1
|
Vaux S, Gautier A, Nassany O, Bonmarin I. Vaccination acceptability in the French general population and related determinants, 2000-2021. Vaccine 2023; 41:6281-6290. [PMID: 37673718 DOI: 10.1016/j.vaccine.2023.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND This study describes the evolution of vaccination acceptability and associated determinants in the French general population between 2000 and 2021, and vaccinations with the highest vaccine hesitancy between 2010 and 2021. METHODS Data were collected from the nine national 'Health Barometer' cross-sectional surveys conducted between 2000 and 2021. These surveys included French-speaking individuals aged 18-75 years old who were selected through randomly generated landline and mobile phone numbers. Participants were asked about their acceptability of vaccination in general and their vaccine hesitancy toward any particular vaccinations. Determinants of vaccination acceptability were studied using univariate and multivariate Poisson regressions. RESULTS The proportion of persons who found vaccination acceptable in general (i.e., answering "very" or "somewhat" favourable in the survey interview) decreased from 91.1% in 2000 to 61.2% in 2010 (the latter year coinciding with the 2009 H1N1 influenza pandemic), increased in 2014 (78.8%), slightly fluctuated until 2019 (74.2%), and increased again in both 2020 (80.0%) and 2021 (82.5%) during the COVID-19 pandemic. Irrespective of the year, acceptability was higher among persons with higher incomes, those with a higher education level, and individuals not living alone. In 2021, for the first time, vaccination acceptability was higher among persons over 44 years old (versus 18-24 year-olds) and among retired persons (versus workers). The highest hesitancy rate for a vaccine was for the 2009 H1N1 influenza virus in 2010 (41% answering "somewhat" or "very" unfavourable). In 2021, the highest rate was for the COVID-19 vaccine (21%). DISCUSSION Unlike the experience of the 2009 AH1N1 influenza pandemic, which led to a collapse in vaccination acceptability among the French general population, acceptability continued to increase during the COVID-19 pandemic. However, the pre-2010 level was not reached. Our results show a tendency towards a widening social and economic gap in terms of vaccine acceptability over time.
Collapse
Affiliation(s)
- Sophie Vaux
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France.
| | - Arnaud Gautier
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France
| | - Oriane Nassany
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France
| | - Isabelle Bonmarin
- Santé publique France (French Institute for Public Health Surveillance), Saint-Maurice, France
| |
Collapse
|
2
|
Lupo J, Truffot A, Andreani J, Habib M, Epaulard O, Morand P, Germi R. Virological Markers in Epstein–Barr Virus-Associated Diseases. Viruses 2023; 15:v15030656. [PMID: 36992365 PMCID: PMC10051789 DOI: 10.3390/v15030656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Epstein–Barr virus (EBV) is an oncogenic virus infecting more than 95% of the world’s population. After primary infection—responsible for infectious mononucleosis in young adults—the virus persists lifelong in the infected host, especially in memory B cells. Viral persistence is usually without clinical consequences, although it can lead to EBV-associated cancers such as lymphoma or carcinoma. Recent reports also suggest a link between EBV infection and multiple sclerosis. In the absence of vaccines, research efforts have focused on virological markers applicable in clinical practice for the management of patients with EBV-associated diseases. Nasopharyngeal carcinoma is an EBV-associated malignancy for which serological and molecular markers are widely used in clinical practice. Measuring blood EBV DNA load is additionally, useful for preventing lymphoproliferative disorders in transplant patients, with this marker also being explored in various other EBV-associated lymphomas. New technologies based on next-generation sequencing offer the opportunity to explore other biomarkers such as the EBV DNA methylome, strain diversity, or viral miRNA. Here, we review the clinical utility of different virological markers in EBV-associated diseases. Indeed, evaluating existing or new markers in EBV-associated malignancies or immune-mediated inflammatory diseases triggered by EBV infection continues to be a challenge.
Collapse
Affiliation(s)
- Julien Lupo
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
- Laboratoire de Virologie, CHU Grenoble Alpes, CS 10217, CEDEX 09, 38043 Grenoble, France
- Correspondence:
| | - Aurélie Truffot
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
- Laboratoire de Virologie, CHU Grenoble Alpes, CS 10217, CEDEX 09, 38043 Grenoble, France
| | - Julien Andreani
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
- Laboratoire de Virologie, CHU Grenoble Alpes, CS 10217, CEDEX 09, 38043 Grenoble, France
| | - Mohammed Habib
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - Olivier Epaulard
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
- Service de Maladies Infectieuses, CHU Grenoble Alpes, CS 10217, CEDEX 09, 38043 Grenoble, France
| | - Patrice Morand
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
- Laboratoire de Virologie, CHU Grenoble Alpes, CS 10217, CEDEX 09, 38043 Grenoble, France
| | - Raphaële Germi
- Institut de Biologie Structurale, Université Grenoble Alpes, UMR 5075 CEA/CNRS/UGA, 71 Avenue des Martyrs, 38000 Grenoble, France
- Laboratoire de Virologie, CHU Grenoble Alpes, CS 10217, CEDEX 09, 38043 Grenoble, France
| |
Collapse
|
3
|
Lotan I, Nishiyama S, Manzano GS, Lydston M, Levy M. COVID-19 and the risk of CNS demyelinating diseases: A systematic review. Front Neurol 2022; 13:970383. [PMID: 36203986 PMCID: PMC9530047 DOI: 10.3389/fneur.2022.970383] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Viral infections are a proposed possible cause of inflammatory central nervous system (CNS) demyelinating diseases, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). During the past 2 years, CNS demyelinating events associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but causality is unclear. Objective To investigate the relationship between CNS demyelinating disease development and exacerbation with antecedent and/or concurrent SARS-CoV-2 infection. Methods A systematic literature review of all publications describing either a new diagnosis or relapse of CNS demyelinating diseases (MS, NMOSD, MOGAD) in association with SARS-CoV-2 infection was performed utilizing PRISMA guidelines. Descriptive statistics were used for data analysis, using a case analysis approach. Results Sixty-seven articles met the inclusion criteria for the study. Most of the reported cases of NMOSD (n = 13, 72.2% of reported cases) and MOGAD (n = 27, 96.5% of reported cases) were of new disease onset, presenting with typical clinical and radiographic features of these conditions, respectively. In contrast, reported MS cases varied amongst newly diagnosed cases (n = 10, 10.5% of reported cases), relapses (n = 63, 66.4%) and pseudo-relapses (n = 22, 23.2%). The median duration between COVID-19 infection and demyelinating event onset was 11.5 days (range 0–90 days) in NMOSD, 6 days (range−7 to +45 days) in MOGAD, and 13.5 days (range−21 to +180 days) in MS. Most cases received high-dose corticosteroids with a good clinical outcome. Conclusion Based upon available literature, the rate of CNS demyelinating events occurring in the setting of preceding or concurrent SARS-CoV-2 infection is relatively low considering the prevalence of SARS-CoV-2 infection. The clinical outcomes of new onset or relapsing MS, NMOSD, or MOGAD associated with antecedent or concurrent infection were mostly favorable. Larger prospective epidemiological studies are needed to better delineate the impact of COVID-19 on CNS demyelinating diseases.
Collapse
Affiliation(s)
- Itay Lotan
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Itay Lotan ;
| | - Shuhei Nishiyama
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Giovanna S. Manzano
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Melissa Lydston
- Treadwell Virtual Library for the Massachusetts General Hospital, Boston, MA, United States
| | - Michael Levy
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
4
|
Kim E, Haag A, Nguyen J, Kesselman MM, Demory Beckler M. Vaccination of multiple sclerosis patients during the COVID-19 era: Novel insights into vaccine safety and immunogenicity. Mult Scler Relat Disord 2022; 67:104172. [PMID: 36116380 PMCID: PMC9462931 DOI: 10.1016/j.msard.2022.104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 09/08/2022] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) is an incurable autoimmune disease known to cause widespread demyelinating lesions in the central nervous system (CNS) and a host of debilitating symptoms in patients. The development of MS is believed to be driven by the breakdown of the blood brain barrier, subsequent infiltration by CD4+ and CD8+ T cells, and widespread CNS inflammation and demyelination. Disease modifying therapies (DMTs) profoundly disrupt these processes and therefore compose an essential component of disease management. However, the effects of these therapeutic agents on vaccine safety and immunogenicity in individuals with MS are not yet fully understood. As such, the primary objective of this review article was to summarize the findings of recently conducted studies on vaccine safety and immunogenicity in MS patients treated with DMTs, particularly in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Discussed in this review are vaccinations against influenza, yellow fever, human papillomavirus, measles, mumps, rubella, Streptococcus pneumoniae, hepatitis B, and COVID-19. This article additionally reviews our current understanding of COVID-19 severity and incidence in this patient population, the risks and benefits of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and vaccination guidelines set forth by MS societies and organizations.
