Table_1_Inadequate Vaccine Responses in Children With Multiple Sclerosis.DOCX

Objective: Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV), are recommended for patients with pediatric onset multiple sclerosis (POMS) and may be required prior to initiation of some disease modifying therapies. However, the efficacy of routine vaccine administration in POMS has never been studied. We sought to assess the humoral mediated vaccine response to HBV and VZV in children with POMS.
Methods: A multi-center retrospective chart-based review of 62 patients with POMS was performed. Clinical data and antibody titers against HBV and VZV were collected prior to initiation of disease modifying therapy or steroids and compared to institutional control data, using t-test and chi squared analysis.
Results: There were low rates of immunity against both HBV and VZV (33 and 25% respectively) among individuals with POMS. Fifteen individuals (24%) were non-immune to both. Compared to institutional control data, individuals with POMS were significantly less likely to be immune to and HBV (p = 0.003, 95% CI: 0.22–0.75) and VZV (p < 0.001, 95% CI: 0.09–0.39).
Interpretation: Individuals with POMS have low rates of antibody-mediated immunity against HBV and VZV, despite receiving the appropriate vaccinations. This suggests an association between POMS and systemic immune dysregulation although further study is needed.

研究目的：针对儿童起病多发性硬化（pediatric onset multiple sclerosis, POMS）患者，临床推荐接种乙型肝炎病毒（Hepatitis B virus, HBV）与水痘带状疱疹病毒（Varicella Zoster virus, VZV）疫苗，且在启动部分疾病修正治疗前可能需要完成此类疫苗接种。然而，目前尚无针对POMS人群常规疫苗接种有效性的相关研究。本研究旨在评估POMS患儿针对HBV与VZV的体液介导疫苗应答情况。
研究方法：本研究针对62例POMS患者开展多中心回顾性病历审查。在启动疾病修正治疗或糖皮质激素治疗前，收集所有受试者的临床数据以及HBV、VZV的抗体滴度，并采用t检验与卡方检验与机构对照数据进行比较。
研究结果：POMS患者针对HBV与VZV的抗体免疫率均较低，分别为33%与25%；其中15例患者（24%）对两种疫苗均无免疫应答。与机构对照数据相比，POMS患者对HBV（p=0.003，95%置信区间：0.22–0.75）与VZV（p<0.001，95%置信区间：0.09–0.39）产生免疫的概率均显著更低。
研究解读：尽管已完成规范疫苗接种，POMS患者针对HBV与VZV的抗体介导免疫率仍较低。这提示POMS与全身免疫失调存在关联，但仍需开展进一步研究予以验证。