MS is now thought to be a neurological autoimmune disease in which the immune system attacks the brain and spinal cord. It is most likely to occur in young people under the age of 40. Vaccinations are often mentioned as a possible risk factor for MS. Professor Bernhard Hemmer, director of the Neurology Department of the TUM hospital, Klinkum rechts der Isar, teamed up with scientists from the Medical Department and the Bavarian Association of Statutory Health Insurance Physicians (KVB) to analyze a large KVB dataset representative of the general population. The data covered over 200,000 individuals, including more than 12,000 MS patients. The study was published in the Tuesday, July 30, 2019, issue of Neurology, the medical journal of the American Academy of Neurology.
Lower vaccination rates among MS patients
The researchers found that five years before being diagnosed, individuals who went on to develop MS had received fewer vaccinations than those who did not develop MS. This applied to all the vaccines investigated: those against pneumococci, meningococci, mumps, measles, rubella, chickenpox, human papilloma virus (HPV), hepatitis A and B, tick-borne encephalitis (TBE) and influenza. The effect was particularly pronounced in the latter three cases: the control group had received significantly more vaccinations than the individuals who later developed MS.
“The causes are still a mystery. It may be that people perceive the disease long before they are diagnosed and therefore avoid putting additional stress on their immune system. Such effects are in fact evident in our data. Or perhaps the vaccines have a protective effect that prevents the immune system from attacking the nervous system. In any case, given the large volume of data analyzed, we can conclusively state that there is no evidence that recent vaccination increases the likelihood of MS or the onset of an initial MS episode”, Alexander Hapfelmeier, lead author of the study, explains.
Effect not evident in Crohn’s disease or psoriasis
The researchers also wanted to rule out the possibility that the results might be an underlying effect of chronic diseases in general. They therefore analyzed data from two other groups: patients with Crohn's disease, an inflammatory bowel disorder, and patients with psoriasis, a chronic skin disease. The vaccinations of these patients had also been recorded five years before their diagnosis.
Those patients, however, had received as many vaccinations as the healthy control group. “Thus, the results are not due solely to the presence of a chronic inflammatory disease, but to behavior specific to MS,” Bernhard Hemmer says, adding: “We already know from other studies that MS sufferers show atypical behavior and medical history long before they are diagnosed. For example, they are more prone to mental illnesses and also tend to have fewer children. All this clearly indicates that MS is perceived long before any neurological symptoms appear. We therefore need to find suitable markers to diagnose the condition earlier. We see this as one of our most important tasks.”
Alexander Hapfelmeier, Christiane Gasperi, Ewan Donnachie and Bernhard Hemmer, A large case-control study on vaccination as risk factor of multiple sclerosis, Neurology, July 30, 2019, DOI: 10.1212/WNL.0000000000008012
The data for the above-described study came from the Bavarian Association of Statutory Physicians (KVB). In addition, the following criteria were important for selecting the members of the MS group: they must have consulted a neurologist, been diagnosed twice with MS, lived in Bavaria during the five-year period investigated and must not have had a medical history suggestive of MS during that period.
Professor Bernhard Hemmer is a member of the DIFUTURE Consortium. MS is the first disease for which the DIFUTURE researchers have developed and tested methods for reliably harnessing data medical data for research and clinical routine. This is the objective of the DIFUTURE Research Association, which is funded by the German Ministry for Education and Research as part of the Medical Informatics Initiative to the tune 30 million euros.
Contacts to this article:
Prof. Dr. Bernhard Hemmer
Director of the Neurology Department
Technical University of Munich, Klinikum rechts der Isar
Tel.: +49 89 4140-4601