Collapse
Affiliation(s)
- Enoch Kim
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Alyssa Haag
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Jackie Nguyen
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Marc M Kesselman
- Division of Rheumatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| | - Michelle Demory Beckler
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States of America.
| |
Collapse
|
5
|
Barkhane Z, Elmadi J, Satish Kumar L, Pugalenthi LS, Ahmad M, Reddy S. Multiple Sclerosis and Autoimmunity: A Veiled Relationship. Cureus 2022; 14:e24294. [PMID: 35607574 PMCID: PMC9123335 DOI: 10.7759/cureus.24294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory illness that affects the central nervous system (CNS) when the body's immune system attacks its tissue. It is characterized by demyelination and varying degrees of axonal loss. This article has compiled various studies elaborating MS and other autoimmune diseases (ADs) co-occurrence. Several conditions that fall into this category, including type 1 diabetes (T1D), rheumatoid arthritis (RA), Guillain-Barre syndrome (GBS), myasthenia gravis (MG), and many others, are found in MS patients and their relatives, suggesting one or more common etiologic mechanisms, including genetic, environmental, and immunological factors, supporting the concept of a possible influence of poly-autoimmunity on MS and the rest of ADs, as well as providing a significant feature for early detection of the disease and also a potential treatment option by clinical neurologists.
Collapse
|
6
|
Sestili C, Grazina I, La Torre G. HBV vaccine and risk of developing multiple sclerosis: a systematic review and meta-analysis. Hum Vaccin Immunother 2021; 17:2273-2278. [PMID: 30260264 PMCID: PMC8189088 DOI: 10.1080/21645515.2018.1528835] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
Hepatitis B virus (HBV) infection is one the most common in the world. Aim of this study is to perform a systematic review on the relationship between HBV vaccination and multiple sclerosis. Research was conducted on Pubmed, ISI Web of Science, and Scopus. Terms "hepatitis b vaccination" and "multiple sclerosis" were used. Meta-analysis and metaregression were performed. 414 papers were found. Seven articles were selected. For the reported crude risk estimates for MS no statistically significant association was observed with pooled OR 1,19 (95%CI: 0,96-1,49). For the adjusted ORs, the pooled odds ratio (OR) was 0, 965 (95%CI: 0,886- 1,051). Meta regression show that year of publication is negatively (β: -0,019; P < 0.001) and NOS score and publishing in Europe are positively associated with O.R. value. Funnel plot showed the presence of publication bias. Results showed that Hepatitis B vaccination is not associated with an increased risk of developing MS.
Collapse
Affiliation(s)
- Cristina Sestili
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Inês Grazina
- Faculty of Pharmacy, University of Lisbon, Portugal
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| |
Collapse
|
7
|
Solmaz I, Anlar B. Immunization in multiple sclerosis and other childhood immune-mediated disorders of the central nervous system: A review of the literature. Eur J Paediatr Neurol 2021; 33:125-134. [PMID: 34214824 DOI: 10.1016/j.ejpn.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
Childhood is a period where most vaccines are administered in order to build-up immunological memory, and immunization against vaccine-preventable diseases is an essential part of child care and health. The administration of vaccines to children with inflammatory diseases is a frequent point of concern for parents and physicians. Published information on the relation between vaccines and autoinflammatory diseases of the central nervous system (CNS) consists of case and cohort studies and reviews, in great majority on adult patients. Vaccines do not have any established causative or triggering effects on these diseases. Another issue is the immunization schedule of patients with autoinflammatory CNS diseases, specifically the interactions between the disorder, the clinical status, the treatment and the vaccine. In this review, we summarize the existing information between autoinflammatory disorders of the CNS and vaccines in childhood and underline the points to be considered under various treatment regimens.
Collapse
Affiliation(s)
- Ismail Solmaz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, 06230, Ankara, Turkey.
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, 06230, Ankara, Turkey
| |
Collapse
|
8
|
Current Immunological and Clinical Perspective on Vaccinations in Multiple Sclerosis Patients: Are They Safe after All? Int J Mol Sci 2021; 22:ijms22083859. [PMID: 33917860 PMCID: PMC8068297 DOI: 10.3390/ijms22083859] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
Vaccines work by stimulating the immune system, and their immunogenicity is key in achieving protection against specific pathogens. Questions have been raised whether in Multiple Sclerosis (MS) patients they could induce disease exacerbation and whether vaccines could possibly act as a trigger in the onset of MS in susceptible populations. So far, no correlation has been found between the vaccinations against influenza, hepatitis B, tetanus, human papillomavirus, measles, mumps, rubella, varicella zoster, tuberculosis, yellow fever, or typhoid fever and the risk of MS. Further research is needed for the potential protective implications of the tetanus and Bacillus Calmette-Guerin vaccines in MS patients. Nowadays with the emerging coronavirus disease 2019 (COVID-19) and recent vaccinations approval and arrival, the risk-benefit in MS patients with regards to safety and efficacy of COVID-19 vaccination in those treated with immunosuppressive therapies is of paramount importance. In this manuscript, we demonstrate how different vaccine types could be related to the immunopathogenesis of MS and discuss the risks and benefits of different vaccinations in MS patients.
Collapse
|
9
|
Al Wutayd O. Association of infections with multiple sclerosis in Gulf Cooperation Council countries: a review. J Int Med Res 2019; 48:300060519884151. [PMID: 31880177 PMCID: PMC7607054 DOI: 10.1177/0300060519884151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, causing inflammation, demyelination, and neurodegeneration. Infection can play a role in its etiology. Herein, a review is presented of studies that have reported an association between infection and MS risk in countries of the Arabian Gulf region. Searches of the PubMed, Google Scholar, and Science Direct databases were carried out using various search terms, and relevant studies published through January 2019 on the epidemiology of MS in Gulf Cooperation Council countries identified. MS has been found to be associated with measles in Saudi Arabia and Epstein–Barr virus in Kuwait whereas no association has been identified between risk of MS and varicella-zoster virus, mumps, or human herpesvirus-6. However, few epidemiological studies on this topic have been conducted in countries of the Gulf region. Longitudinal and serological studies to establish robust evidence between infection and risk of MS are highly recommended, and a regional MS registry is needed.
Collapse
Affiliation(s)
- O Al Wutayd
- O Al Wutayd, Department of Family and Community Medicine, Unaizah College of Medicine, Qassim University, P.O. Box 3174, Unaizah 51911, Saudi Arabia.
| |
Collapse
|
10
|
Ahmed SI, Aziz K, Gul A, Samar SS, Bareeqa SB. Risk of Multiple Sclerosis in Epstein-Barr Virus Infection. Cureus 2019; 11:e5699. [PMID: 31720167 PMCID: PMC6823003 DOI: 10.7759/cureus.5699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neuro-inflammatory, immune-mediated disorder of the central nervous system; however, less is known about its cause. It causes neurological disability in young adults, more commonly in women. Several risk factors including environmental, genetics, and infections have been identified, which contribute to the abnormal immune response. Viruses belonging to the Herpes family have been indicated as a potential risk for MS; their biological mechanisms are not known but several possibilities have been discussed. Epstein-Barr virus (EBV) is the leading and most common virus associated with MS. It is a potential oncogenic virus that hosts the B lymphocytes and has been associated with numerous cancers such as Burkitt's lymphoma, Hodgkin's lymphoma, and nasopharyngeal carcinoma. The risk of MS is low in patients who are EBV negative but increases by several folds in individuals who have a history of infectious mononucleosis (IM). Several ecological studies, co-occurring pathologies, and experimental laboratory-based research provide evidence to support the relationship between EBV and MS.
Collapse
Affiliation(s)
- Syed Ijlal Ahmed
- Neurology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Kashif Aziz
- Neurology, Jersey Neurosciences, New Jersey, USA
| | - Amna Gul
- Internal Medicine, Liaqat National Hospital and Medical College, Karachi, PAK
| | - Syeda Sana Samar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | |
Collapse
|
11
|
Hapfelmeier A, Gasperi C, Donnachie E, Hemmer B. A large case-control study on vaccination as risk factor for multiple sclerosis. Neurology 2019; 93:e908-e916. [DOI: 10.1212/wnl.0000000000008012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/29/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate the hypothesis that vaccination is a risk factor for multiple sclerosis (MS) by use of German ambulatory claims data in a case-control study.MethodsUsing the ambulatory claims data of the Bavarian Association of Statutory Health Insurance Physicians covering 2005–2017, logistic regression models were used to assess the relation between MS (n = 12,262) and vaccinations in the 5 years before first diagnosis. Participants newly diagnosed with Crohn disease (n = 19,296) or psoriasis (n = 112,292) and participants with no history of these autoimmune diseases (n = 79,185) served as controls.ResultsThe odds of MS were lower in participants with a recorded vaccination (odds ratio [OR] 0.870, p < 0.001 vs participants without autoimmune disease; OR 0.919, p < 0.001 vs participants with Crohn disease; OR 0.973, p = 0.177 vs participants with psoriasis). Lower odds were most pronounced for vaccinations against influenza and tick-borne encephalitis. These effects were consistently observed for different time frames, control cohorts, and definitions of the MS cohort. Effect sizes increased toward the time of first diagnosis.ConclusionsResults of the present study do not reveal vaccination to be a risk factor for MS. On the contrary, they consistently suggest that vaccination is associated with a lower likelihood of being diagnosed with MS within the next 5 years. Whether this is a protective effect needs to be addressed by future studies.
