AAN Updates Guidelines on Vaccinations in Patients With MS

Individuals with multiple sclerosis (MS) should receive all regularly recommended vaccines, including the annual influenza vaccine, according to updated guidelines from the American Academy of Neurology (AAN).¹ 

The guidelines—which are an update to the 2002 AAN guidelines on immunization and MS—come after a panel performed a systematic review of all articles available in the AAN system.

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“We reviewed all of the available evidence, and for people with MS, preventing infections through vaccine use is a key part of medical care,” guideline lead author Mauricio F. Farez, MD, MPH, from the FLENI Institution in Buenos Aires, Argentina, said in a press release. “People with MS should feel safe and comfortable getting their recommended vaccinations.”² 

Unless there are specific contraindications, patients with MS should follow the local vaccine standards, according to the guidelines.

The guideline authors highlight the need for clinicians to counsel patients about local vaccine-preventable disease risks as well as infection risks associated with specific immunosuppressive/immunomodulating medications and treatment-specific vaccination guidance according to prescribing information.

The guideline authors also recommend:

• Patients with MS would be vaccinated as needed at least 4 to 6 weeks before initiating immunosuppressive or immunomodulating therapy,
• Patients with MS should be screened for infections according to prescribing information before initiating immunosuppressive or immunomodulating therapy,
• Patients with MS who test positive for latent infections should be treated,
• High-risk patient populations should be screened for latent infections before starting immunosuppressive or immunomodulating therapy even when it is not specifically mentioned in prescribing information,
• Clinicians should consult specialists about treating patients who screen positive for latent infection, 
• The panel recommends against administering live-attenuated vaccines in patients with MS who are receiving immunosuppressive or immunomodulating therapies. 

The guidelines also state that clinicians should delay vaccinating patients with MS who are experiencing a relapse.

“After reviewing all the available evidence, we found that there is not enough information to say whether or not vaccinations trigger or worsen MS flares,” said Dr Farez. “Still, experts in MS urge their patients to hold off on scheduling their vaccinations if they are having an MS flare simply to avoid the potential for any complications.”² 

—Colleen Murphy

References:

1. Farez MF, Correale J, Armstrong MJ, et al; Guideline Development, Dissemination, and Implementation Subcommittee. Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology [published online August 28, 2019]. Neurology. doi: 10.1212/WNL.0000000000008157.
2. AAN issues guidelines on vaccines and multiple sclerosis [press release]. Minneapolis, MN: American Academy of Neurology; August 28, 2019. https://www.aan.com/PressRoom/Home/PressRelease/2745.  Accessed August 29, 2019.