World Multiple Sclerosis Day: Multiple sclerosis and Vaccination - how can it be administered?

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The development of an EBV (Epstein-Barr virus) vaccine for administration in early childhood can lower the risk of having MS in the future.

World Multiple Sclerosis Day: Multiple sclerosis and Vaccination - how can it be administered?
Multiple sclerosis is an autoimmune disorder in human beings that affects myelin tissue, covering the nerve cells. Myelin sheath does the protective function of the nerve cells, and it helps in signal transmission. The nerve cells receive sensory input and send signals to our muscles to act. Multiple sclerosis results in scars or sclerosis in the brain stem, cerebellum, optic nerve, and in many areas of the brain. It is due to damage of myelin sheath by immune cells. As a result, the body cannot do its functions since it disrupts the signal transmission between the nerve cells.
Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently, while others with mild disease may experience long periods of disease freedom without any new symptoms. Common symptoms are Numbness or weakness in one or more limbs, lack of coordination or unsteady gait, partial or complete loss of vision usually in one eye at a time; slurred speech, problems focusing or remembering, fatigue, dizziness, tingling or pain in parts of the body, electric-shock sensations that occur with certain neck movements, problems with sexual function or passing stool and urine.
The etiology of MS is still obscure. However, the genetic predisposition of the person and the environmental conditions influences its occurrence. The treatment for this disorder involves medications,   physical exercises,   plasma exchange, immunoglobulins,   occupational therapy,   speech and swallowing therapy,   and cognitive rehabilitation. A lot of treatment options are available, both injection and tablets and patients should understand that treatment is long term and helps limit the relapses and disease progression.
Vaccination guidelines for People with  Multiple sclerosis
Vaccines are biological products that cause an immune response against pathogens and give lasting protection.  There are four types of vaccines:  live attenuated vaccines (BCG, Oral polio vaccine, Measles, Yellow fever), inactivated whole-cell vaccines (hepatitis A, polio, typhoid, cholera), purified protein vaccines (toxoid), and genetically engineered (hepatitis B, HPV) vaccines.
The present recommendations suggest that MS patients should be screened for vaccine-preventable infections.   Also,   the necessary vaccines should be administered, including the annual influenza vaccine.
  • All vaccines are generally considered safe for MS patients not receiving any DMTs (Disease Modifying Treatments).
    • MS patients receiving DMTs should not be given the Live Attenuated Vaccine (LAV) such as BCG.
      • Live attenuated vaccines can be given to untreated MS patients.
        • The Attenuated Vaccines do not cause MS relapse, and hence they can be given. This treatment stands as an exception for the yellow fever vaccine because it is seen that the 17D strain vaccine induces exacerbation in patients with MS.
          • Administration of vaccines with adjuvants is not encouraged because studies show that the adjuvants like aluminium salts have neurotoxic properties. People who are experiencing a relapse should delay vaccination until the relapse symptoms are no longer worsening or have resolved
            • Patients who are on certain DMTs ( Rituximab, Natalizumab, Mitoxantrone), will need to take their vaccines at specified intervals preceding or following their medication.
              • A complete history of vaccination must be noted by the neurologist as soon as MS is diagnosed. Also, booster shots should be given if required.
                • The development of an EBV (Epstein-Barr virus) vaccine for administration in early childhood can lower the risk of having MS in the future.
                • -by PR Krishnan, Consultant Neurology, Fortis Hospital, Bannerghatta Road, Bangalore

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