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Review
. 2020 Jan 28;8(1):50.
doi: 10.3390/vaccines8010050.

Infections, Vaccines and Autoimmunity: A Multiple Sclerosis Perspective

Dejan Jakimovski  1 , Bianca Weinstock-Guttman  2 , Murali Ramanathan  3 , Michael G Dwyer  1 , Robert Zivadinov  1   4
Affiliations
Review

Infections, Vaccines and Autoimmunity: A Multiple Sclerosis Perspective

Dejan Jakimovski et al. Vaccines (Basel). .

Abstract

Background: Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease that is associated with multiple environmental factors. Among suspected susceptibility events, studies have questioned the potential role of overt viral and bacterial infections, including the Epstein Bar virus (EBV) and human endogenous retroviruses (HERV). Furthermore, the fast development of immunomodulatory therapies further questions the efficacy of the standard immunization policies in MS patients. Topics reviewed: This narrative review will discuss the potential interplay between viral and bacterial infections and their treatment on MS susceptibility and disease progression. In addition, the review specifically discusses the interactions between MS pathophysiology and vaccination for hepatitis B, influenza, human papillomavirus, diphtheria, pertussis, and tetanus (DTP), and Bacillus Calmette-Guerin (BCG). Data regarding potential interaction between MS disease modifying treatment (DMT) and vaccine effectiveness is also reviewed. Moreover, HERV-targeted therapies such as GNbAC1 (temelimab), EBV-based vaccines for treatment of MS, and the current state regarding the development of T-cell and DNA vaccination are discussed. Lastly, a reviewing commentary on the recent 2019 American Academy of Neurology (AAN) practice recommendations regarding immunization and vaccine-preventable infections in the settings of MS is provided. Conclusion: There is currently no sufficient evidence to support associations between standard vaccination policies and increased risk of MS. MS patients treated with immunomodulatory therapies may have a lower benefit from viral and bacterial vaccination. Despite their historical underperformance, new efforts in creating MS-based vaccines are currently ongoing. MS vaccination programs follow the set back and slow recovery which is widely seen in other fields of medicine.

Keywords: DNA-vaccine; Epstein Barr virus; T-cell vaccine; hepatitis B; immunization; influenza; multiple sclerosis.

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Conflict of interest statement

D.J. has nothing to declare. B.W-G. received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Novartis, Genentech and Mallickrodt. B.W-G. received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Novartis, Genentech and Mallinckrodt. M. R. received research funding or consulting fees from the National Multiple Sclerosis Society, the Department of Defense, the National Institutes of Health, National Science Foundation and Otuska Pharmaceutical Development. M.G.D. has received research grant support from Novartis and Keystone Heart. R. Z. received personal compensation from EMD Serono, Genzyme-Sanofi, Celgene and Novartis for speaking and consultant fees. He received financial support for research activities from Genzyme-Sanofi, Novartis, Celgene, Mapi Pharma, Keystone Heart and Protembis. None of the disclosures are related to this manuscript.

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