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Arch Neurol. Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis
[Source: JAMA, Archive of Neurology, full text: (LINK). Abstract, edited.]
Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis
Mauricio F. Farez, MD, MPH; Jorge Correale, MD
Arch Neurol. Published online June 13, 2011.
doi:10.1001/archneurol.2011.131
Objective
To investigate the effect of yellow fever (YF)<SUP> </SUP>immunization on the subsequent multiple sclerosis (MS) relapse<SUP> </SUP>risk.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Design
Self-controlled case series study.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Setting
An MS outpatient clinic.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Patients
Seven patients with clinical relapsing-remitting<SUP> </SUP>MS traveling to endemic YF areas who received the YF 17D-204<SUP> </SUP>vaccine were studied.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Intervention
The YF 17D-204 vaccine.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Main Outcome Measure
Number of relapses. Secondary outcomes<SUP> </SUP>included the number of new lesions on magnetic resonance imaging<SUP> </SUP>and peripheral mononuclear cell cytokine and chemokine production.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP> Results
The annual exacerbation rate during risk periods<SUP> </SUP>following immunization was 8.57, while the relapse rate outside<SUP> </SUP>the risk period was only 0.67 (rate ratio = 12.778;<SUP> </SUP>P < .001). Three months after immunization, patients<SUP> </SUP>showed a significant increase in new or enlarging T2-weighted<SUP> </SUP>lesions and gadolinium-enhancing lesions compared with 12 months<SUP> </SUP>prior to vaccination and 9 months after immunization (both P < .001).<SUP> </SUP>Moreover, blood myelin basic protein and myelin oligodendrocyte<SUP> </SUP>glycoprotein responses showed significant increases in interferon<SUP> </SUP>
?induced protein 10 kDa?, interferon ?, interleukin<SUP> </SUP>1α?, interleukin 1β?, and tumor necrosis<SUP> </SUP>factor?secreting cell numbers as well as complement component<SUP> </SUP>C1qB production after YF vaccination in patients with MS compared<SUP> </SUP>with unvaccinated patients with MS, patients with MS vaccinated<SUP> </SUP>against influenza, and healthy control subjects (P = .01<SUP> </SUP>and P < .001, respectively).<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Conclusion
For patients with MS traveling to endemic YF<SUP> </SUP>areas, vaccination should be recommended on the basis of carefully<SUP> </SUP>weighing the risk of exacerbation against the likelihood of<SUP> </SUP>exposure to the YF virus.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP> Author Affiliations:
Department of Neurology, Institute for Neurological Research Dr Ra?l Carrea, Fundaci?n para la Lucha contra las Enfermedades Neurol?gicas de la Infancia, Buenos Aires, Argentina.
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ONLINE FIRST
Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis
Mauricio F. Farez, MD, MPH; Jorge Correale, MD
Arch Neurol. Published online June 13, 2011.
doi:10.1001/archneurol.2011.131
Objective
To investigate the effect of yellow fever (YF)<SUP> </SUP>immunization on the subsequent multiple sclerosis (MS) relapse<SUP> </SUP>risk.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Design
Self-controlled case series study.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Setting
An MS outpatient clinic.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Patients
Seven patients with clinical relapsing-remitting<SUP> </SUP>MS traveling to endemic YF areas who received the YF 17D-204<SUP> </SUP>vaccine were studied.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Intervention
The YF 17D-204 vaccine.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP>
Main Outcome Measure
Number of relapses. Secondary outcomes<SUP> </SUP>included the number of new lesions on magnetic resonance imaging<SUP> </SUP>and peripheral mononuclear cell cytokine and chemokine production.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP> Results
The annual exacerbation rate during risk periods<SUP> </SUP>following immunization was 8.57, while the relapse rate outside<SUP> </SUP>the risk period was only 0.67 (rate ratio = 12.778;<SUP> </SUP>P < .001). Three months after immunization, patients<SUP> </SUP>showed a significant increase in new or enlarging T2-weighted<SUP> </SUP>lesions and gadolinium-enhancing lesions compared with 12 months<SUP> </SUP>prior to vaccination and 9 months after immunization (both P < .001).<SUP> </SUP>Moreover, blood myelin basic protein and myelin oligodendrocyte<SUP> </SUP>glycoprotein responses showed significant increases in interferon<SUP> </SUP>
?induced protein 10 kDa?, interferon ?, interleukin<SUP> </SUP>1α?, interleukin 1β?, and tumor necrosis<SUP> </SUP>factor?secreting cell numbers as well as complement component<SUP> </SUP>C1qB production after YF vaccination in patients with MS compared<SUP> </SUP>with unvaccinated patients with MS, patients with MS vaccinated<SUP> </SUP>against influenza, and healthy control subjects (P = .01<SUP> </SUP>and P < .001, respectively).<SUP> </SUP><SUP></SUP>
<SUP></SUP>
Conclusion
For patients with MS traveling to endemic YF<SUP> </SUP>areas, vaccination should be recommended on the basis of carefully<SUP> </SUP>weighing the risk of exacerbation against the likelihood of<SUP> </SUP>exposure to the YF virus.<SUP> </SUP>
<SUP></SUP>
<SUP></SUP> Author Affiliations:
Department of Neurology, Institute for Neurological Research Dr Ra?l Carrea, Fundaci?n para la Lucha contra las Enfermedades Neurol?gicas de la Infancia, Buenos Aires, Argentina.
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