Safety of tetanus vaccination in relapsing-remitting multiple sclerosis

Tetanus and Diphtheria Toxoid-Containing Vaccine in Multiple Sclerosis Patients: A Real-World Prospective, Open-Label, Multi-Centre Study

Objective: To assess changes in disease activity in Multiple Sclerosis (MS) patients on various disease-modifying-drugs, as well as immunogenicity, safety and clinical tolerability following combined tetanus- and diphtheria-vaccination. Methods: We conducted a prospective, multicentre, non-randomised real-world observational study at specialised outpatient MS care centres in Germany. We enrolled multiple sclerosis patients receiving a combined tetanus- and diphtheria-vaccination who had a stable MS-treatment regimen for at least six months and had an indication for this vaccination. Serum samples were obtained before and four weeks after vaccination for specific antibody response. Antibody concentrations against vaccine antigens were measured in duplicate via ELISA. Subjects were followed for one year after immunisation. MS disease activity (EDSS and relapse rates) was evaluated at follow-up visits. Local and systemic adverse events were registered four weeks after vaccination. Results: In total, 72 MS patients received tetanus and diphtheria vaccination. The annualised relapse rates in the year after vaccination were comparable to the year before vaccination (0.39 vs. 0.37). During the study period, the EDSS score did not change significantly. The score was 2.0 and 2.2 in the two years prior to vaccination and 2.5 in the year following vaccination. No subjects experienced severe adverse events. However, 14 (19.4%) had local adverse events, and 10 (13.9%) had systemic reactions. Following vaccination, all subjects had protective antibody titres against tetanus- and diphtheria-toxoid. Geometric mean antibody titres of tetanus toxoid antibodies increased from 0.64 IU/mL to 2.23 IU/mL (p < 0.0001) and of diphtheria toxoid antibodies from 0.1 IU/mL to 0.45 IU/mL (p < 0.0001). Conclusions: Tetanus- and diphtheria vaccination proved to be safe and effective in MS patients in a real-world situation.

Vaccination against infection in patients with multiple sclerosis

Bacterial and viral infections have been shown to induce relapses and accelerate the progression of multiple sclerosis (MS). Vaccination to prevent communicable disease in such patients is, therefore, of key importance. Reports of potentially detrimental effects of immunization on the course of MS, however, have prompted patients and physicians to adopt a cautious attitude towards the use of vaccines. The risks associated with a number of vaccines have been investigated in patients with MS. Vaccines against some diseases, such as tetanus and hepatitis B, are not associated with an elevated risk of MS exacerbation, whereas vaccines against other diseases, such as yellow fever, are contraindicated in patients with MS. Many patients with MS receive immunosuppressive or immunomodulatory therapy, which could make them more susceptible to infectious diseases and might also affect their ability to respond to immunization. Here, we review the indications for and possible adverse effects of vaccines in patients with MS, and address issues of vaccination in the context of immunomodulatory therapy for MS.

[Vaccination and multiple sclerosis]

Vaccinations to prevent communicable diseases are, like in other chronic diseases, of special importance in patients with multiple sclerosis (MS). Various bacterial and viral infections have been shown to induce relapses of MS. Reports of possible adverse effects of vaccinations on the course of multiple sclerosis have led patients and treating physicians to exercise caution in the use of vaccines. A number of vaccines have been studied with respect to the risk in MS patients. Some vaccines, for example against yellow fever, are not indicated in MS due to the risk of MS exacerbation. In contrast, tetanus or hepatitis B vaccines do not represent a risk for manifestation or disease progression of MS. Before and during immunomodulatory therapy of MS special attention should be given to adequate protection against vaccine preventable diseases.This paper reviews the indications and specific side effects of vaccinations in MS patients. Additionally, issues of vaccination under immunomodulatory therapy of MS are discussed.