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[Approaches to vaccine prevention in multiple sclerosis]
D S Kasatkin1, D S Korobko2,3, M D Matson4
1Yaroslavl State Medical University, Yaroslavl, Russia.
Abstract:
The article presents an overview of modern approaches to vaccine prevention in multiple sclerosis (MS). Compared with the general population, patients with MS have been shown to have an increased risk of morbidity, a tendency to have a more severe course, and a greater mortality from vaccine-preventable infections. At the same time, in Russia, until recently, traditionally adhered to a conservative tactic of limiting vaccination in patients with autoimmune diseases, including MS. The use of various disease-modifying therapies (DMT) may also affect the susceptibility to infections and the severity of their course. Screening for latent infections, determination of immune status, collection of history of past infections and development of a vaccination plan based on these data are an important part of the preparation before the appointment of DMT to control the occurrence or reactivation of infections. The use of inactivated, subunit, conjugate, and toxoid-based vaccines are preferable for MS patients. When developing a vaccination plan, avoid live-attenuated vaccines whenever possible. There are no restrictions on vaccination during first line DMT intake. In case of vaccination in MS patients while using immunosuppressants, including drugs for immune reconstitution therapy, an individual risk assessment and timing are required. The available data on the awareness of patients about vaccine prophylaxis are significantly limited and require mass information events.
Insights
Vaccinating patients with multiple sclerosis (MS) against preventable infections is crucial due to their higher risk of severe illness and mortality. This overview guides optimal vaccine strategies for MS patients, considering disease-modifying therapies.
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.
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