Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis
Yellow Fever Vaccination and Increased Relapse Rate in Travelers With Multiple Sclerosis
复制标题
DOI：
10.1001/archneurol.2011.131
复制
发表时间：
2011-10-01
影响因子：
--
通讯作者：
Correale, Jorge
中科院分区：
文献类型：
--
作者：
Farez, Mauricio F.;Correale, Jorge
目的：研究黄热病（YF）免疫接种对随后多发性硬化（MS）复发风险的影响。设计：自身对照病例系列研究。设置：MS门诊。患者：7例前往流行性YF地区接受YF 17 D-204疫苗的临床复发缓解型MS患者。干预：YF 17 D-204疫苗。主要结局指标：复发次数。次要结果包括磁共振成像和外周血单核细胞细胞因子和趋化因子production.Results的新病变的数量：免疫接种后的风险期内的年恶化率为8.57，而风险期外的复发率仅为0.67（率比= 12.778; P <0.001）。免疫后3个月，与接种前12个月和免疫后9个月相比，患者显示新的或扩大的T2加权病变和钆增强病变显著增加（均P < .001）。此外，与未接种疫苗的MS患者相比，MS患者接种YF疫苗后，血髓鞘碱性蛋白和髓鞘少突胶质细胞糖蛋白应答显示干扰素γ诱导蛋白10 kDa-、干扰素γ-、白细胞介素1 α-、白细胞介素1 β-和肿瘤坏死因子分泌细胞数量以及补体成分C1 qB产生显著增加，MS患者接种流感疫苗和健康对照组（分别为P = .01和P < .001）.结论：对于MS患者旅行到流行性YF地区，应在仔细权衡病情加重风险和暴露于YF病毒的可能性的基础上推荐接种疫苗。
Objective: To investigate the effect of yellow fever (YF) immunization on the subsequent multiple sclerosis (MS) relapse risk.Design: Self-controlled case series study.Setting: An MS outpatient clinic.Patients: Seven patients with clinical relapsing-remitting MS traveling to endemic YF areas who received the YF 17D-204 vaccine were studied.Intervention: The YF 17D-204 vaccine.Main Outcome Measure: Number of relapses. Secondary outcomes included the number of new lesions on magnetic resonance imaging and peripheral mononuclear cell cytokine and chemokine production.Results: The annual exacerbation rate during risk periods following immunization was 8.57, while the relapse rate outside the risk period was only 0.67 (rate ratio = 12.778; P < .001). Three months after immunization, patients showed a significant increase in new or enlarging T2-weighted lesions and gadolinium-enhancing lesions compared with 12 months prior to vaccination and 9 months after immunization (both P < .001). Moreover, blood myelin basic protein and myelin oligodendrocyte glycoprotein responses showed significant increases in interferon gamma-induced protein 10 kDa-, interferon gamma-, interleukin 1 alpha-, interleukin 1 beta-, and tumor necrosis factor-secreting cell numbers as well as complement component C1qB production after YF vaccination in patients with MS compared with unvaccinated patients with MS, patients with MS vaccinated against influenza, and healthy control subjects (P = .01 and P < .001, respectively).Conclusion: For patients with MS traveling to endemic YF areas, vaccination should be recommended on the basis of carefully weighing the risk of exacerbation against the likelihood of exposure to the YF virus.