV, HCV, HBV), bacterial (mycobacteria), and fungal (Cryptococcus) infections are advised before specific immunotherapies.
- Vaccination schedules should be updated according to national guidelines.
Conclusions:
- Updating vaccination schedules is crucial at MS diagnosis and before therapeutic strategy selection.
- Informing patients about infection risks and screening for immune deficiencies are vital before immunosuppressive treatment.
- Dissemination of updated recommendations on infections and MS to professionals and patients is essential.