Vaccinations and multiple sclerosis
Vaccinations and multiple sclerosis
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DOI：
10.1007/s100720170014
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发表时间：
2001-04-01
影响因子：
3.3
通讯作者：
Gout, O
中科院分区：
文献类型：
--
作者：
Gout, O
关于疫苗接种和多发性硬化症之间的关系必须考虑两个问题：疫苗接种是否有利于多发性硬化症的首次发作？它们是否会增加已知疾病患者的短期或长期风险？这些问题的答案很难回答，因为报告的病例很少，我们忽视了基于前瞻性研究的疫苗中神经不良事件的准确频率，最后是缺乏完善的病理生理学。在大多数情况下，疫苗的作用是基于注射和神经系统疾病发作之间的时间联系，很少与积极的重新引入有关。急性播散性脑脊髓炎(ADEM)是一种白质和灰质的单相和多灶性疾病，在各种病毒或细菌感染以及百日咳、破伤风和黄热病等疾病的疫苗注射后被观察到。ADEM和实验性变态反应性脑炎(EAE)之间的相似之处提示了一个免疫过程。除了ADEM的戏剧性表现外，在注射疫苗后报告了更有限的白质参与，如视神经炎或脊髓炎，有时被算作MS的第一次发作。在法国，从1991年到1999年，2500万居民，几乎占人口的一半，接种了乙肝疫苗。向药物警戒股报告了数百例接种乙肝疫苗后发生的急性中枢性脱髓鞘事件，导致学校修改了疫苗接种政策，并启动了几项旨在检查疫苗和中枢性脱髓鞘事件之间可能关系的研究。这些研究的结果未能确定乙肝疫苗之间的因果关系。然而，乙肝抗原(S)与一种或多种髓鞘蛋白之间的分子模拟，或自身反应性淋巴细胞的非特异性激活，可能构成这些不良神经事件的可能发病机制。
Two problems must be considered in regard to the relationship between vaccinations and MS: Do vaccinations favour the first attack of MS? Do they increase the short- or long-term risk in patients with known disease? Answers to these questions are difficult due to the paucity of reported cases, our ignorance of the precise frequency of neurological adverse events in vaccines based on prospective studies, and finally by the lack of a well established pathophysiology. In most instances, the role of the vaccine is based on a temporal link between the injection and the onset of neurological disease, and more rarely to a positive reintroduction. Acute disseminated encephalomyelitis (ADEM), a monophasic and multifocal illness of the white and grey matter, has been observed following various viral or bacterial infections as well as vaccine injections for diseases such as pertussis, tetanus and yellow fever. The similarities between ADEM and experimental allergic encephalitis (EAE) are suggestive of an immunological process. In addition to the dramatic presentation of ADEM, more limited white matter involvement, such as optic neuritis or myelitis, has been reported following vaccine injections, and has occasionally been counted as the first attack of MS. In France, 25 million inhabitants, almost half of the population, were vaccinated against hepatitis B (HB) between 1991 and 1999. Several hundred cases of an acute central demyelinating event following HB vaccination were reported to the pharmacovigilance unit, leading to a modification of vaccination policy in the schools and the initiation of several studies designed to examine the possible relationship between the vaccine and the central demyelinating events. The results of these studies failed to establish the causality of the HB vaccine. Nevertheless, molecular mimicry between HB antigen(s) and one or more myelin proteins, or a non-specific activation of autoreactive lymphocytes, could constitute possible pathogenetic mechanisms for these adverse neurological events.