Collapse
|
12
|
Lebrun C, Vukusic S. Immunization and multiple sclerosis: Recommendations from the French multiple sclerosis society. Mult Scler Relat Disord 2019; 31:173-188. [DOI: 10.1016/j.msard.2019.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
|
13
|
Lebrun C, Vukusic S, Abadie V, Achour C, Ader F, Alchaar H, Alkhedr A, Andreux F, Androdias G, Arjmand R, Audoin B, Audry D, Aufauvre D, Autreaux C, Ayrignac X, Bailbe M, Benazet M, Bensa C, Bensmail D, Berger E, Bernady P, Bertagna Y, Biotti D, Blanchard-Dauphin A, Bonenfant J, Bonnan M, Bonnemain B, Borgel F, Botelho-Nevers E, Boucly S, Bourre B, Boutière C, Branger P, Brassat D, Bresch S, Breuil V, Brochet B, Brugeilles H, Bugnon P, Cabre P, Camdessanché JP, Carra-Dalière C, Casez O, Chamouard JM, Chassande B, Chataignier P, Chbicheb M, Chenet A, Ciron J, Clavelou P, Cohen M, Colamarino R, Collongues N, Coman I, Corail PR, Courtois S, Coustans M, Creange A, Creisson E, Daluzeau N, Davenas C, De Seze J, Debouverie M, Depaz R, Derache N, Divio L, Douay X, Dulau C, Durand-Dubief F, Edan G, Elias Z, Fagniez O, Faucher M, Faucheux JM, Fournier M, Gagneux-Brunon A, Gaida P, Galli P, Gallien P, Gaudelus J, Gault D, Gayou A, Genevray M, Gentil A, Gere J, Gignoux L, Giroux M, Givron P, Gout O, Grimaud J, Guennoc AM, Hadhoum N, Hautecoeur P, Heinzlef O, Jaeger M, Jeannin S, Kremer L, Kwiatkowski A, Labauge P, Labeyrie C, Lachaud S, Laffont I, Lanctin-Garcia C, Lannoy J, Lanotte L, Laplaud D, Latombe D, Lauxerois M, Le Page E, Lebrun-Frenay C, Lejeune P, Lejoyeux P, Lemonnier B, Leray E, Loche CM, Louapre C, Lubetzki C, Maarouf A, Mada B, Magy L, Maillart E, Manchon E, Marignier R, Marque P, Mathey G, Maurousset A, Mekies C, Merienne M, Michel L, Milor AM, Moisset X, Montcuquet A, Moreau T, Morel N, Moussa M, Naudillon JP, Normand M, Olive P, Ouallet JC, Outteryck O, Pacault C, Papeix C, Patry I, Peaureaux D, Pelletier J, Pichon B, Pittion S, Planque E, Pouget MC, Pourcher V, Radot C, Robert I, Rocher F, Ruet A, Ruet A, Saint-Val C, Salle JY, Salmon A, Sartori E, Schaeffer S, Stankhof B, Taithe F, Thouvenot E, Tizon C, Tourbah A, Tourniaire P, Vaillant M, Vermersch P, Vidil S, Wahab A, Warter MH, Wiertlewski S, Wiplosz B, Wittwer B, Zaenker C, Zephir H. Immunization and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Rev Neurol (Paris) 2019; 175:341-357. [DOI: 10.1016/j.neurol.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 03/31/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
|
14
|
Hepatitis B vaccination and central demyelination - History, description and observed/expected analyses of 624 cases reported to the French pharmacovigilance over a 20-year period. Vaccine 2019; 37:2142-2148. [PMID: 30851966 DOI: 10.1016/j.vaccine.2019.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Confidence in vaccines is essential for achieving targeted immunization coverage. The current skepticism about vaccine safety feeds on controversies such as the suspicion about a link between hepatitis B (HB) vaccination and central demyelination (CD) after the massive HB immunization campaign in France in 1994-2000. This study assesses the robustness of this signal by analysing all validated cases reported in 1980-2000 and by conducting observed-to-expected (OE) comparisons. METHODS After characterizing case profiles, reporting rates per 1,000,000 vaccine doses sold were computed for the period and per year. OE comparisons were conducted by using individual-based and person-year approaches and were stratified by gender. FINDING A total of 624CD cases including 422 incident cases of multiple sclerosis (MS) were reported over 20 years. Women accounted for 73.2% (n = 457). Mean age was 29.8 years (SD = 11.1). Incidence of events peaked in 1995-1996 and 1997, these years accounting for 59.8% (n = 373) of cases. Events were mainly reported after booster doses (46.3%, n = 289). The overall reporting rate was 6.5 per 1,000,000 doses sold. The OE analyses produced inconclusive results, the number of observed cases remaining below the expected number. CONCLUSIONS The complete disjunction between target and joint populations in the 1990s French HB immunization campaign created an unpreceded situation with ∼26 million of adults exposed at the age of MS onset. Two findings are noteworthy: the non-random distribution of reports according to the rank of vaccination or years of survey, and the fact that the number of reports sometimes approached the baseline incidence of MS, irrespective of underreporting. While the nature of the link remains unclear, our results are not consistent with a strong association between HB vaccine and MS. Current recommendations targeting newborns with a possible catch-up of at-risk adults should remain the preferred strategy in low-endemic countries.
Collapse
|
15
|
Abdollahpour I, Nedjat S, Mansournia MA, Eckert S, Weinstock-Guttman B. Infectious exposure, antibiotic use, and multiple sclerosis: A population-based incident case-control study. Acta Neurol Scand 2018; 138:308-314. [PMID: 29740825 DOI: 10.1111/ane.12958] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The existing reports regarding the potential role of infections as well as antibiotic use in multiple sclerosis (MS) etiology are inconclusive. OBJECTIVES We aimed to investigate the association of viral infections as well as antibiotic use and the risk of developing MS. MATERIALS & METHODS This was a population-based incident case-control study of 547 incident cases and 1057 general population controls obtained from 22 municipality areas of Tehran (7/8/2013-17/2/2015). Multiple logistic regression models were used to determine the adjusted associations. RESULTS Overall antibiotic use for ≥14 days during 3 years before the index date, significantly decreased the odds of MS OR 0.69 (95%CI: 0.53-0.91, P = .008). The results were consistent for different types of antibiotics, including penicillin OR 0.50 (95%CI: 0.34-0.75, P = .001) and cephalosporins OR 0.25 (95%CI: 0.12-0.50, P < .001). History of IM was associated with a more than 5fold increased risk of MS OR = 5.7 (95%CI, 1.28-25.37). There was no statistically significant association between any other single or cumulative number of viral infections with subsequent risk of MS (P > .05). CONCLUSIONS Considering the possibility of reverse causation, the results of this large case-control study suggest that use of antibiotics may be associated with a decreased risk of MS. However, viral disease other than infectious mononucleosis was not associated with MS risk.
Collapse
Affiliation(s)
- I. Abdollahpour
- Department of Epidemiology; School of Public Health; Arak University of Medical Sciences; Arak Iran
| | - S. Nedjat
- Department of Epidemiology and Biostatistics; School of Public Health; Knowledge Utilization Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - M. A. Mansournia
- Department of Epidemiology and Biostatistics; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - S. Eckert
- University at Buffalo; Jacobs School of Medicine and Biomedical Sciences; Buffalo NY USA
| | - B. Weinstock-Guttman
- Neurology; Jacobs School of Medicine and Biomedical Science; University of Buffalo; Buffalo NY USA
| |
Collapse
|
16
|
Elwood JM, Ameratunga R. Autoimmune diseases after hepatitis B immunization in adults: Literature review and meta-analysis, with reference to 'autoimmune/autoinflammatory syndrome induced by adjuvants' (ASIA). Vaccine 2018; 36:5796-5802. [PMID: 30100071 DOI: 10.1016/j.vaccine.2018.07.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To assess if hepatitis B vaccination in adults is causally associated with autoimmune diseases. Such causation has been claimed based mainly on case reports and uncontrolled studies, and a syndrome 'Autoimmune/autoinflammatory Disorder Induced by Adjuvants' (ASIA) has been claimed to be linked to immunization, particularly hepatitis B vaccination. METHODS Review of peer-reviewed literature from January 1990 to March 2017 identifying controlled studies with documented incidence of autoimmune diseases occurring after hepatitis B vaccinations in adults. From 1297 studies identified, 259 were further assessed and 49 reviewed further; 19 relevant papers reporting 21 results are reviewed here, and 14 results included in a meta-analysis. RESULTS Overall no association between hepatitis B vaccination and the onset of autoimmune diseases was seen. The overall odds ratio was 1.06, with 95% confidence limits of 0.93-1.21, with non-significant heterogeneity. Only one study showed a significant excess risk between hepatitis B immunisation and autoimmune disease. CONCLUSIONS Despite multiple case reports, there is no reliable scientific evidence of autoimmune diseases being caused by hepatitis B vaccinations.
