Inadequate Vaccine Responses in Children With Multiple Sclerosis
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Published on: September 23, 2022
Jonathan D Santoro1,2, Laura E Saucier3, Runi Tanna4
1Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.
Insights
Children with pediatric onset multiple sclerosis (POMS) show reduced immunity to Hepatitis B virus (HBV) and Varicella Zoster virus (VZV) vaccines. This suggests potential immune dysregulation in POMS patients despite appropriate vaccination.
Area of Science:
- Immunology
- Neurology
- Pediatrics
Background:
- Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV) are recommended for pediatric onset multiple sclerosis (POMS) patients.
- Vaccine efficacy in POMS has not been previously studied, yet may be critical before initiating disease-modifying therapies.
Purpose of the Study:
- To evaluate the antibody-mediated immune response to HBV and VZV vaccinations in children diagnosed with POMS.
- To compare vaccine response rates in POMS patients against institutional control data.
Main Methods:
- A multi-center retrospective chart review of 62 POMS patients was conducted.
- Antibody titers for HBV and VZV were collected pre-treatment and compared to controls.
- Statistical analyses included t-tests and chi-squared tests.
Main Results:
- Low immunity rates were observed: 33% for HBV and 25% for VZV among POMS patients.
- Twenty-four percent of POMS patients were non-immune to both viruses.
- POMS patients demonstrated significantly lower immunity to HBV (p=0.003) and VZV (p<0.001) compared to controls.
Conclusions:
- Individuals with POMS exhibit diminished antibody-mediated immunity to HBV and VZV post-vaccination.
- This finding suggests a possible link between POMS and systemic immune dysregulation.
- Further research is warranted to confirm the association and understand the underlying mechanisms.
Abstract:
Objective: Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV), are recommended for patients with pediatric onset multiple sclerosis (POMS) and may be required prior to initiation of some disease modifying therapies. However, the efficacy of routine vaccine administration in POMS has never been studied. We sought to assess the humoral mediated vaccine response to HBV and VZV in children with POMS. Methods: A multi-center retrospective chart-based review of 62 patients with POMS was performed. Clinical data and antibody titers against HBV and VZV were collected prior to initiation of disease modifying therapy or steroids and compared to institutional control data, using t-test and chi squared analysis. Results: There were low rates of immunity against both HBV and VZV (33 and 25% respectively) among individuals with POMS. Fifteen individuals (24%) were non-immune to both. Compared to institutional control data, individuals with POMS were significantly less likely to be immune to and HBV (p = 0.003, 95% CI: 0.22-0.75) and VZV (p < 0.001, 95% CI: 0.09-0.39). Interpretation: Individuals with POMS have low rates of antibody-mediated immunity against HBV and VZV, despite receiving the appropriate vaccinations. This suggests an association between POMS and systemic immune dysregulation although further study is needed.
