Guidelines Updated for Vaccination in Multiple Sclerosis

Guidelines have been updated on vaccinations in patients with multiple sclerosis (MS); a practice guideline update summary was published online in Neurology.

Mauricio F. Farez, M.D., M.P.H., from Centro para la Investigación de Enfermedades Neuroinmunológicas in Buenos Aires, Argentina, and colleagues performed a systematic review to update the 2002 American Academy of Neurology guideline regarding immunization and MS.

The authors note that clinicians should discuss the evidence relating to immunizations in MS with patients and address their opinions, preferences, and questions. Patients with MS should be advised to follow all local vaccine standards, except in the case of specific contraindications. Clinicians should recommend all MS patients receive the influenza vaccination annually and should counsel MS patients regarding infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance. Patients with MS should be vaccinated as needed at least four to six weeks before initiation of ISIM medications. Before initiating ISIM medications, clinicians must screen for infections according to prescribing information; patients screening positive should be treated for latent infections. Clinicians should screen for latent infections in high-risk populations, even when not specifically mentioned in prescribing information. For people with MS receiving ISIM therapies, clinicians should recommend against live-attenuated vaccines. People with MS experiencing relapse should have vaccines delayed.

"We reviewed all of the available evidence and for people with MS, preventing infections through vaccine use is a key part of medical care," Farez said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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