Mauricio F Farez1, Jorge Correale1, Melissa J Armstrong1, Alexander Rae-Grant1, David Gloss1, Diane Donley1, Yolanda Holler-Managan1, Norman J Kachuck1, Douglas Jeffery1, Maureen Beilman1, Gary Gronseth1, David Michelson1, Erin Lee1, Julie Cox1, Tom Getchius1, James Sejvar1, Pushpa Narayanaswami1. 1. Centro para la Investigación de Enfermedades Neuroinmunológicas (M.F.F., J.C.), FLENI, Buenos Aires, Argentina; Servicio de Neuroinmunología y Enfermedades Desmielinizantes (J.C.), Departamento de Neurología, FLENI, Buenos Aires, Argentina; Department of Neurology (M.J.A.), University of Florida, Gainesville; Mellen Center (A.R.-G.), Cleveland Clinic, Cleveland; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Northern Michigan Neurology (D.D.), Traverse City; Division of Neurology (Y.H.-M.), Ann & Robert H. Lurie Children's Hospital of Chicago; MS Comprehensive Care Center (N.J.K.), Keck School of Medicine of University of Southern California, Los Angeles; Lake Norman Neurology (D.J.), Piedmont HealthCare, Mooresville, NC; The Marriage and Family Institute (M.B.), Saint Louis, MO; Department of Neurology (G.G.), Kansas University Medical Center, Kansas City; Neurology Division (D.M.), Department of Pediatrics, Loma Linda University Health Care, CA; American Academy of Neurology (E.L., J.C., T.G.), Minneapolis, MN; US Centers for Disease Control and Prevention (J.S.), Atlanta, GA; Department of Neurology (P.N.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: To update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS). METHODS: The panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended. MAJOR RECOMMENDATIONS LEVEL B EXCEPT WHERE INDICATED: Clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions. Clinicians should recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications and weigh local vaccine-preventable disease risks when counseling patients. Clinicians should recommend that patients with MS receive the influenza vaccination annually. Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4-6 weeks before initiating patients' ISIM therapy. Clinicians must screen for infections according to PI before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in PI (Level A) and should consult specialists regarding treating patients who screen positive for latent infection. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies. Clinicians should delay vaccinating people with MS who are experiencing a relapse.
OBJECTIVE: To update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS). METHODS: The panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended. MAJOR RECOMMENDATIONS LEVEL B EXCEPT WHERE INDICATED: Clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions. Clinicians should recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications and weigh local vaccine-preventable disease risks when counseling patients. Clinicians should recommend that patients with MS receive the influenza vaccination annually. Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4-6 weeks before initiating patients' ISIM therapy. Clinicians must screen for infections according to PI before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in PI (Level A) and should consult specialists regarding treating patients who screen positive for latent infection. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies. Clinicians should delay vaccinating people with MS who are experiencing a relapse.
Authors: Neha Kumar; Kelsey Graven; Nancy I Joseph; John Johnson; Scott Fulton; Robert Hostoffer; Hesham Abboud Journal: Int J MS Care Date: 2020 Mar-Apr