Do Vaccines Cause Multiple Sclerosis?



Influenza vaccines do not cause multiple sclerosis (MS). Other vaccines currently routinely recommended to the general population in the U.S.* have not been shown to cause MS.

Epidemiological Evidence

Most studies described in the 2012 report by the Institute of Medicine (IOM), now called the National Academy of Medicine (NAM), found no association between vaccination and MS, whether assessing onset [1-5] or relapse [6, 7] in adults, or onset [1, 8] or relapse [9] in children; however, these studies did not provide convincing evidence due to a lack of validity and precision [10]. Studies published since the 2012 IOM report focusing on the pandemic H1N1 influenza vaccine Pandemrix [11-13], quadrivalent HPV vaccine (Gardasil) [14-16] and hepatitis B vaccine [15] have also found no association with MS. A white paper on influenza vaccine safety published in 2015 concluded that while each individual study had relatively low power, as a group they provide consistent evidence against a causal association between influenza vaccine in adults and MS onset or relapse; although the data are more limited in children, there is no signal to indicate concern [17]. A recent systematic review found no increase in risk of development of MS after vaccination against hepatitis B, HPV, influenza, MMR, tetanus, diphtheria, polio, smallpox, or BCG vaccines [18]. Another recent literature review also found no increase in risk of onset or relapse of MS after vaccination [19].

Proposed Biological Mechanism

Hypersensitivity reactions triggered by autoimmunity, genetics or environmental factors such as viral infection are often incriminated in the destruction of the host’s myelin basic protein (MBP) and other antigens [20]. Similarities in features of MS and other demyelinating disorders have been described and some subjects with the diagnosis of Acute Disseminated Encephalomyelitis (ADEM) have had recurrences and progressed to MS [21, 22]. One possible mechanism is molecular mimicry, which refers to the possibility that similar epitopes shared between self-peptides and foreign peptides (introduced via infection or immunization) inadvertently cause the activation of autoreactive T or B cells, leading to autoimmunity. Of the many vaccines assessed for a possible association with MS, the hepatitis B vaccine has captured the most interest, because molecular mimicry has been demonstrated in rabbits between hepatitis B viral polymerase and the part of the MBP that leads to encephalitis [23]. This suggests that infection with a virus showing similarities with MBP regions associated with the development of encephalitis could induce MS through molecular mimicry. However, the IOM concluded that there was no mechanistic evidence for an association between vaccination and MS, as the publications reviewed provided no evidence beyond a temporal association [10].


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2. Ascherio A, Zhang SM, Hernan MA, et al. Hepatitis B vaccination and the risk of multiple sclerosis. The New England journal of medicine 2001;344:327-32.
3. DeStefano F, Verstraeten T, Jackson LA, et al. Vaccinations and risk of central nervous system demyelinating diseases in adults. Arch Neurol 2003;60:504-9.
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5. Hocine MN, Farrington CP, Touze E, et al. Hepatitis B vaccination and first central nervous system demyelinating events: reanalysis of a case-control study using the self-controlled case series method. Vaccine 2007;25:5938-43.
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8. Mikaeloff Y, Caridade G, Rossier M, Suissa S, Tardieu M. Hepatitis B vaccination and the risk of childhood-onset multiple sclerosis. Archives of pediatrics & adolescent medicine 2007;161:1176-82.
9. Mikaeloff Y, Caridade G, Assi S, Tardieu M, Suissa S. Hepatitis B vaccine and risk of relapse after a first childhood episode of CNS inflammatory demyelination. Brain : a journal of neurology 2007;130:1105-10.
10. Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
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13. Farez MF, Ysrraelit MC, Fiol M, Correale J. H1N1 vaccination does not increase risk of relapse in multiple sclerosis: a self-controlled case-series study. Multiple sclerosis (Houndmills, Basingstoke, England) 2012;18:254-6.
14. Chao C, Klein NP, Velicer CM, et al. Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. J Intern Med 2012;271:193-203.
15. Langer-Gould A, Qian L, Tartof SY, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA neurology 2014;71:1506-13.
16. Scheller NM, Svanstrom H, Pasternak B, et al. Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. Jama 2015;313:54-61.
17. Vichnin M, et al. An Overview of Quadrivalent Human Papillomavirus Vaccine Safety: 2006 to 2015. Pediatr Infect Dis J 2015;34(9):983-91. 18. Halsey NA, Talaat KR, Greenbaum A, et al. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2015;33 Suppl 5:F1-f67.
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20. Frederiksen JL, Topsoe Mailand M. Vaccines and multiple sclerosis. Acta Neurol Scand 2017;136 Suppl 201:49-51. 21. Pena JA, Lotze TE. Pediatric multiple sclerosis: current concepts and consensus definitions. Autoimmune diseases 2013;2013:673947.
22. Krupp LB, Tardieu M, Amato MP, et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Multiple sclerosis (Houndmills, Basingstoke, England) 2013;19:1261-7.
23. Sejvar JJ, Kohl KS, Bilynsky R, et al. Encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM): case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2007;25:5771-92.
24. Fujinami RS, Oldstone MB. Amino acid homology between the encephalitogenic site of myelin basic protein and virus: mechanism for autoimmunity. Science 1985;230:1043-5.The information on this page was last updated on October 16 2018 |© 2019 Institute for Vaccine