Collapse
Affiliation(s)
- J Mark Elwood
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
| | - Rohan Ameratunga
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland 1010, New Zealand
| |
Collapse
|
17
|
Hepatitis B vaccination and the putative risk of central demyelinating diseases – A systematic review and meta-analysis. Vaccine 2018; 36:1548-1555. [DOI: 10.1016/j.vaccine.2018.02.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 01/24/2023]
|
18
|
Lavery AM, Collins BN, Waldman AT, Hart CN, Bar-Or A, Marrie RA, Arnold D, O'Mahony J, Banwell B. The contribution of secondhand tobacco smoke exposure to pediatric multiple sclerosis risk. Mult Scler 2018; 25:515-522. [PMID: 29393768 DOI: 10.1177/1352458518757089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pediatric acquired demyelinating syndromes (ADSs) are monophasic (mono-ADS) in 70% of cases and represent the first attack of multiple sclerosis (MS) in 30%. Secondhand tobacco smoke (SHS) exposure has been implicated as a risk factor for adult-onset MS. Little is known about whether SHS presents an additive risk beyond genetic factors and other environmental exposures associated with pediatric MS. METHODS This study examined SHS exposure in 216 children with mono-ADS and 81 children with MS. Interactions between SHS, HLA-DRB1*15 alleles, serum 25-hydroxyvitamin D concentrations, and serological evidence of remote Epstein-Barr virus (EBV) exposure were evaluated. RESULTS SHS exposure was more common in children with MS (37% exposed) compared to mono-ADS (29.5% exposed). Compared to mono-ADS, SHS exposure was not an independent risk factor for MS. When both SHS exposure and HLA-DRB1*15 were present, the odds for MS increased (odds ratio (OR) = 3.7; 95% confidence interval (CI): 1.17-11.9) compared to mono-ADS. Interactions between SHS and vitamin D or EBV did not associate with MS. CONCLUSION Exposure to SHS is a risk factor for central nervous system (CNS) demyelination. Results suggest that SHS exposure and HLA-DRB1*15 interact to increase risk for MS in children diagnosed with mono-ADS.
Collapse
Affiliation(s)
- Amy M Lavery
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA/Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Amy T Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA/Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Amit Bar-Or
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Douglas Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Julia O'Mahony
- Institute of Health Policy, Management, and Evaluation, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
19
|
van den Ende C, Marano C, van Ahee A, Bunge EM, De Moerlooze L. The immunogenicity of GSK’s recombinant hepatitis B vaccine in children: a systematic review of 30 years of experience. Expert Rev Vaccines 2017; 16:789-809. [DOI: 10.1080/14760584.2017.1338569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | | | - Ayla van Ahee
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | - Eveline M. Bunge
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | | |
Collapse
|
20
|
Van Den Ende C, Marano C, Van Ahee A, Bunge EM, De Moerlooze L. The immunogenicity and safety of GSK’s recombinant hepatitis B vaccine in adults: a systematic review of 30 years of experience. Expert Rev Vaccines 2017; 16:811-832. [DOI: 10.1080/14760584.2017.1338568] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Ayla Van Ahee
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | - Eveline M. Bunge
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | | |
Collapse
|
21
|
Bermúdez-Morales VH, Castrejon-Salgado R, Torres-Poveda K, de Jesús Flores-Rivera J, Flores-Aldana M, Madrid-Marina V, Hernández-Girón C. Papel de las enfermedades infecciosas en el desarrollo de la esclerosis múltiple: evidencia científica. NEUROLOGÍA ARGENTINA 2017. [PMCID: PMC7154617 DOI: 10.1016/j.neuarg.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introducción La esclerosis múltiple (EM) es el trastorno inflamatorio más común del sistema nervioso central (SNC) y la causa principal de discapacidad neurológica en adultos jóvenes. Los factores ambientales e infecciosos han sido fuertemente asociados al incremento de la ocurrencia de la enfermedad, hasta más del doble, en los últimos 10 años. En este artículo de revisión se describen los principales hallazgos reportados sobre la relación entre ciertas infecciones virales y bacterianas con la aparición y progresión de la EM. Métodos Se realizó un plan metodológico de búsqueda de artículos científicos relacionados con infección y EM, mediante la búsqueda de artículos científicos, principalmente publicados en inglés, en las plataformas virtuales de Pubmed, Medline y Cochrane. Para la búsqueda se utilizaron como palabras claves (términos MeSH): «virus, bacteria, autoimmune disease of the nervous system, multiple sclerosis». Se eligieron artículos publicados en revistas indexadas durante los últimos 15 años. Resultados Estudios epidemiológicos sugieren que la EM tiene un componente etiológico infeccioso que origina un proceso inflamatorio que puede contribuir a la iniciación o exacerbación de la enfermedad. Particularmente, la infección viral y los eventos de desmielinización en el SNC puede deberse a la penetración de un virus como el virus Epstein-Barr (EBV), a través del torrente sanguíneo, específicamente hacia el SNC. Por otro lado, las infecciones bacterianas crónicas pueden causar procesos de desmielinización en el SNC que agravan la enfermedad de EM. Conclusiones Este estudio contribuye a aportar evidencia científica donde se demuestra la multicausalidad implicada en la ocurrencia de la EM. Aún falta desarrollar más estudios epidemiológicos que demuestren y comprueben la relación y la implicación de agentes virales y bacterianos en el origen, el desarrollo y la severidad de la enfermedad.
Collapse
Affiliation(s)
- Victor Hugo Bermúdez-Morales
- Centro de Investigación sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Ricardo Castrejon-Salgado
- Médico familiar, Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social, Xochitepec, Morelos, México
| | - Kirvis Torres-Poveda
- Centro de Investigación sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - José de Jesús Flores-Rivera
- Médico neurólogo, Departamento de enfermedades desmielinizantes, Instituto nacional de neurología y neurocirugía, Ciudad de México (CDMX), México
| | - Mario Flores-Aldana
- Profesor investigador, Centro de Investigación en Salud Poblacional, CISP, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Vicente Madrid-Marina
- Centro de Investigación sobre enfermedades infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Carlos Hernández-Girón
- Profesor investigador, Centro de Investigación en Salud Poblacional, CISP, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Autor para correspondencia.
| |
Collapse
|
22
|
Halsey NA, Talaat KR, Greenbaum A, Mensah E, Dudley MZ, Proveaux T, Salmon DA. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2016; 33 Suppl 5:F1-F67. [PMID: 26822822 DOI: 10.1016/j.vaccine.2015.10.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
Most influenza vaccines are generally safe, but influenza vaccines can cause rare serious adverse events. Some adverse events, such as fever and febrile seizures, are more common in children than adults. There can be differences in the safety of vaccines in different populations due to underlying differences in genetic predisposition to the adverse event. Live attenuated vaccines have not been studied adequately in children under 2 years of age to determine the risks of adverse events; more studies are needed to address this and several other priority safety issues with all influenza vaccines in children. All vaccines intended for use in children require safety testing in the target age group, especially in young children. Safety of one influenza vaccine in children should not be extrapolated to assumed safety of all influenza vaccines in children. The low rates of adverse events from influenza vaccines should not be a deterrent to the use of influenza vaccines because of the overwhelming evidence of the burden of disease due to influenza in children.
Collapse
Affiliation(s)
- Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Kawsar R Talaat
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adena Greenbaum
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eric Mensah
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina Proveaux
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
23
|
Mailand MT, Frederiksen JL. Vaccines and multiple sclerosis: a systematic review. J Neurol 2016; 264:1035-1050. [PMID: 27604618 DOI: 10.1007/s00415-016-8263-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
Vaccinations are often the most effective tool against some disease known to mankind. This study offers a literature review on the role of vaccines regarding the risk of developing multiple sclerosis (MS) and MS relapse. The method used in this study is a systematic literature review on the database PubMed. The study found no change in risk of developing multiple sclerosis (MS) after vaccination against hepatitis B virus, human papillomavirus, seasonal influenza, measles-mumps-rubella, variola, tetanus, Bacillus Calmette-Guérin (BCG), polio, or diphtheria. No change in risk of relapse was found for influenza. Further research is needed for the potential therapeutic use of the BCG vaccine in patients in risk of developing MS and for the preventive potential of the tetanus and diphtheria vaccine.
Collapse
Affiliation(s)
| | - Jette Lautrup Frederiksen
- Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Nordre Ringvej 57, 2600, Glostrup, Denmark.
| |
Collapse
|
24
|
Márquez AC, Horwitz MS. The Role of Latently Infected B Cells in CNS Autoimmunity. Front Immunol 2015; 6:544. [PMID: 26579121 PMCID: PMC4623415 DOI: 10.3389/fimmu.2015.00544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022] Open
Abstract
The onset of multiple sclerosis (MS) is caused by both genetic and environmental factors. Among the environmental factors, it is believed that previous infection with Epstein–Barr virus (EBV) may contribute in the development of MS. EBV has been associated with other autoimmune diseases, such as systemic lupus erythematous, and cancers like Burkitt’s lymphoma. EBV establishes a life-long latency in B cells with occasional reactivation of the virus throughout the individual’s life. The role played by B cells in MS pathology has been largely studied, yet is not clearly understood. In MS patients, Rituximab, a novel treatment that targets CD20+ B cells, has proven to have successful results in diminishing the number of relapses in remitting relapsing MS; however, the mechanism of how this drug acts has not been clearly established. In this review, we analyze the evidence of how B cells latently infected with EBV might be altering the immune system response and helping in the development of MS. We will also discuss how animal models, such as experimental autoimmune encephalomyelitis (EAE) and murine gammaherpesvirus-68 (γHV-68), can be used as powerful tools in the study of the relationship between EBV, MS, and B cells.
