Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I

Yıl: 2023 Cilt: 29 Sayı: 1 Sayfa Aralığı: 2 - 11 Metin Dili: Türkçe DOI: 10.4274/tnd.2023.62592 İndeks Tarihi: 30-05-2023

Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I

Öz:
Multipl skleroz (MS) merkezi sinir sisteminin otoimmün ve demiyelinizan hastalığıdır. Kronik bir hastalık olup bireye ait tüm diğer sağlık ve yaşamsal süreçlerin değerlendirilmesinde hastalık süreci, hastanın kullandığı ilaçları göz önüne alarak karar vermek gereklidir. Aşılama, çocukluktan yetişkinliğe yaşamın her döneminde uygulanabildiği için MS tanılı bireylerde de her bir aşının özelliği dışında hastanın immün sistem etkinliği mutlaka gözden geçirilmelidir. Bu derlemede MS tanılı bireylerde farklı aşıların uygulamaları tartışılacak olup, farklı iki bölüm halinde yayınlanacaktır.
Anahtar Kelime:

Vaccination in Individuals with Multiple Sclerosis – Part I

Öz:
Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • 1. Gold R, Fätkenheuer G, Hartung HP, et al. Vaccination in multiple sclerosis patients treated with highly effective disease-modifying drugs: an overview with consideration of cladribine tablets. Ther Adv Neurol Disord 2021;14:17562864211019598.
  • 2. Williamson EM, Chahin S, Berger JR. Vaccines in multiple sclerosis. Curr Neurol Neurosci Rep 2016;16:36.
  • 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- 509.
  • 4. Langer-Gould A, Qian L, Tartof SY, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA Neurol 2014;71:1506-1513.
  • 5. Confavreux C, Suissa S, Saddier P, et al. Vaccinations and the risk of relapse in multiple sclerosis. Vaccines in Multiple Sclerosis Study Group. N Engl J Med 2001;344:319-326.
  • 6. Farez MF, Correale J, Armstrong MJ, et al. Practice guideline update summary: vaccine-preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2019;93:584-594.
  • 7. Mailand MT, Frederiksen JL. Vaccines and multiple sclerosis: a systematic review. J Neurol 2017;264:1035-1050.
  • 8. Zrzavy T, Kollaritsch H, Rommer PS, et al. Vaccination in multiple sclerosis: friend or foe? Front Immunol 2019;10:1883.
  • 9. Salemi S, D’Amelio R. Could autoimmunity be induced by vaccination? Int Rev Immunol 2010;29:247-269.
  • 10. Committee to Review Adverse Effects of Vaccines; Institute of Medicine. Adverse Effects of Vaccines: Evidence and Causality. Stratton K, Ford A, Rusch E, Clayton EW, editors. Washington (DC): National Academies Press (US); 2011.
  • 11. Farez MF, Correale J. Immunizations and risk of multiple sclerosis: systematic review and meta-analysis. J Neurol 2011;25:1197-1206.
  • 12. Riva A, Barcella V, Benatti SV, et al. Vaccinations in patients with multiple sclerosis: A Delphi consensus statement. Mult Scler 2021;27:347-359.
  • 13. Miauton A, Tan R, Pantazou V, Du Pasquier R, Genton B. Vaccine-associated measles in a pat ent treated with natalizumab: a case report. BMC Infect Dis 2020;20:753.
  • 14. Erişkin bağışıkama rehberi. Available from: https://www.ekmud.org.tr/ emek/rehberler/1-ekmud-rehberleri
  • 15. Otero-Romero S, Ascherio A, Lebrun-Frénay C. Vaccinations in multiple sclerosis patients receiving disease-modifying drugs. Curr Opin Neurol 2021;34:322-328.
  • 16. Winkelmann A, Loebermann M, Barnett M, Hartung HP, Zettl UK. Vaccination and immunotherapies in neuroimmunological diseases. Nat Rev Neurol 2022;18:289-306.
  • 17. Kappos L, Mehling M, Arroyo R, et al. Randomized trial of vaccination in fingolimod-treated patients with multiple sclerosis. Neurology 2015;84:872-879.
  • 18. Bar-Or A, Calkwood JC, Chognot C, et al. Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: The VELOCE study. Neurology 2020;95:e1999-e2008.
  • 19. von Hehn C, Howard J, Liu S, et al. Immune response to vaccines is maintained in patients treated with dimethyl fumarate. Neurol Neuroimmunol Neuroinflamm 2017;5:e409.
  • 20. Kaufman M, Pardo G, Rossman H, et al. Natalizumab treatment shows no clinically meaningful effects on immunization responses in patients with relapsing-remitting multiple sclerosis. J Neurol Sci 2014;341:22-27.
