III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, L. Sacco Hospital, Milan, Italy.
Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
Mult Scler. 2021 Mar;27(3):347-359. doi: 10.1177/1352458520952310. Epub 2020 Sep 17.
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.
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.
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.
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.
多发性硬化症（MS）患者感染风险增加。接种疫苗可以降低这些风险，但前提是疫苗对 MS 患者安全且有效，包括正在接受疾病修正治疗的患者。
采用改良 Delphi 共识流程（2017 年 10 月至 2018 年 6 月），为 MS 患者的疫苗接种决策制定具有临床意义的推荐意见。2018 年 4 月，一组专家根据 2017 年 10 月进行的文献回顾，生成了一系列关于 MS 患者疫苗接种的疗效、安全性和时间安排的陈述和建议。
建议包括在诊断时为每位患者的传染病和免疫接种史制作“传染病卡”，以排除和最终治疗潜伏感染。我们建议实施当地推荐的疫苗接种，如果可能在 MS 诊断时进行，否则根据计划/当前 MS 治疗调整疫苗接种时间，并每年接种季节性流感疫苗，无论接受何种治疗。
MS 患者应谨慎权衡风险和获益后接种疫苗。但是，迫切需要对 MS 患者的疫苗接种进行更多研究，以指导基于证据的决策。
