Vaccination Safety

Recent studies continue to affirm the safety of
vaccinations for people with MS. An evaluation of
several reports and trial outcomes by the US Penitentiary
Health Services Unit in Terre Haute, IN, concluded
that the hepatitis B (HB), influenza, and tetanus
vaccines do not increase the risk of developing MS
or exacerbating its symptoms.

Although an acute central demyelinating event following
HB vaccination was reported in a portion of those
vaccinated in France between 1991 and 1999 (several
hundred out of roughly 12 million vaccinated), follow-up
studies failed to establish the causality of the
HB vaccine. The Centers for Disease Control and Prevention
in Atlanta, GA, report that immunizations are unlikely
to be a major cause of autoimmune disease (AID),
but point out the need for additional epidemiological
studies to asses the risk in some susceptible individuals.
While some evidence for immunization leading to AID
comes from several sources including animal studies,
more rigorous (or scientifically accurate) investigation
has failed to confirm most of these claims.

A case-crossover study (at the European Database
for Multiple Sclerosis Coordinating Center and the
Service de Neurologie A, Hospital Neurologique in
Lyons, France) was conducted to determine if vaccinations
increased the risk of relapse in MS. Researchers
contacted 643 individuals with MS who experienced
a relapse between 1993 and 1997, but who had no other
disease exacerbation for at least one year prior
to that time. Relapses were confirmed by visits to
the neurologist, and information on vaccinations
was confirmed through medical records.

No evidence of specific risk for relapse was associated
with tetanus, HB, or influenza vaccinations. Researchers
concluded that vaccines do not appear to increase
the short-term risk of relapse in MS.

An earlier article written by AE Miller, et al,
for Neurology, provides results of a multicenter,
randomized, double-blind, placebo-controlled trial
of influenza immunization in MS. The article states, “Prevention
of a febrile viral illness is clearly desirable in
MS, and previous studies suggest that immunization
is safe. Despite this, many clinicians avoid vaccination
because they fear precipitating an MS exacerbation.”

More than 100 people with MS at five MS centers
were given the standard influenza vaccine or a placebo.
The researchers concluded, “The two groups showed
no difference in attack rate or disease progression
over six months. Influenza immunization in MS patients
is neither associated with an increased exacerbation
rate in the post-vaccination period nor a change
in disease course over the subsequent six months.”

These studies and others continue to support the
safety of vaccinations for individuals with MS. This
is good news for people who would like to have added
protection against one of the previously mentioned
illnesses (hepatitis B, tetanus, and influenza).
Individuals with MS should consult their physician
before receiving any vaccination to be sure that
other health conditions would not be affected.

Sources for this article include:

Chen RT, et al, Epidemiology of autoimmune reactions
induced by vaccination, Journal of Autoimmunity,
vol. 16 (3) pp. 309-318, May 2001.

Confavreux C., et al, Vaccinations and the risk
of relapse in multiple sclerosis, New England Journal
of Medicine, vol. 344 (5), pp. 319-326, Feb. 2001.

Gout O, Vaccinations and multiple sclerosis, Neurological
Sciences, vol. 22 (2), pp. 151-154, April 2001.

Miller AE, et al, A multicenter randomized, double-blind,
placebo-controlled trial of influenza immunization
in multiple sclerosis, Neurology, vol. 48 (2), pp.
312-314, Feb. 1997.

Sievers EJ, Heyneman CA, Relationship between vaccinations
and multiple sclerosis, Annals of Pharmacotherapy,
vol. 36 (1), pp. 160-162, Jan. 2002.