Agostino Riva1, Valeria Barcella2, Simone V Benatti3, Marco Capobianco4, Ruggero Capra5, Paola Cinque6, Giancarlo Comi7, Maria Michela Fasolo8, Fabio Franzetti9, Massimo Galli10, Simonetta Gerevini11, Luca Meroni1, Massimo Origoni12, Luca Prosperini13, Massimo Puoti14, Cristina Scarpazza15, Carla Tortorella13, Mauro Zaffaroni16, Lucia Moiola17. 1. III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, L. Sacco Hospital, Milan, Italy. 2. Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy. 3. Department of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy. 4. SCDO Neurology and Regional Reference Multiple Sclerosis Center, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy. 5. Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Italy. 6. Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy/Institute of Experimental Neurology and Multiple Sclerosis Center IRCCS, San Raffaele Hospital, Milan, Italy. 7. Institute of Experimental Neurology and Multiple Sclerosis Center IRCCS, San Raffaele Hospital, Milan, Italy. 8. Division of Infectious Diseases, Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, University Hospital, Milan, Italy. 9. Infectious Diseases Unit, Busto Arsizio Hospital, Varese, Italy. 10. Department of Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy. 11. Division of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroradiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy. 12. Department of Gynecology and Obstetrics, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Milano, Italy. 13. Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy. 14. SC Infectious Diseases, ASST Niguarda Ca' Grande Hospital, Milan, Italy. 15. Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Italy/Department of General Psychology, University of Padova, Padova, Italy. 16. Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy. 17. Multiple Sclerosis Center, IRCCS San Raffaele Hospital, Milan, Italy/Neurology Department, IRCCS San Raffaele Hospital, Milan, Italy.
Abstract
BACKGROUND: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. METHODS: A modified Delphi consensus process (October 2017-June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. RESULTS: Recommendations include the need for an 'infectious diseases card' of each patient's infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. CONCLUSION: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.
BACKGROUND:Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. METHODS: A modified Delphi consensus process (October 2017-June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. RESULTS: Recommendations include the need for an 'infectious diseases card' of each patient's infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. CONCLUSION:Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.
Authors: Maria Antonella Zingaropoli; Patrizia Pasculli; Marco Iannetta; Valentina Perri; Matteo Tartaglia; Sebastiano Giuseppe Crisafulli; Chiara Merluzzo; Viola Baione; Lorenzo Mazzochi; Ambra Taglietti; Flavia Pauri; Marco Frontoni; Marta Altieri; Aurelia Gaeta; Guido Antonelli; Antonella Conte; Claudio Maria Mastroianni; Maria Rosa Ciardi Journal: Mult Scler J Exp Transl Clin Date: 2022-01-04