[Approaches to vaccine prevention in multiple sclerosis]

Area of Science:

• Neurology
• Immunology
• Public Health

Background:

• Multiple sclerosis (MS) patients face elevated risks of severe outcomes from vaccine-preventable infections compared to the general population.
• Historically, vaccination in MS patients, particularly in Russia, has been approached conservatively due to concerns about autoimmune diseases.
• Disease-modifying therapies (DMTs) used in MS can influence infection susceptibility and disease course, necessitating careful vaccination planning.

Purpose of the Study:

• To provide an overview of contemporary vaccine prevention strategies for individuals with multiple sclerosis.
• To highlight the increased vulnerability of MS patients to vaccine-preventable infections and the need for updated vaccination guidelines.
• To address the impact of DMTs on infection risk and vaccination recommendations in MS management.

Main Methods:

• Review of current literature on vaccine efficacy and safety in the context of multiple sclerosis.
• Analysis of the interplay between MS, disease-modifying therapies, and infectious disease risks.
• Development of evidence-based recommendations for vaccination protocols in MS patients.

Main Results:

• MS patients exhibit higher morbidity, more severe disease courses, and increased mortality from vaccine-preventable infections.
• Pre-treatment screening, including infection history and immune status assessment, is vital before initiating DMTs.
• Inactivated, subunit, conjugate, and toxoid vaccines are preferred; live-attenuated vaccines should be avoided when possible. Vaccination is generally permissible during first-line DMTs, but requires risk assessment with immunosuppressants.

Conclusions:

• Vaccination is a critical component of comprehensive care for multiple sclerosis patients to mitigate infection risks.
• Personalized vaccination plans, considering DMTs and individual patient factors, are essential for optimizing protection.
• There is a significant need for public health information campaigns to improve vaccine awareness among MS patients.