  • 21. World Health Organization (WHO) 2023. Rabies fact shoet. Available from: https://www.who.int/news-room/fact-sheets/detail/rabies
  • 22. T.C Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Kuduz Proflaksi Rehberi. Ankara. 2019. Available from: https://hsgm.saglik.gov.tr
  • 23. Fuenzalida E, Palacios R, Borgono JM. Antirabies antibody response in man to vaccine made from infected suckling-mouse brains. Bull World Health Organ 1964;30:431-436.
  • 24. Scott TF. Postinfectious and vaccinal encephalitis. Med Clin North Am 1967;51:701-717.
  • 25. Frequently asked questions about rabies for clinicians. version 2018. Available from: https://apps.who.int/rabies/Rabies_Clinicians_FAQs_20Sep2018.pdf?ua=1
  • 26. Loebermann M, Winkelmann A, Hartung HP, et al. Vaccination against infection in patients with multiple sclerosis. Nat Rev Neurol 2012;8:143-151.
  • 27. Center for Disease Control and Prevention. Principles of Vaccination. Available online: https://www.cdc..gov./vaccines/pubs/pinkbook/prinvac. html
  • 28. Huttner A, Lascano AM, Roth S, et al. Rabies vaccination and multiple sclerosis relapse: a retrospective cohort study. Mult Scler Relat Disord 2021;51:102906.
  • 29. Kulkarni V, Nadgir D, Tapiawala S, et al. Biphasic demyelination of the nervous system following anti-rabies vaccination. Neurol India 2004;52:106-108.
  • 30. Britton DE, Houff SA, Eiben RM. Possible interactions between rabies vaccination and a progressive degenerative CNS disease. Arch Neurol 1978;35:693.
  • 31. Kumar R, Singh AK, Pradhan RN, Pathak VK. A case report of post rabipur (purified chick embryo rabies vaccine) acute disseminated encephalomyelitis. J Assoc Physicians India 2015;63:56-58.
  • 32. Arrab R, Draiss G, Rada N, Bourouss M, Bouskraoui M. Encéphalomyélite aiguë disséminée post-vaccination antirabique: à propos d’un cas [Acute disseminated encephalomyelitis after rabies vaccination: a case report]. Arch Pediatr 2015;22:47-49.
  • 33. Bar-Or A, Wiendl H, Miller B, et al. Randomized study of teriflunomide effects on immune responses to neoantigen and recall antigens. Neurol Neuroimmunol Neuroinflamm 2015;2:e70.
  • 34. Liu C, Cahill JD. Epidemiology of Rabies and Current US Vaccine Guidelines. R I Med J (2013). 2020 Aug 3;103(6):51-53. PMID: 32752569.
  • 35. Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia (Nathan) 2020;12:11.
  • 36. GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018;18:1191- 1210.
  • 37. Schwid SR, Decker MD, Lopez-Bresnahan M; Rebif-Influenza Vaccine Study Investigators. Immune response to influenza vaccine is maintained in patients with multiple sclerosis receiving interferon beta-1a. Neurology 2005;65:1964-6.
  • 38. Bar-Or A, Freedman MS, Kremenchutzky M, et al. Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Neurology 2013;81:552-558.
  • 39. Mehling M, Fritz S, Hafner P, et al. Preserved antigen-specific immune response in patients with multiple sclerosis responding to IFNβ-therapy. PLoS One 2013;8:e78532.
  • 40. Olberg HK, Cox RJ, Nostbakken JK, et al. Immunotherapies influence the influenza vaccination response in multiple sclerosis patients: an explorative study. Mult Scler 2014;20:1074-1080.
  • 41. Metze C, Winkelmann A, Loebermann M, et al. Immunogenicity and predictors of response to a single dose trivalent seasonal influenza vaccine in multiple sclerosis patients receiving disease-modifying therapies. CNS Neurosci Ther 2019;25:245-254.
  • 42. von Hehn C, Howard J, Liu S, et al. Immune response to vaccines is maintained in patients treated with dimethyl fumarate. Neurol Neuroimmunol Neuroinflamm 2017;5:e409.
  • 43. Olberg HK, Eide GE, Cox RJ, et al. Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy. Eur J Neurol 2018;25:527-534.
  • 44. Winkelmann A, Metze C, Frimmel S, et al. Tick-borne encephalitis vaccination in multiple sclerosis: a prospective, multicenter study. Neurol Neuroimmunol Neuroinflamm 2020;7:e664.
  • 45. Bar-Or A, Pachner A, Menguy-Vacheron F, Kaplan J, Wiendl H. Teriflunomide and its mechanism of action in multiple sclerosis. Drugs 2014;74:659-674.
