Multiple sclerosis and the hepatitis B vaccine

Medical Update Memo
September 3, 1998

Summary
Anecdotal accounts in the European media have linked vaccination against the hepatitis B virus and the subsequent development of multiple sclerosis, despite the lack of any scientific evidence. One study in France has found that the frequency of neurological disease, including MS, is actually lower in people who received hepatitis B vaccine than in the general population. Other studies are underway. However, people may have concerns raised by this unsubstantiated claim and may decide not to be vaccinated against the hepatitis B virus, even in cases where they may be at risk in contacting the virus. The hepatitis B virus can cause hepatitis, an infection of the liver. It can be fatal or have long-term complications.

Background
Spurred by anecdotal reports in the media, mostly in France, concerns have been raised that there may be a link between vaccination against the hepatitis B virus and the subsequent development of multiple sclerosis. At this point, there is no scientific evidence to back up this claim. The French National Drug Surveillance Committee conducted a study of people who received more than 60 million doses of hepatitis B vaccine between 1989 and 1997 and found that the frequency of neurological disease, including MS, was actually lower in this group than in the general population.

In Canada, a preliminary analysis of hospital admission data between 1975 and 1995 suggests that the introduction of the hepatitis B vaccine to Canada in the mid to late 1980s has not been matched by an increase in the incidence of multiple sclerosis, according to information from the Alberta Ministry of Health. In the United States, an expert panel of the U.S. Centers for Disease Control concluded, after reviewing data from the centers' adverse vaccine experience database, that there was no scientific evidence of a link.

Health Canada will monitor the use of the hepatitis B vaccine through the Laboratory Centre for Disease Control and through contacts with neurologists who specialize in multiple sclerosis. In the United States, the Centers for Disease Control is undertaking a prospective clinical study of the possible association of the vaccine and demyelinating disease, including MS. Additional studies are underway in Europe.

Hepatitis B is one of several viruses that cause hepatitis, an infection of the liver which is a serious and sometimes fatal disease. Long-term complications of hepatitis include liver cirrhosis and cancer. The virus is usually associated with exposure to blood or body fluids from someone who is carrying the virus. The hepatitis B vaccine offers long-term protection against this form of hepatitis. Since healthcare workers are at higher risk of exposure, vaccination against hepatitis B is often mandatory. In addition, since the early 1990s many provinces have carried out hepatitis B vaccination campaigns in senior schools and high schools.

The cause of MS is still unknown, but may result because a genetically susceptible individual comes in contact with an environmental or infectious agent which sets off a misdirected immune attack on central nervous system myelin. Investigators have looked for possible viral links to MS, but after decades of searching have yet to identify an environmental or infectious trigger. There is no statistically significant data to support a link between the hepatitis B vaccine and MS.

People who already have MS may question whether they should have a hepatitis B vaccination or other vaccinations. Generally speaking, physicians are cautious about giving vaccinations to people who have an autoimmune disease, however, in some cases the benefits outweigh the potential risks. A recent study of the effects of the influenza vaccine on people with relapsing-remitting MS concluded it was not associated with an increased risk of exacerbations.

Disclaimer
The Multiple Sclerosis Society of Canada is an independent, voluntary health agency and does not approve, endorse or recommend any specific product or therapy but provides information to assist individuals in making their own decisions.