Collapse
Affiliation(s)
- Ana Citlali Márquez
- Department of Microbiology and Immunology, The University of British Columbia , Vancouver, BC , Canada
| | - Marc Steven Horwitz
- Department of Microbiology and Immunology, The University of British Columbia , Vancouver, BC , Canada
| |
Collapse
|
25
|
Jons D, Sundström P, Andersen O. Targeting Epstein-Barr virus infection as an intervention against multiple sclerosis. Acta Neurol Scand 2015; 131:69-79. [PMID: 25208981 DOI: 10.1111/ane.12294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 12/25/2022]
Abstract
We here review contemporary data on genetic and environmental risk factors, particularly Epstein-Barr virus infection, for multiple sclerosis. There is an important immunogenetic etiological factor for multiple sclerosis. However, a general assumption is that immune defense genes are activated by the environment, basically by infections. We contend that the relationship between infectious mononucleosis and multiple sclerosis cannot be completely explained by genetics and inverse causality. Epstein-Barr infection as indicated by positive serology is an obligatory precondition for multiple sclerosis, which is a stronger attribute than a risk factor only. Data on events in the early pathogenesis of multiple sclerosis are cumulating from bio-banks with presymptomatic specimens, but there is only little information from the critical age when Epstein-Barr infection including infectious mononucleosis is acquired, nor on the detailed immunological consequences of this infection in individuals with and without multiple sclerosis. We discuss how focused bio-banking may elaborate a rationale for the development of treatment or vaccination against Epstein-Barr virus infection. A cohort in which intervention against Epstein-Barr infections was performed should be the object of neurological follow-up.
Collapse
Affiliation(s)
- D. Jons
- Section of Clinical Neuroscience and Rehabilitation; Institution of Neuroscience and Physiology; the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - P. Sundström
- Section of Neurology; Department of Pharmacology and Clinical Neuroscience; University of Umeå; Umeå Sweden
| | - O. Andersen
- Section of Clinical Neuroscience and Rehabilitation; Institution of Neuroscience and Physiology; the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
26
|
Abstract
Since the implementation of the mass vaccination campaign against hepatitis B in France, the appearance of multiple sclerosis, sometimes occurring in the aftermath of vaccinations, led to the publication of epidemiological international studies. This was also justified by the sharp increase in the annual incidence of multiple sclerosis reported to the French health insurance in the mid-1990s. Almost 20 years later, a retrospective reflection can be sketched from these official data and also from the national pharmacovigilance agency. Statistical data from these latter sources seem to show a significant correlation between the number of hepatitis B vaccinations performed and the declaration to the pharmacovigilance of multiple sclerosis occurring between 1 and 2 years later. The application of the Hill's criteria to these data indicates that the correlation between hepatitis B vaccine and multiple sclerosis may be causal.
Collapse
Affiliation(s)
- Dominique Le Houézec
- REVAHB ("Réseau Vaccin Hépatite B" in French), 32 rue du Clos Herbert, 14000, Caen, France,
| |
Collapse
|
27
|
Farez MF, Balbuena Aguirre ME, Varela F, Köhler AA, Nagel V, Correale J. Low familial risks for multiple sclerosis in Buenos Aires, Argentina. J Neurol Sci 2014; 346:268-70. [DOI: 10.1016/j.jns.2014.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/26/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
|
28
|
Dumas A, Amiable N, de Rivero Vaccari JP, Chae JJ, Keane RW, Lacroix S, Vallières L. The inflammasome pyrin contributes to pertussis toxin-induced IL-1β synthesis, neutrophil intravascular crawling and autoimmune encephalomyelitis. PLoS Pathog 2014; 10:e1004150. [PMID: 24875775 PMCID: PMC4038594 DOI: 10.1371/journal.ppat.1004150] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/15/2014] [Indexed: 12/27/2022] Open
Abstract
Microbial agents can aggravate inflammatory diseases, such as multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE). An example is pertussis toxin (PTX), a bacterial virulence factor commonly used as an adjuvant to promote EAE, but whose mechanism of action is unclear. We have reported that PTX triggers an IL-6-mediated signaling cascade that increases the number of leukocytes that patrol the vasculature by crawling on its luminal surface. In the present study, we examined this response in mice lacking either TLR4 or inflammasome components and using enzymatically active and inactive forms of PTX. Our results indicate that PTX, through its ADP-ribosyltransferase activity, induces two series of events upstream of IL-6: 1) the activation of TLR4 signaling in myeloid cells, leading to pro-IL-1β synthesis; and 2) the formation of a pyrin-dependent inflammasome that cleaves pro-IL-1β into its active form. In turn, IL-1β stimulates nearby stromal cells to secrete IL-6, which is known to induce vascular changes required for leukocyte adhesion. Without pyrin, PTX does not induce neutrophil adhesion to cerebral capillaries and is less effective at inducing EAE in transgenic mice with encephalitogenic T lymphocytes. This study identifies the first microbial molecule that activates pyrin, a mechanism by which infections may influence MS and a potential therapeutic target for immune disorders.
Collapse
Affiliation(s)
- Aline Dumas
- Axis of Neuroscience, University Hospital Center of Quebec, Quebec, Quebec, Canada
| | - Nathalie Amiable
- Axis of Neuroscience, University Hospital Center of Quebec, Quebec, Quebec, Canada
| | - Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, United States of America
| | - Jae Jin Chae
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland, United States of America
| | - Robert W. Keane
- Department of Physiology and Biophysics, University of Miami, Miami, Florida, United States of America
| | - Steve Lacroix
- Axis of Neuroscience, University Hospital Center of Quebec, Quebec, Quebec, Canada
- Department of Molecular Medicine, Laval University, Quebec, Quebec, Canada
| | - Luc Vallières
- Axis of Neuroscience, University Hospital Center of Quebec, Quebec, Quebec, Canada
- Department of Molecular Medicine, Laval University, Quebec, Quebec, Canada
| |
Collapse
|
29
|
Demicheli V, Jefferson T, Al-Ansary LA, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev 2014:CD001269. [PMID: 24623315 DOI: 10.1002/14651858.cd001269.pub5] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Different types of influenza vaccines are currently produced worldwide. Vaccination of pregnant women is recommended internationally, while healthy adults are targeted in North America. OBJECTIVES To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harm) of vaccines against influenza in healthy adults, including pregnant women. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 2), MEDLINE (January 1966 to May 2013) and EMBASE (1990 to May 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy individuals aged 16 to 65 years. We also included comparative studies assessing serious and rare harms. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS We included 90 reports containing 116 data sets; among these 69 were clinical trials of over 70,000 people, 27 were comparative cohort studies (about eight million people) and 20 were case-control studies (nearly 25,000 people). We retrieved 23 reports of the effectiveness and safety of vaccine administration in pregnant women (about 1.6 million mother-child couples).The overall effectiveness of parenteral inactivated vaccine against influenza-like illness (ILI) is limited, corresponding to a number needed to vaccinate (NNV) of 40 (95% confidence interval (CI) 26 to 128). The overall efficacy of inactivated vaccines in preventing confirmed influenza has a NNV of 71 (95% CI 64 to 80). The difference between these two values depends on the different incidence of ILI and confirmed influenza among the study populations: 15.6% of unvaccinated participants versus 9.9% of vaccinated participants developed ILI symptoms, whilst only 2.4% and 1.1%, respectively, developed laboratory-confirmed influenza.No RCTs assessing vaccination in pregnant women were found. The only evidence available comes from observational studies with modest methodological quality. On this basis, vaccination shows very limited effects: NNV 92 (95% CI 63 to 201) against ILI in pregnant women and NNV 27 (95% CI 18 to 185) against laboratory-confirmed influenza in newborns from vaccinated women.Live aerosol vaccines have an overall effectiveness corresponding to a NNV 46 (95% CI 29 to 115).The performance of one-dose or two-dose whole virion pandemic vaccines was higher, showing a NNV of 16 (95% CI 14 to 20) against ILI and a NNV of 35 (95% CI 33 to 47) against influenza, while a limited impact on hospitalisation was found (NNV 94, 95% CI 70 to 1022).Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms. No evidence of association with serious adverse events was found, but the harms evidence base was limited.The overall risk of bias in the included trials is unclear because it was not possible to assess the real impact of bias. AUTHORS' CONCLUSIONS Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population, including pregnant women. No evidence of association between influenza vaccination and serious adverse events was found in the comparative studies considered in the review. This review includes 90 studies, 24 of which (26.7%) were funded totally or partially by industry. Out of the 48 RCTs, 17 were industry-funded (35.4%).
Collapse
Affiliation(s)
- Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Azienda Sanitaria Locale ASL AL, Via Venezia 6, Alessandria, Piemonte, 15121, Italy. .
| | | | | | | | | | | |
Collapse
|
30
|
Hader WJ, Yee IM. The prevalence of familial multiple sclerosis in saskatoon, Saskatchewan. Mult Scler Int 2014; 2014:545080. [PMID: 24672728 PMCID: PMC3941120 DOI: 10.1155/2014/545080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/09/2013] [Indexed: 12/05/2022] Open
Abstract
Background. A population-based prevalent cohort of 150 clinical definite multiple sclerosis (MS) cases (102 women; 48 men) ascertained on January 1, 1977, Saskatoon, Saskatchewan, was found to have a familial rate of MS as 17.3%. Objectives. To determine the occurrence of familial MS cases and the frequency of MS among the biological relatives of the study cohort. Methods. The search for new familial cases MS affected relatives continued for 35 years until 2012. The natural history of the disease of sporadic cases is compared with that of the familial cases. SPSS V19 and Kaplan-Meier survival analysis were used for data analysis. Results. Of the 150 unrelated MS patients, 49 cases (32.7%) (36 women and 13 men) were reported of having at least one family member with MS. There were a total of 86 affected relatives, 26 (30.2%) first-degree relatives, 15 (17.4%) second-degree relatives, 20 (23.3%) third-degree relatives, and 25 (29.1%) distant relatives. The average age of MS onset for men with sporadic MS was 33.9 (SD = 10) years and 27.6 (SD = 8.4) years for familial cases and 29.3 (SD = 8.3) years and 26.8 (SD = 8.5) years for women. Conclusion. This 35-year longitudinal natural history study reveals a high frequency of cases with family members developing MS and supports a genetic influence in the etiology of MS.
