Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
Division of Rheumatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
Mult Scler Relat Disord. 2022 Nov;67:104172. doi: 10.1016/j.msard.2022.104172. Epub 2022 Sep 10.
Multiple sclerosis (MS) is an incurable autoimmune disease known to cause widespread demyelinating lesions in the central nervous system (CNS) and a host of debilitating symptoms in patients. The development of MS is believed to be driven by the breakdown of the blood brain barrier, subsequent infiltration by CD4 and CD8 T cells, and widespread CNS inflammation and demyelination. Disease modifying therapies (DMTs) profoundly disrupt these processes and therefore compose an essential component of disease management. However, the effects of these therapeutic agents on vaccine safety and immunogenicity in individuals with MS are not yet fully understood. As such, the primary objective of this review article was to summarize the findings of recently conducted studies on vaccine safety and immunogenicity in MS patients treated with DMTs, particularly in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Discussed in this review are vaccinations against influenza, yellow fever, human papillomavirus, measles, mumps, rubella, Streptococcus pneumoniae, hepatitis B, and COVID-19. This article additionally reviews our current understanding of COVID-19 severity and incidence in this patient population, the risks and benefits of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and vaccination guidelines set forth by MS societies and organizations.
多发性硬化症(MS)是一种无法治愈的自身免疫性疾病,已知会导致中枢神经系统(CNS)广泛脱髓鞘病变,并导致患者出现多种衰弱症状。MS 的发展被认为是由血脑屏障的破坏、随后 CD4 和 CD8 T 细胞的浸润以及广泛的 CNS 炎症和脱髓鞘引起的。疾病修正疗法(DMT)深刻地破坏了这些过程,因此构成了疾病管理的重要组成部分。然而,这些治疗药物对 MS 患者疫苗安全性和免疫原性的影响尚未完全了解。因此,本综述文章的主要目的是总结最近关于 DMT 治疗的 MS 患者疫苗安全性和免疫原性的研究结果,特别是在当前 2019 年冠状病毒病(COVID-19)大流行的背景下。本文讨论了针对流感、黄热病、人乳头瘤病毒、麻疹、腮腺炎、风疹、肺炎链球菌、乙型肝炎和 COVID-19 的疫苗接种。本文还回顾了我们目前对该患者人群中 COVID-19 严重程度和发病率的理解、接种严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)疫苗的风险和益处,以及 MS 协会和组织制定的疫苗接种指南。