  • 46. Ciotti JR, Valtcheva MV, Cross AH. Effects of MS disease-modifying therapies on responses to vaccinations: A review. Mult Scler Relat Disord 2020;45:102439.
  • 47. Sabatino JJ Jr, Mittl K, Rowles WM, et al. Multiple sclerosis therapies differentially affect SARS-CoV-2 vaccine-induced antibody and T cell immunity and function. JCI Insight 2022;7:e156978.
  • 48. Signoriello E, Bonavita S, Sinisi L, et al. Is antibody titer useful to verify the immunization after VZV Vaccine in MS patients treated with Fingolimod? A case series. Mult Scler Relat Disord 2020;40:101963.
  • 49. Ufer M, Shakeri-Nejad K, Gardin A, et al. Impact of siponimod on vaccination response in a randomized, placebo-controlled study. Neurol Neuroimmunol Neuroinflamm 2017;4:e398.
  • 50. Moser T, Schwenker K, Seiberl M, et al. Long-term peripheral immune cell profiling reveals further targets of oral cladribine in MS. Ann Clin Transl Neurol 2020;7:2199-2212.
  • 51. Brill L, Rechtman A, Zveik O, et al. Effect of cladribine on COVID-19 serology responses following two doses of the BNT162b2 mRNA vaccine in patients with multiple sclerosis. Mult Scler Relat Disord 2022;57:103343.
  • 52. Sørensen PS, Centonze D, Giovannoni G, et al. Expert opinion on the use of cladribine tablets in clinical practice. Ther Adv Neurol Disord 2020;13:1756286420935019.
  • 53. McCarthy CL, Tuohy O, Compston DA, et al. Immune competence after alemtuzumab treatment of multiple sclerosis. Neurology 2013;81:872-876. 54. Baghbanian SM. Influenza vaccination in patients with multiple sclerosis is possible with some considerations. Iran J Neurol 2016;15:109-110.
  • 55. Klotz L, Havla J, Schwab N, et al. Risks and risk management in modern multiple sclerosis immunotherapeutic treatment. Ther Adv Neurol Disord 2019;12:1756286419836571.
  • 56. Türkiye Viral Hepatit Önleme ve Kontrol Programı. Ankara: Sağlık Bakanlığı yayın no: 1102; 2018.
  • 57. Averhoff F, Mahoney F, Coleman P, et al. Immunogenicity of hepatitis B Vaccines. Implications for persons at occupational risk of hepatitis B virus infection. Am J Prev Med 1998;15:1-8.
  • 58. Bock HL, Löscher T, Scheiermann N, et al. Accelerated Schedule for hepatitis B immunization. J Travel Med 1995;2:213-217.
  • 59. Mangione R, Stroffolini T, Tosti ME, Fragapani P, Mele A. Delayed third hepatitis B vaccine dose and immune response. Lancet 1995;345:1111- 1112.
  • 60. Hepatitis B: The Green Book. Chapter 18: UK Health Security Agency; 2022.
  • 61. WHO. Hepatitis B vaccines: WHO position paper-July 2017. Weekly Epidemiological Record 2017;27:369-392.
  • 62. Information Sheet: observed rate of vaccine reactions: hepatitis B vaccine. World Health Organization, 2012.
  • 63. Sirbu CA, Florea AA, Ghinescu MC, et al. Vaccination in multiple sclerosis - challenging practices (review). Exp Ther Med 2020;20:217.
  • 64. Ciardi MR, Iannetta M, Zingaropoli MA, et al. Reactivation of hepatitis B virus with immune-escape mutations after ocrelizumab treatment for multiple sclerosis. Open Forum Infect Dis 2018;6:ofy356.
  • 65. Köksal İ. Immunosuppressive therapy and hepatitis B virus reactivation. Viral Hepat J 2016;22:69-73.
  • 66. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018;67:1560-1599.
  • 67. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:309-318.
  • 68. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. The Pink Book. 13th ed: Washington DC: Public Health Foundation; 2015. p. 157-174.
  • 69. Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol 2012;4:68-73.
  • 70. Viral hepatit 2018/editörler: Rahmet Güner, Fehmi Tabak ; editör yardımcısı: Cemal Bulut, Tansu Yamazhan, Ebubekir Şenateş, Nurcan Baykam, Esragül Akıncı. 9786059528757. İstanbul Tıp Kitapevleri, 2018, İstanbul
  • 71. Tosun S. Hepatit A virüs enfeksiyonu. Tabak F, Tosun S, editörler. Viral Hepatit 2013. p. 215-246.
  • 72. Wu D, Guo CY. Epidemiology and prevention of hepatitis A in travelers. J Travel Med 2013;20:394-399.
  • 73. Garcia Garrido HM, Wieten RW, Grobusch MP, Goorhuis A. Response to hepatitis A vaccination in immunocompromised travelers. J Infect Dis 2015;212:378-385.