Collapse
Affiliation(s)
- Walter J. Hader
- Department of Physical Medicine and Rehabilitation Saskatoon, University of Saskatchewan, Saskatchewan, Canada
- Saskatoon City Hospital, 701 Queen Sreet, Suite 7717, Saskatoon, Saskatchewan, Canada S7K 0M7
| | - Irene M. Yee
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, British Columbia, 2211 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2B5
| |
Collapse
|
31
|
Sadovnick AD. Differential effects of genetic susceptibility factors in males and females with multiple sclerosis. Clin Immunol 2013; 149:170-5. [DOI: 10.1016/j.clim.2013.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/01/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
|
32
|
Lossius A, Riise T, Pugliatti M, Bjørnevik K, Casetta I, Drulovic J, Granieri E, Kampman MT, Landtblom AM, Lauer K, Magalhaes S, Myhr KM, Pekmezovic T, Wesnes K, Wolfson C, Holmøy T. Season of infectious mononucleosis and risk of multiple sclerosis at different latitudes; the EnvIMS Study. Mult Scler 2013; 20:669-74. [PMID: 24072723 DOI: 10.1177/1352458513505693] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Seasonal fluctuations in solar radiation and vitamin D levels could modulate the immune response against Epstein-Barr virus (EBV) infection and influence the subsequent risk of multiple sclerosis (MS). METHODS Altogether 1660 MS patients and 3050 controls from Norway and Italy participating in the multinational case-control study of Environmental Factors In Multiple Sclerosis (EnvIMS) reported season of past infectious mononucleosis (IM). RESULTS IM was generally reported more frequently in Norway (p=0.002), but was associated with MS to a similar degree in Norway (odds ratio (OR) 2.12, 95% confidence interval (CI) 1.64-2.73) and Italy (OR 1.72, 95% CI 1.17-2.52). For all participants, there was a higher reported frequency of IM during spring compared to fall (p<0.0005). Stratified by season of IM, the ORs for MS were 1.58 in spring (95% CI 1.08-2.31), 2.26 in summer (95% CI 1.46-3.51), 2.86 in fall (95% CI 1.69-4.85) and 2.30 in winter (95% CI 1.45-3.66). CONCLUSIONS IM is associated with MS independently of season, and the association is not stronger for IM during spring, when vitamin D levels reach nadir. The distribution of IM may point towards a correlation with solar radiation or other factors with a similar latitudinal and seasonal variation.
Collapse
|
33
|
Araki Y, Kinoshita M, Motoyama R, Matsushita T, Nakagawa M, Kira JI, Tanaka M. Month of birth in multiple sclerosis with and without longitudinally extensive spinal cord lesions: A study of a Japanese national survey. J Neurol Sci 2013; 330:67-70. [DOI: 10.1016/j.jns.2013.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 04/07/2013] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
|
34
|
Hawkes CH, Boniface D. Risk associated behavior in premorbid multiple sclerosis: A case-control study. Mult Scler Relat Disord 2013; 3:40-7. [PMID: 25877972 DOI: 10.1016/j.msard.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is generally accepted that individuals who subsequently develop MS are more likely to be smokers, have suffered glandular fever and to have a low blood vitamin D level. Previous research suggested that a unifying premise is risk-associated behavior before MS onset. This survey explores several health-adverse premorbid behaviors using a case-control design. METHODS A questionnaire was completed by 94 patients with clinically definite MS. Their responses were compared to a control group of 59 who were patients with benign headache. Questions explored pre-symptomatic experience of: (a) alcohol, smoking, substance abuse, glandular fever; (b) blood transfusion; (c) hazardous sport, gambling (d) sexual history, gynecologic infection, number of pregnancies, terminations of pregnancy. Data were adjusted for age of first symptoms, gender and smoking. RESULTS Compared to the headache group, MS subjects showed significant differences prior to symptom onset, adjusted for age of first symptoms, gender and smoking, with odds ratios for reporting or means and 95% confidence intervals as follows: (a) consuming alcoholic drinks, OR 6.91 (1.74 to 27.45; p=0.006) and at an earlier age, mean 16.9y (16.4 to 17.5; p=0.046) (b) cigarette smoking, OR 2.24 (1.09 to 4.59; p=0.028) and to have smoked more per day, mean 9.45 (5.55 to 13.35; p=0.001) (c) history of glandular fever/infectious mononucleosis, OR 3.07 (1.11 to 8.49; p=0.031); (d) consumed recreational drugs, OR 3.90 (1.32 to 11.50; p=0.014), notably cannabis, OR 4.10 (1.40 to 12.09; p=0.011); (e) used a car seat belt, OR 4.45 (1.43 to 13.83; p=0.010); (f) attended all-night parties, OR 2.45 (1.12 to 5.36; p=0.025); (g) sunbathed, OR 2.770 (1.02 to 7.52; p=0.046); (h) had more sexual partners, mean 3.97 (2.00 to 5.95; p<0.001), more pregnancies, mean 1.43 (0.99 to 1.86; p=0.015) and one or more terminations of pregnancy, OR 5.05 (1.003 to 25.386; p=0.049). CONCLUSION All but one of the statistically significant variables (use of car seat belt) supports our hypothesis that MS subjects lead a riskier premorbid lifestyle. Strong associations were found for smoking, alcohol and glandular fever as suggested by others. Novel associations were found for recreational drug use; attending all-night parties; gambling on the lottery; more sexual partners, more pregnancies and one or more terminations of pregnancy. Such behavior during the MS prodrome may expose an individual to a variety of hostile environmental agents.
Collapse
Affiliation(s)
- Christopher H Hawkes
- Neuroscience Centre, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, United Kingdom.
| | - David Boniface
- Department of Epidemiology and Public Health, University College, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| |
Collapse
|
35
|
Verheul F, Smolders J, Trojano M, Lepore V, Zwanikken C, Amato MP, Grand'Maison F, Butzkueven H, Marrosu M, Duquette P, Comi G, Izquierdo G, Grammond P, Lus G, Petersen T, Bergamaschi R, Giuliani G, Boz C, Coniglio G, Van Pesch V, Lechner-Scott J, Cavalla P, Granella F, Avolio C, Fiol M, Poehlau D, Saladino ML, Gallo P, Deri N, Oleschko Arruda W, Paine M, Ferro M, Barnett M, Cabrera-Gomez JA, Slee M, Moore F, Shaw C, Petkovska-Boskova T, Rutherford M, Engelsen O, Damoiseaux J, Hupperts R. Fluctuations of MS births and UV-light exposure. Acta Neurol Scand 2013; 127:301-8. [PMID: 22970985 DOI: 10.1111/ane.12007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) are more frequently born in spring when compared to autumn. Fluctuation of UV-light has been hypothesized to drive this phenomenon. AIM To assess the correlation between fluctuation of sunlight and birth season in persons with MS. METHODS For this record-linkage study, we collected from the international MSBase and the Italian MS iMed-web databases the dates of birth of 11,415 patients with MS from 36 centres from 15 countries worldwide and compared these to dates of live-births from national registries. From all participating sites, we collected data on UV-light fluctuation and assessed its correlation with seasonal fluctuation in MS births. RESULTS Compared with the reference cohort, an increased proportion of persons with MS were born in spring and a decreased proportion in autumn (odds ratio (OR) to be born in spring versus autumn = 1.158, χ² = 36.347, P < 0.001). There was no significantly increased fluctuation of MS births with increased quartile of ambient UV-light fluctuation (Ptrend = 0.086). CONCLUSION Seasonal fluctuation of MS births as found in this worldwide cohort of patients with MS did not correlate with variation in seasonal fluctuation of UV-light. Most likely, it results from a complex interplay between fluctuation of sunlight, behavioural factors, other environmental factors and (epi)genetic factors.
