Vaccine Myths Detected as Major Reason for Low Vaccination Rates Among Patients With MS

Patients with multiple sclerosis (MS) who had not been vaccinated in the past year reported beliefs about adverse events and worsening MS resulting from vaccines as reasons they avoided getting innoculated against various diseases, suggesting that more education on vaccine safety need to be relayed to patients, according to a recent study.

The large cross-sectional study, published in Neurology: Clinical Practice, highlighted the lower-than-desired vaccination rates among the US MS population and explored the reasons behind the low rates.

A lack of vaccinations places people with MS at an increased risk of complications and hospitalizations resulting from preventable infections.

“Misconceptions about the safety of vaccination in the context of MS appear to play an important role in the choice to not obtain vaccinations, highlighting the importance of education about these issues and consistent recommendations by health care providers,” wrote the investigators.

People with MS have elevated risks of infection and postinfectious complications compared with people without MS. Influenza infection can also lead to increased risk of relapse. Due to an increase in stronger immunodulating therapies for MS management, vaccinations have been a subject of concern because immunodulating therapies may influence the need for and safety of vaccines.

Studies evaluating vaccination uptake in people with MS have mostly focused on influenza and are scarce overall. In other populations with immune-mediated diseases, such as inflammatory bowel disease (IBD), patients have a number of general and disease-specific barriers to vaccinations, but relevant barriers have not yet been reported for MS populations.

The investigators collected data that was reported in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry, which is a self-report registry for people with MS containing sociodemographic and clinical information. In spring 2020, the investigators surveyed participants in the NARCOMS registry to gauge the patients’ vaccination status and reasoning.

Out of 10,210 patients who were distributed the survey, 5244 patients who resided in the United States, had a clinical MS diagnosis, and had symptom onset starting after 16 years of age, were included in the final analysis. The mean (SD) age of the participants was 61.8 (10.1) and 88.5% are age 50 years or older. In total, 3749 (71.5%) of participants have gone some form of postsecondary education and the median Patient Determined Disease Steps score was 4.

The most common vaccinations received were tetanus (88.5%; n = 4305); measles, mumps, rubella (74.1%; n = 3523); and influenza (74.1%; n = 3766). The rate that participants received a seasonal flu vaccine in the year prior to the survey increased with age, ranging from 59.1% for patients aged 18 to 24 years to 79.9% for those aged 65 years or older.

Overall, 43.0% (n = 2161/5032) of the participants said that their neurologist had ever inquired about their immunization history, and 39.1% reported that they had never been asked.

During the multivariate analysis, the investigators found the postsecondary education and household income of greater than $100,000 or less than $50,000 were associated with increased odds of being vaccinated. Younger-aged patients and current smokers were associated with reduced odds of vaccination. Patients who used a disease modifying therapy (DMTs) demonstrated a 41% increased odd of receiving a seasonal flu vaccine.

Of the 1303 participants who did not receive an influenza vaccination during the previous flu season and who reported their reasoning for not doing so, personal preferences was the most commonly reported reason (29.6%), followed by concerns about possible adverse events (29.3%), and concerns about the vaccine worsening patients’ MS (23.7%).

The personal reasons category was dominated by patients who felt that they did not need it (86.7%). Additionally, some misconceptions that injectable flu vaccines were contraindicated with several DMTs were reported.

The investigators mentioned that an IBD clinic saw impressive increases in vaccination rates when offering patients influenza and pneumococcal vaccines during clinic visits, increasing rates from 54% to 81% in 1 year for influenza vaccines and 31% to 54% for pneumococcal vaccines over a 5-year period, suggesting this may be a helpful way to increase vaccination rates among patients with MS.

“Provider recommendation is strongly associated with uptake of the seasonal influenza vaccine; thus, recommendations at the time of routine clinic visits may be helpful,” the investigators suggested.

Limitations of the study included the 62.5% response rate, the small differences in sociodemographic factors that could potentially limit generalizability of the results, and the reliance on self-reported vaccination status.

Reference

Marrie RA, Kosowan L, Cutter GR, Fox R, Salter A. Uptake and attitudes about immunizations in people with multiple sclerosis. Neurol Clin Pract. August 2021;11(4):327-334. doi: 10.1212/CPJ.0000000000001099