To establish recommendations on immunization and multiple sclerosis (MS) 

Vaccines have been suspected in the past to trigger MS or MS exacerbations. Other concerns arose more recently, with the extension of the immunoactive treatment arsenal, about an increased risk of infections or a decreased effectiveness of immunization in immunosuppressed patients. 

The French Group for Recommendations in Multiple Sclerosis (France4MS) did a systematic review of articles from PubMed and universities databases (January 1975 through June 2018). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. Twenty-four MS experts worked on the full-text review and a group of 110 multidisciplinary health care specialists validated the final evaluation of summarized evidences.

Neurologists should double check vaccination status as soon as possible after MS diagnosis and before the disease-modifying treatment (DMT) introduction. The French vaccinal calendar should be applied to MS patients and they should be advised to receive seasonal influenza vaccine. If possible, serological status, including A, B, C hepatitis, measles, mumps, pertussis, rubella, small pox, varicella-zoster should be checked before starting a DMT. In case of treatment-induced immunosuppression, MS patients should be informed about infections risks and vaccine standards from the French High council of

Health should be applied. Live attenuated vaccines are contra-indicated in MS patients currently or recently treated with immunosuppressive drugs, including corticosteroids; other vaccines can be proposed whatever the treatment, but their effectiveness may be partly reduced with some drugs. 

Physicians and patients should be aware of the updated recommendations for immunizations and MS. Practice guidelines will be delivered by the French MS Society for the medical and patients communities.

On behalf the SFSEP and the FRANCE4MS group