  • 74. Karadag O, Kasifoglu T, Birol O, et al. Guideline of the viral hepatitis screening before biologic agents use in patients with rheumatic diseases. RAED Dergisi 2015;7:28-32.
  • 75. Luca S, Mihaescu T. History of BCG Vaccine. Maedica (Bucur) 2013;8:53- 58.
  • 76. World Health Organization. BCG vaccine: WHO position paper, February 2018 - Recommendations. Vaccine 2018;36:3408-3410.
  • 77. T.C. Sağlık Bakanlığı Tüberküloz Tanı ve Tedavi Rehberi, 2019. https:// hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/haberler/Tuberkuloz_ Tani_Ve_Tedavi_Rehberi_/Tuberkuloz_Tani_ve_Tedavi_Rehberi.pdf
  • 78. Matsuzaki G, Teruya N, Kiyohara Kohama H, et al. Mycobacterium bovis BCG-mediated suppression of Th17 response in mouse experimental autoimmune encephalomyelitis. Immunopharmacol Immunotoxicol 2021;43:203-211.
  • 79. Ristori G, Buzzi MG, Sabatini U, et al. Use of Bacille Calmette-Guèrin (BCG) in multiple sclerosis. Neurology 1999;53:1588-1589.
  • 80. Ciotti JR, Valtcheva MV, Cross AH. Effects of MS disease-modifying therapies on responses to vaccinations: A review. Mult Scler Relat Disord 2020;45:102439.
  • 81. Nakken O, Holmøy T, Stigum H, et al. Strong tuberculin response after BCG vaccination is associated with low multiple sclerosis risk: a populationbased cohort study. Int J Epidemiol 2022;51:1637-1644.
APA Piri Cinar B, Tuncer a, BİLGE N, Bünül S, Gozubatik-Celik R, Derle E, GENÇ G, KARAMAN B, Kılıç a, SARITEKE A, Seferoğlu M, Tiftikcioglu B, TUNÇ A, UNCU G, yavaş i, Yetkin M, Efendi H, Siva A (2023). Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. , 2 - 11. 10.4274/tnd.2023.62592
Chicago Piri Cinar Bilge,Tuncer aslı,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,GENÇ Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. (2023): 2 - 11. 10.4274/tnd.2023.62592
MLA Piri Cinar Bilge,Tuncer aslı,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,GENÇ Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. , 2023, ss.2 - 11. 10.4274/tnd.2023.62592
AMA Piri Cinar B,Tuncer a,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,GENÇ G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. . 2023; 2 - 11. 10.4274/tnd.2023.62592
Vancouver Piri Cinar B,Tuncer a,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,GENÇ G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. . 2023; 2 - 11. 10.4274/tnd.2023.62592
IEEE Piri Cinar B,Tuncer a,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,GENÇ G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I." , ss.2 - 11, 2023. 10.4274/tnd.2023.62592
ISNAD Piri Cinar, Bilge vd. "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I". (2023), 2-11. https://doi.org/10.4274/tnd.2023.62592
APA Piri Cinar B, Tuncer a, BİLGE N, Bünül S, Gozubatik-Celik R, Derle E, GENÇ G, KARAMAN B, Kılıç a, SARITEKE A, Seferoğlu M, Tiftikcioglu B, TUNÇ A, UNCU G, yavaş i, Yetkin M, Efendi H, Siva A (2023). Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. Türk Nöroloji Dergisi, 29(1), 2 - 11. 10.4274/tnd.2023.62592
Chicago Piri Cinar Bilge,Tuncer aslı,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,GENÇ Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. Türk Nöroloji Dergisi 29, no.1 (2023): 2 - 11. 10.4274/tnd.2023.62592
MLA Piri Cinar Bilge,Tuncer aslı,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,GENÇ Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. Türk Nöroloji Dergisi, vol.29, no.1, 2023, ss.2 - 11. 10.4274/tnd.2023.62592
AMA Piri Cinar B,Tuncer a,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,GENÇ G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. Türk Nöroloji Dergisi. 2023; 29(1): 2 - 11. 10.4274/tnd.2023.62592
Vancouver Piri Cinar B,Tuncer a,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,GENÇ G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I. Türk Nöroloji Dergisi. 2023; 29(1): 2 - 11. 10.4274/tnd.2023.62592
IEEE Piri Cinar B,Tuncer a,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,GENÇ G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I." Türk Nöroloji Dergisi, 29, ss.2 - 11, 2023. 10.4274/tnd.2023.62592
ISNAD Piri Cinar, Bilge vd. "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm I". Türk Nöroloji Dergisi 29/1 (2023), 2-11. https://doi.org/10.4274/tnd.2023.62592