The American Academy of Neurology (AAN) has issued a practice guideline update for vaccine-preventable infections and immunizations for individuals with multiple sclerosis (MS), its first since 2002. A subcommittee of the AAN — tasked with developing, disseminating and implementing these guidelines — found improvements and additions to the previously issued recommendations. The guideline has been endorsed by the Multiple Sclerosis Association of America and by the Consortium of Multiple Sclerosis Centers. Complete findings, including rationale and recommendations, were published in Neurology.

The AAN’s 2002 guideline statement, “Immunization in multiple sclerosis: a summary of published evidence and recommendations” did not evaluate the effectiveness of immunization in patients with MS who are receiving DMTs. This update aimed to evaluate and incorporate new evidence, vaccines, and disease-modifying therapies (DMTs).

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

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Recommendations were developed based on evidence from a systematic review (developed in accordance with the development process and AAN guidelines from 2011), as well as strong related evidence, previously established principles of care, and inferences made by the panel. The strength of these findings, risk-benefit ratio, variation in patient preferences, feasibility/availability, and patient cost informed the level of each recommendation issued.

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The review included randomized control trials, cohort studies and case-control studies published between 1990 and March 2018. Inclusion criteria required that studies described incidence, prevalence and effect of vaccine-preventable illnesses, and the risk of developing MS or relapse of the disease. Other criteria required the inclusion of studies with a sample size ≥10 and studies that evaluated the interaction between DMTs and vaccine efficacy. Unless safety data or laboratory reference standards were included, the panel excluded case reports and case series from their review.

The following is a summary of the recommendation statements endorsed by the guideline subcommittee. For more information, including a description of the process by which evidence was classified, how conclusions were derived, and how recommendations were established, refer to the full guideline publication.

Recommendation for general care for individuals with MS when considering immunization and vaccine-preventable infections.

1a. There is no definite evidence suggesting that vaccination increases the risk for MS, although a link cannot be completely excluded, given the lack of relevant data. However, vaccinations against human papilloma virus infection, tetanus toxoid, pertussis, and smallpox were associated with a lower likelihood of a subsequent MS diagnosis. Vaccine preventable infections can be associated with morbidity and mortality, therefore clinicians should discuss evidence from the systematic review regarding immunization in MS with their patients (Level B).

This article originally appeared on Infectious Disease Advisor