Langhorst Silvan Elias, Frahm Niklas, Hecker Michael, Mashhadiakbar Pegah, Streckenbach Barbara, Baldt Julia, Heidler Felicita, Zettl Uwe Klaus
Department of Neurology, Neuroimmunology Section, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany.
Department of Neurology, Ecumenic Hainich Hospital, Pfafferode 102, 99974 Mühlhausen, Germany.
J Pers Med. 2022 Apr 23;12(5):677. doi: 10.3390/jpm12050677.
Multiple sclerosis (MS) is a chronic immune-mediated disease with a neurodegenerative component of the central nervous system. Immunomodulatory therapy can increase the risk of infection, which is a particular risk for MS patients. Therefore, a complete vaccination status is of utmost importance as protection against vaccine-preventable infectious diseases. Our aim was to investigate the vaccination status, vaccination card knowledge and the vaccination behavior of MS patients with regard to vaccinations against tetanus, diphtheria, pertussis and poliomyelitis. Three hundred twenty-seven patients with MS were evaluated by anamnesis, clinical examination, structured interview and vaccination card control in this two-center study. Based on the recommendations of the Robert Koch Institute, we assessed the completeness of the vaccination status of the examined vaccinations. Furthermore, a comparative analysis of patients with complete/incomplete or correctly/wrongly self-reported vaccination status was performed. In the cohort analyzed, the vaccination coverage was 79.5% for tetanus, 79.2% for diphtheria, 74.8% for pertussis and 84.8% for poliomyelitis. The assumed vaccination status was higher for tetanus (86.5%) and lower for diphtheria (69.4%), pertussis (61.2%) and poliomyelitis (75.9%). Patients who were unvaccinated or only partially vaccinated against tetanus had received vaccination advice from a physician less often in the past year (13.4 vs. 36.9%, p < 0.001) and had no one to check the vaccination card more often (35.8 vs. 12.3%, p < 0.001). High sensitivity (93.7%) and low specificity (30.3%) were determined regarding the validity of self-reported tetanus vaccination status. Patients with a correctly reported tetanus vaccination status were more likely to have their vaccination card checked by a physician than those who overestimated or underestimated their vaccination status (76.7 vs. 63.0/43.8%, p = 0.002). Similar findings were seen with regard to diphtheria, pertussis and poliomyelitis vaccination. Patients without a regular vaccination card control (17.1%) were more likely to be male (44.6 vs. 29.4%, p = 0.037), had fewer siblings on average (1.1 vs. 1.6, p = 0.016), dealt less frequently with the issue of vaccination in the past year (32.1 vs. 69.3%, p < 0.001) and more frequently had the wish to receive vaccination advice (48.2 vs. 34.4%, p = 0.030) than patients in whom the vaccination card was checked regularly by a physician. To minimize the risk of infection in MS patients, treating physicians should provide regular vaccination counseling and perform vaccination card controls, as these factors are associated with a higher vaccination coverage and a higher validity of self-reported vaccination statuses.
多发性硬化症（MS）是一种慢性免疫介导疾病，具有中枢神经系统的神经退行性成分。免疫调节疗法会增加感染风险，这对MS患者来说是一项特殊风险。因此，完整的疫苗接种状况对于预防疫苗可预防的传染病至关重要。我们的目的是调查MS患者在破伤风、白喉、百日咳和脊髓灰质炎疫苗接种方面的疫苗接种状况、疫苗接种卡知识和疫苗接种行为。在这项双中心研究中，通过问诊、临床检查、结构化访谈和疫苗接种卡核查对327例MS患者进行了评估。根据罗伯特·科赫研究所的建议，我们评估了所检查疫苗接种状况的完整性。此外，还对疫苗接种状况完整/不完整或自我报告正确/错误的患者进行了比较分析。在所分析的队列中，破伤风疫苗接种覆盖率为79.5%，白喉为79.2%，百日咳为74.8%，脊髓灰质炎为84.8%。假定的疫苗接种状况破伤风较高（86.5%），白喉（69.4%）、百日咳（61.2%）和脊髓灰质炎（75.9%）较低。过去一年中，未接种或仅部分接种破伤风疫苗的患者从医生处获得疫苗接种建议的频率较低（13.4%对36.9%，p<0.001），且无人检查疫苗接种卡的频率较高（35.8%对12.3%，p<0.001）。关于自我报告的破伤风疫苗接种状况的有效性，确定其敏感性高（93.7%）而特异性低（30.3%）。自我报告破伤风疫苗接种状况正确的患者比高估或低估其疫苗接种状况的患者更有可能让医生检查其疫苗接种卡（76.7%对63.0%/43.8%，p=0.002）。在白喉、百日咳和脊髓灰质炎疫苗接种方面也观察到类似结果。与医生定期检查疫苗接种卡的患者相比，没有定期检查疫苗接种卡的患者（17.1%）更可能为男性（44.6%对29.4%，p=0.037），平均兄弟姐妹较少（1.1对1.6，p=0.016），过去一年中较少处理疫苗接种问题（32.1%对69.3%，p<0.001），且更频繁地希望获得疫苗接种建议（48.2%对34.4%，p=0.030）。为了将MS患者感染的风险降至最低水平，主治医生应提供定期的疫苗接种咨询并进行疫苗接种卡核查，因为这些因素与更高的疫苗接种覆盖率和更高的自我报告疫苗接种状况有效性相关。
