Abstract
ObjectiveTo update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS).MethodsThe panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended.Major recommendations (Level B except where indicated)Clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions. Clinicians should recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications and weigh local vaccine-preventable disease risks when counseling patients. Clinicians should recommend that patients with MS receive the influenza vaccination annually. Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4-6 weeks before initiating patients' ISIM therapy. Clinicians must screen for infections according to PI before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in PI (Level A) and should consult specialists regarding treating patients who screen positive for latent infection. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies. Clinicians should delay vaccinating people with MS who are experiencing a relapse.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 584-594 |
| Number of pages | 11 |
| Journal | Neurology |
| Volume | 93 |
| Issue number | 13 |
| DOIs | |
| State | Published - Sep 24 2019 |
Funding
M.F. Farez has received funding for travel from Teva Argentina, Novartis Argentina, and Merck Serono Argentina and has received research support from Biogen Idec. J. Correale is a member of the scientific advisory boards of Merck Serono LATAM, Novartis Argentina, Genzyme Argentina, and Genzyme Global; has received funding for travel from Merck Serono Argentina; is a member of the editorial boards of Current Neurology and Neuroscience Reports, Frontiers in Multiple Sclerosis and Neuroimmunology, Multiple Sclerosis and Related Disorders, and Latin American Multiple Sclerosis Journal; serves as associate editor for the Multiple Sclerosis Journal and Multiple Sclerosis Journal Experimental Translational and Clinical; served on the editorial board of Neurología Argentina; has received honoraria from Merck Serono Argentina, Merck Serono LATAM, Genzyme Argentina, Genzyme LATAM, Genzyme Global, Biogen Idec Argentina, Ivax-Teva Argentina, Roche Argentina, and Novartis Argentina; and has received research support from Genzyme Argentina, Biogen Idec Argentina, and Novartis Argentina. M.J. Armstrong servesontheLevelofEvidenceEditorialBoardforNeurology® (not compensated financially); receives publishing royalties from Oxford University Press for coediting Parkinson’s Disease: Improving Patient Care; received honoraria for teaching at the 2014, 2015, and 2016 American Academy of Neurology (AAN) Annual Meetings and the 2013 and 2014 International Congresses of Parkinson’s Disease and Movement Disorders; serves as a paid evidence-based medicine methodologist for the AAN; serves as faculty on the AAN online course “EBM Online”; has served as a local investigator for studies sponsored by AbbVie, the Parkinson Study Group (PSG), PSG/ Biotie, the Huntington Study Group, CHDI Foundation, Inc, and Insightec, Inc, and is currently supported by a career development award from the Agency for Healthcare Research and Quality (K08HS024159-03); and worked at the University of Maryland through August 2015 and currently works for the University of Florida. A. Rae-Grant received royalties from publishing, including Multiple Sclerosis and Related Disorders from Demos Medical Publishing, and serves as a deputy editor for DynaMed, an online medical textbook, and as a part time employee of EBSCO Industries. D. Gloss has served as a paid evidence-based medicine consultant for the AAN. D. Donley serves as a reviewer of child neurology cases for Physicians Review Organization of Michigan and serves as a blinded rater for multiclinic clinical drug trials for MS, Parkinson disease, dementia, and epilepsy. Her spouse reviews adult cases for the Physician Review Organization of Michigan and serves as a principal investigator. Y. Holler-Managan receives funding for travel from the AAN and serves on the editorial advisory board for Brain & Life. N.J. Kachuck has served on speakers’ bureaus for Teva Pharmaceuticals and Acorda Therapeutics; serves as medical director for Glycominds Laboratories, Inc.; and assisted in the preparation of a patent extension appeal by Acorda Therapeutics. D. Jeffery serves on scientific advisory boards for Teva, Novartis, Biogen, Acorda, and Bayer; serves as an editor for the Journal of the Neurological Sciences; has received honoraria and serves on speakers’ bureaus for Teva, Novartis, Biogen, Bayer, and Acorda; has received research support from Teva, Serono, Pfizer, Novartis, Sanofi, Roche, Biogen, continuing medical education companies, the University of South Florida, and the University of Massachusetts; and has provided expert testimony as a defense expert witness. M. Beilman reports no disclosures relevant to the manuscript. G. Gronseth serves as an associate editor of Neurology; serves on the editorial advisory board for Brain & Life; served as a paid evidence-based medicine methodologist for the AAN; and received honoraria for presentations given at the AAN annual meeting. D. Michelson receives publishing royalties of $500 per year as coauthor for 1 UpToDate article. E. Lee and J. Cox are currently full-time employees of the AAN. T. Getchius was a full-time employee of the AAN when he made his contribution to this guideline. J. Sejvar reports no disclosures relevant to the manuscript. P. Narayanaswami has received grant support from the AHRQ, the Patient-Centered Outcomes Research Institute, and Merz Pharmaceuticals; has consulted for Momenta Pharmaceuticals; served on an advisory board of Alexion Pharmaceuticals; is an associate editor for Muscle & Nerve; and serves on the editorial boards of the Journal of Clinical Neuromuscular Disease and Annals of Neurology. Go to Neurology.org/N for full disclosures.
ASJC Scopus subject areas
- Clinical Neurology