Collapse
Affiliation(s)
- F. Verheul
- Groene Hart Ziekenhuis; Gouda; The Netherlands
| | | | | | - V. Lepore
- Consorzio Mario Negri Sud; Santa Maria Imbaro; Italy
| | | | | | | | - H. Butzkueven
- Department of Medicine; Melbourne Brain Centre; University of Melbourne; Melbourne; Vic.; Australia
| | | | | | - G. Comi
- University of Milan; Milan; Italy
| | | | | | - G. Lus
- Second University of Naples; Naples; Italy
| | | | | | | | - C. Boz
- Karadeniz Technical University; Trabzon; Turkey
| | | | - V. Van Pesch
- Cliniques Universitaires Saint-Luc; Brussels; Belgium
| | | | | | | | | | - M. Fiol
- FLENI; Buenos Aires; Argentina
| | | | | | - P. Gallo
- University of Padova; Padova; Italy
| | - N. Deri
- Hospital Fernandez; Buenos Aires; Argentina
| | | | - M. Paine
- St Vincent's Hospital; Melbourne; Vic.; Australia
| | | | - M. Barnett
- Brain and Mind Research Institute; Sydney; NSW; Australia
| | | | - M. Slee
- Flinders Medical Centre; Bedford Park; SA; Australia
| | - F. Moore
- Jewish General Hospital; Montreal; Canada
| | - C. Shaw
- Geelong Hospital; Geelong; Vic.; Australia
| | | | | | - O. Engelsen
- Norwegian Institute for Air Research; Tromsø; Norway
| | - J. Damoiseaux
- Maastricht University Medical Center; Maastricht; The Netherlands
| | - R. Hupperts
- Orbis Medical Center; Sittard; The Netherlands
| |
Collapse
|
36
|
Tavares Da Silva F, De Keyser F, Lambert PH, Robinson WH, Westhovens R, Sindic C. Optimal approaches to data collection and analysis of potential immune mediated disorders in clinical trials of new vaccines. Vaccine 2013; 31:1870-6. [DOI: 10.1016/j.vaccine.2013.01.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 12/21/2012] [Accepted: 01/22/2013] [Indexed: 01/05/2023]
|
37
|
Bove R, Chitnis T. Sexual disparities in the incidence and course of MS. Clin Immunol 2013; 149:201-10. [PMID: 23608496 DOI: 10.1016/j.clim.2013.03.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/06/2013] [Accepted: 03/11/2013] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) affects three times more women than men and this ratio appears to be increasing. However male patients experience increased disease progression, brain atrophy, and cognitive impairment. Gonadal hormones may modulate these sex differences. For example, female puberty heralds an increased risk of MS, and during pregnancy disease activity is milder, with an increased risk of postpartum relapses. Gonadal hormones likely have complex and inflammatory and neuroprotective effects, and may interact with other disease modulators, such as vitamin D. Sex differences in the heritability of disease susceptibility genes implicate a role for epigenetic modification. Many questions remain, including the impact of sex on treatment response and epigenetic changes, and the modulatory potential of hormonal treatments. This article summarizes what is known about sexual dimorphism in MS onset and course, as well as potential interactions between sex and other factors influencing MS pathogenesis, incidence and severity.
Collapse
Affiliation(s)
- Riley Bove
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
38
|
Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis. Ther Adv Neurol Disord 2013; 6:81-116. [PMID: 23483715 PMCID: PMC3582312 DOI: 10.1177/1756285612473513] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis (MS) is reviewed. Among the multiple recently discovered actions of vitamin D, an immunomodulatory role has been documented in experimental autoimmune encephalomyelitis and in humans. This action in the peripheral immune system is currently the main known mechanism through which vitamin D might influence MS, but other types of actions could be involved within the central nervous system. Furthermore, vitamin D insufficiency is widespread in temperate countries and in patients with MS at the earliest stages of the disease, suggesting that the deleterious effects related to vitamin D insufficiency may be exerted in these patients. In fact, many genetic and environmental risk factors appear to interact and contribute to MS. In genetics, several human leukocyte antigen (HLA) alleles (more particularly HLA-DRB1*1501) could favour the disease whereas some others could be protective. Some of the genes involved in vitamin D metabolism (e.g. CYP27B1) also play a significant role. Furthermore, three environmental risk factors have been identified: past Epstein-Barr virus infection, vitamin D insufficiency and cigarette smoking. Interactions between genetic and environmental risk or protective factors may occur during the mother's pregnancy and could continue during childhood and adolescence and until the disease is triggered in adulthood, therefore possibly modulating the MS risk throughout the first decades of life. Furthermore, some clinical findings already strongly suggest that vitamin D status influences the relapse rate and radiological lesions in patients with MS, although the results of adequately powered randomized clinical trials using vitamin D supplementation have not yet been reported. While awaiting these incontrovertible results, which might be long in coming, patients with MS who are currently in vitamin D insufficiency should be supplemented, at least for their general health status, using moderate doses of the vitamin.
Collapse
Affiliation(s)
- Charles Pierrot-Deseilligny
- Service de Neurologie 1, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (Paris VI), Paris, France
| | | |
Collapse
|
39
|
Casiraghi C, Horwitz MS. Epstein–Barr virus and autoimmunity: the role of a latent viral infection in multiple sclerosis and systemic lupus erythematosus pathogenesis. Future Virol 2013. [DOI: 10.2217/fvl.12.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis (MS) and systemic lupus erythematosus (SLE) are both chronic autoimmune diseases with unknown etiology. To date, EBV is the most closely implicated infectious agent to be associated with both MS and SLE. Epidemiological findings show a strong correlation between EBV infection and the risk of developing these diseases. The type and magnitude of both EBV-specific antibodies and T-cell responses produced by MS or SLE patients are dysregulated when compared with healthy cohorts. Despite all these findings, it is still not clear if and how EBV triggers autoimmunity. EBV infects and establishes latency mainly in B cells, but it can also infect other cell types and indirectly influence the activation status of the immune system by stimulating the production of proinflammatory mediators. This could play a role in both MS and SLE pathogenesis. In this review we will summarize recent literature that links EBV infection to SLE and MS, and discuss possible new mechanisms that explain how EBV drives autoimmunity.
Collapse
Affiliation(s)
- Costanza Casiraghi
- Department of Microbiology & Immunology, The University British Columbia, Vancouver, British Columbia, Canada
| | - Marc S Horwitz
- Department of Microbiology & Immunology, The University British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
40
|
Martínez-Sernández V, Figueiras A. Central nervous system demyelinating diseases and recombinant hepatitis B vaccination: a critical systematic review of scientific production. J Neurol 2012; 260:1951-9. [PMID: 23086181 DOI: 10.1007/s00415-012-6716-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 12/20/2022]
Abstract
The etiology of multiple sclerosis has not yet been fully described. A potential link between the recombinant hepatitis B vaccine and an increased risk of onset or exacerbation of multiple sclerosis emerged in the mid-1990s, leading to several spontaneous reports and studies investigating this association. We conducted a critical systematic review aimed at assessing whether hepatitis B vaccination increases the risk of onset or relapse of multiple sclerosis and other central nervous system demyelinating diseases. MEDLINE and EMBASE were used as data sources, and the search covered the period between 1981 and 2011. Twelve references met the inclusion criteria. No significant increased risk of onset or relapse of the diseases considered was associated with hepatitis B vaccination, except in one study. Most studies included in this review displayed methodological limitations and heterogeneity among them, which rendered it impossible to draw robust conclusions about the safety of hepatitis B vaccination in healthy subjects and patients with multiple sclerosis. Therefore, on the basis of current data there is no need to modify the vaccination recommendations; however, there is a need to improve the quality of observational studies with emphasis on certain considerations that are discussed in this review.
Collapse
Affiliation(s)
- V Martínez-Sernández
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain.
| | | |
Collapse
|
41
|
Solar radiation and vitamin D: mitigating environmental factors in autoimmune disease. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:619381. [PMID: 22523507 PMCID: PMC3317188 DOI: 10.1155/2012/619381] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 11/29/2011] [Accepted: 12/13/2011] [Indexed: 12/14/2022]
Abstract
This paper looks at the environmental role of vitamin D and solar radiation as risk reduction factors in autoimmune disease. Five diseases are considered: multiple sclerosis, type 1 diabetes, rheumatoid arthritis, autoimmune disease of the thyroid, and inflammatory bowel disease. Clinical relevant studies and factors that may indicate evidence that autoimmune disease is a vitamin D-sensitive disease are presented. Studies that have resulted in prevention or amelioration of some autoimmune disease are discussed. An example of the utility of supplementing vitamin D in an unusual autoimmune disease, idiopathic thrombocytic purpura, is presented.
Collapse
|
42
|
Jafari N, Broer L, van Duijn CM, Janssens ACJW, Hintzen RQ. Perspectives on the use of multiple sclerosis risk genes for prediction. PLoS One 2011; 6:e26493. [PMID: 22164203 PMCID: PMC3229479 DOI: 10.1371/journal.pone.0026493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 09/28/2011] [Indexed: 11/19/2022] Open
Abstract
Objective A recent collaborative genome-wide association study replicated a large number of susceptibility loci and identified novel loci. This increase in known multiple sclerosis (MS) risk genes raises questions about clinical applicability of genotyping. In an empirical set we assessed the predictive power of typing multiple genes. Next, in a modelling study we explored current and potential predictive performance of genetic MS risk models. Materials and Methods Genotype data on 6 MS risk genes in 591 MS patients and 600 controls were used to investigate the predictive value of combining risk alleles. Next, the replicated and novel MS risk loci from the recent and largest international genome-wide association study were used to construct genetic risk models simulating a population of 100,000 individuals. Finally, we assessed the required numbers, frequencies, and ORs of risk SNPs for higher discriminative accuracy in the future. Results Individuals with 10 to 12 risk alleles had a significantly increased risk compared to individuals with the average population risk for developing MS (OR 2.76 (95% CI 2.02–3.77)). In the simulation study we showed that the area under the receiver operating characteristic curve (AUC) for a risk score based on the 6 SNPs was 0.64. The AUC increases to 0.66 using the well replicated 24 SNPs and to 0.69 when including all replicated and novel SNPs (n = 53) in the risk model. An additional 20 SNPs with allele frequency 0.30 and ORs 1.1 would be needed to increase the AUC to a slightly higher level of 0.70, and at least 50 novel variants with allele frequency 0.30 and ORs 1.4 would be needed to obtain an AUC of 0.85. Conclusion Although new MS risk SNPs emerge rapidly, the discriminatory ability in a clinical setting will be limited.
Collapse
Affiliation(s)
- Naghmeh Jafari
- Department of Neurology, ErasMS Center, Erasmus MC, Rotterdam, The Netherlands
| | - Linda Broer
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Rogier Q. Hintzen
- Department of Neurology, ErasMS Center, Erasmus MC, Rotterdam, The Netherlands
- * E-mail:
| |
Collapse
|
43
|
Jafari N, Broer L, van Duijn CM, Janssens ACJW, Hintzen RQ. Perspectives on the use of multiple sclerosis risk genes for prediction. PLoS One 2011. [PMID: 22164203 DOI: 10.1371/journal.pone.0026493]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE A recent collaborative genome-wide association study replicated a large number of susceptibility loci and identified novel loci. This increase in known multiple sclerosis (MS) risk genes raises questions about clinical applicability of genotyping. In an empirical set we assessed the predictive power of typing multiple genes. Next, in a modelling study we explored current and potential predictive performance of genetic MS risk models. MATERIALS AND METHODS Genotype data on 6 MS risk genes in 591 MS patients and 600 controls were used to investigate the predictive value of combining risk alleles. Next, the replicated and novel MS risk loci from the recent and largest international genome-wide association study were used to construct genetic risk models simulating a population of 100,000 individuals. Finally, we assessed the required numbers, frequencies, and ORs of risk SNPs for higher discriminative accuracy in the future. RESULTS Individuals with 10 to 12 risk alleles had a significantly increased risk compared to individuals with the average population risk for developing MS (OR 2.76 (95% CI 2.02-3.77)). In the simulation study we showed that the area under the receiver operating characteristic curve (AUC) for a risk score based on the 6 SNPs was 0.64. The AUC increases to 0.66 using the well replicated 24 SNPs and to 0.69 when including all replicated and novel SNPs (n = 53) in the risk model. An additional 20 SNPs with allele frequency 0.30 and ORs 1.1 would be needed to increase the AUC to a slightly higher level of 0.70, and at least 50 novel variants with allele frequency 0.30 and ORs 1.4 would be needed to obtain an AUC of 0.85. CONCLUSION Although new MS risk SNPs emerge rapidly, the discriminatory ability in a clinical setting will be limited.
Collapse
Affiliation(s)
- Naghmeh Jafari
- Department of Neurology, ErasMS Center, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
44
|
Abstract
Multiple sclerosis (MS) is the most common disease of the central nervous system that causes permanent disability in young adults. Based on strong circumstantial evidence, MS is considered to be putative autoimmune disorder, but much remains to be understood about the etiology and clinical onset of the disease. It seems unlikely that MS results from a single causative event, but rather is the result of genetic and environmental factors and the interactions thereof. This article discusses the epidemiology of MS.
Collapse
Affiliation(s)
- Sreeram V Ramagopalan
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | | |
Collapse
|
45
|
Ramagopalan SV, Hoang U, Seagroatt V, Handel A, Ebers GC, Giovannoni G, Goldacre MJ. Geography of hospital admissions for multiple sclerosis in England and comparison with the geography of hospital admissions for infectious mononucleosis: a descriptive study. J Neurol Neurosurg Psychiatry 2011; 82:682-7. [PMID: 21212107 PMCID: PMC3090127 DOI: 10.1136/jnnp.2010.232108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It is well recognised that variation in the geographical distribution of multiple sclerosis (MS) exists. Early studies in England have shown the disease to have been more common in the North than the South. However, this could be an artefact of inaccurate diagnosis and ascertainment, and recent data on MS prevalence are lacking. In the present study, data were analysed to provide a more contemporary map of the distribution of MS in England and, as infectious mononucleosis (IM) has been shown to be associated with the risk of MS, the geographical distribution of IM with that of MS was compared. METHODS Analysis of linked statistical abstracts of hospital data for England between 1999 and 2005. RESULTS There were 56,681 MS patients. The admission rate for MS was higher in females (22/10(5); 95% CI 21.8 to 22.3) than males (10.4/10(5); 95% CI 10.2 to 10.5). The highest admission rate for MS was seen for residents of Cumbria and Lancashire (North of England) (20.1/10(5); 95% CI 19.3 to 20.8) and the lowest admission rate was for North West London residents (South of England) (12.4/10(5); 95% CI 11.8 to 13.1). The geographical distributions of IM and MS were significantly correlated (weighted regression coefficient (r (w))=0.70, p<0.0001). Admission rates for MS were lowest in the area quintile with the highest level of deprivation and they were also lowest in the area quintile with the highest percentage of population born outside the UK. A significant association between northernliness and MS remained after adjustment for deprivation and UK birthplace. CONCLUSIONS The results show the continued existence of a latitude gradient for MS in England and show a correlation with the distribution of IM. The data have implications for healthcare provision, because lifetime costs of MS exceed £1 million per case in the UK, as well as for studies of disease causality and prevention.
Collapse
|
46
|
Abstract
Multiple sclerosis (MS) is a one of the group of diseases labeled as "common complex". Virtually all common complex traits, genetic and environmental components have important roles, both independently and interactively, in disease susceptibility and stochastic and epigenetic effects cannot be overlooked. Data presented are largely part of the Canada-wide prospective, population-based longitudinal Canadian Collaborative Project on Genetic Susceptibility to MS (CCPGSMS) which includes over 30,000 unique families having at least 1 member with MS. Findings do not support a general propensity to autoimmune disease in MS families, but clearly highlight the importance of controlling for gender (patient, informant) when conducting such studies. The MHC class II association has been fine-mapped to the HLA-DRB5*0101-HLA-DRB1*1501-HLA-DQA1*0102-HLA-DQB1*0602 extended haplotype. This HLA haplotype confers a relative risk of approximately 3 and homozygosity for this haplotype increases the risk by over 6 fold. However, the HLA haplotype loci interactions are complex and include, epistasis, trans and cis effects, and parent-of-origin effects. As well, there may be interactions of EBV and vitamin D with the HLA, In conclusion, using MS as an example, susceptibility for common complex disease most likely results from interactions of genes, environmental interactions and gene/environment interactions.
Collapse
Affiliation(s)
- A Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
47
|
van der Mei I, Simpson S, Stankovich J, Taylor B. Individual and Joint Action of Environmental Factors and Risk of MS. Neurol Clin 2011; 29:233-55. [DOI: 10.1016/j.ncl.2010.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
48
|
Environmental triggers of multiple sclerosis. FEBS Lett 2011; 585:3724-9. [PMID: 21486562 DOI: 10.1016/j.febslet.2011.04.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 04/02/2011] [Accepted: 04/04/2011] [Indexed: 12/20/2022]
Abstract
Multiple sclerosis is a chronic immune-mediated disease of the central nervous system that develops in young adults with a complex genetic predisposition. Similar to other autoimmune disease, HLA-DR and -DQ alleles within the HLA class II region on chromosome 6p21 are by far the strongest risk-conferring genes. Less robust susceptibility effects have been reported for non-MHC related genetic variants. Improvements in the design of epidemiological studies helped to identify consistent environmental risk-associations such as the increased susceptibility for MS in individuals with a history of infectious mononucleosis, a symptomatic primary infection with the human γ-herpesvirus Epstein-Barr virus (EBV). Sun exposure and serum vitamin D levels are emerging non-infectious environmental risk factors that may have independent roles. The analysis of environmental effects will likely expand in the next few years and will allow for the generation of testable hypotheses as to how environmental insults interact with genetic factors to jointly determine the susceptibility to MS. Insights gained from these studies might facilitate the development of prevention strategies and more effective treatments for MS.
Collapse
|
49
|
Varicella zoster virus and relapsing remitting multiple sclerosis. Mult Scler Int 2011; 2011:214763. [PMID: 22096629 PMCID: PMC3195831 DOI: 10.1155/2011/214763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/04/2011] [Accepted: 02/02/2011] [Indexed: 01/24/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disorder; however, little is known about the triggering factors of the abnormal immune response. Different viruses from the herpes family have been mentioned as potential participants. Here, we review the evidences that support the association of varicella zoster virus (VZV) with MS. Epidemiological studies from geographical areas, where incidence of MS has increased in recent decades, pointed out a high frequency of varicella and zoster in the clinical antecedents of MS patients, and also laboratory investigations have found large quantities of DNA from VZV in leucocytes and cerebrospinal fluid of MS patients restricted to the ephemeral period of MS relapse, followed by disappearance of the virus during remission. The above observations and the peculiar features of VZV, mainly characterized by its neurotropism and long periods of latency followed by viral reactivation, support the idea on the participation of VZV in the etiology of MS. However, as with reports from studies with other viruses, particularly Epstein Barr virus, conflicting results on confirmatory studies about the presence of viral gene products in brain tissue indicate the need for further research on the potential participation of VZV in the etiology of MS.
Collapse
|
50
|
|