Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II

Multipl skleroz (MS) merkezi sinir sisteminin otoimmün ve demiyelinizan hastalığıdır. Kronik bir hastalık olup bireye ait tüm diğer sağlık ve yaşamsal süreçlerin değerlendirilmesinde hastalık seyri, 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 yayınlanması planlanmıştır.

Anahtar Kelime:

Vaccination in Individuals with Multiple Sclerosis – Part II

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 about vaccination should be made considering the disease process and the medications used by the patient. Since vaccination can be performed at any stage of life, immune system activity should be reviewed in patients with MS except where it is characteristic of the vaccine. In this review, the applications of different vaccines in patients with MS are discussed in two separate sections (part 1 was published in the previous issue).

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices, United States, 2021-22 Influenza Season. MMWR Recomm Rep 2021;70:1-28.
2. Available from: https://www.ekmud.org.tr; Erişkin bağışıklama rehberi V.2 2019.
3. Fiore AE, Uyeki TM, Broder K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010;59:1-62.
4. Available from: https://www.klimik.org.tr/calisma-gruplari/eriskin-bagisiklamasi- calisma-grubu/grip-bilgi-notu/
5. Mailand MT, Frederiksen JL. Vaccines and multiple sclerosis: a systematic review. J Neurol 2017;264:1035-1050.
6. Bamford CR, Sibley WA, Laguna JF. Swine influenza vaccination in patients with multiple sclerosis. Arch Neurol 1978;35:242-243.
7. McNicholas N, Chataway J. Relapse risk in patients with multiple sclerosis after H1N1 vaccination, with or without seasonal influenza vaccination. J Neurol 2011;258:1545-1547.
8. Nguyen J, Hardigan P, Kesselman MM, Demory Beckler M. Immunogenicity of The influenza vaccine in multiple sclerosis patients: a systematic review and meta-analysis. Mult Scler Relat Disord 2021;48:102698.
9. 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.
10. 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.
11. 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.
12. 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.
13. Society NMS. Living Well With MS. Available from: http://www. nationalmssociety.org/Living-Well-With-MS
14. Baghbanian SM. Influenza vaccination in patients with multiple sclerosis is possible with some considerations. Iran J Neurol 2016;15:109-110.
15. Filippi M, Capra R, Centonze D, et al. Therapeutic recommendations and seasonal influenza vaccine for multiple sclerosis patients in treatment with ocrelizumab: an expert consensus. J Neurol 2021;268:1540-1543.
16. Riva A, Barcella V, Benatti SV, et al. Vaccinations in patients with multiple sclerosis: a Delphi consensus statement. Mult Scler 2021;27:347-359.
17. 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;95:1999-2008.
18. Loebermann M, Winkelmann A, Hartung HP, et al. Vaccination against infection in patients with multiple sclerosis. Nat Rev Neurol 2012;8:143-151.
19. Koray M. Clinical assesment, laboratory diagnosis and treatment of Herpes virus infections. Journal of Istanbul University Faculty of Dentistry 2013;38:1-8.
20. Sütlü S. Vaccination applications in adults over 65 years old. Curr Perspect Health Sci 2022;3:39-44.
21. Aşı Takvimi. Available from: saglik.gov.tr
22. Varilrix-Summary of Product Characteristics. European Medicines Agency (EMA). Available from: https://www.ema.europa.eu/en/medicines/human/ referrals/varilrix)
23. Cunningham AL, Lal H, Kovac M, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med 2016;375:1019- 1032.
24. Winkelmann A, Löbermann M, Zettl UK. Varicella-zoster- und Herpes- zoster-Impfindikation bei Multipler Sklerose: aktuelle Situation [Indications for varicella zoster and herpes zoster vaccination in multiple sclerosis: current situation]. Nervenarzt 2019;90:1254-1260.
25. Altıntaş A, Uygunoğlu U, Zeydan B, Coşkun T. Management of multiple sclerosis patients in special conditions. Turk J Neurol 2013;19:77-84.
26. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Aşı Sonrası İstenmeyen Etkiler Genelgesi (2009). Available from: https://www. saglik.gov.tr/TR,11136/asi-sonrasi-istenmeyen-etkiler-genelgesi-2009. html
27. World Health Organization, Global Vaccine Safety, WHO vaccine reaction rates information sheets. Available from: http://www.who.int/vaccine_ safety/initiative/tools/vaccinfosheets/en/
28. Lebrun C, Vukusic S; French Group for Recommendations in Multiple Sclerosis (France4MS) and the Société Francophone de la Sclérose En Plaques (SFSEP). Immunization and multiple sclerosis: Recommendations from the French multiple sclerosis society. Mult Scler Relat Disord 2019;31:173-188.
29. Centers For Disease Control and Prevention (C.D.C.). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE): recombinant zoster vaccine (RZV) and herpes zoster live attenuated vaccine (ZVL). Available from: https://www.cdc.gov/vaccines/acip/recs/grade/ herpes-zoster.html#
30. 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.
31. Cheng DR, Barton R, Greenway A, Crawford NW. Rituximab and protection from vaccine preventable diseases: applying the evidence to pediatric patients. Expert Rev Vaccines 2016;15:1567-1574.
32. Rapisarda L, Valentino P, Barone S, et al. Varicella zoster immunity loss in multiple sclerosis patient treated with ocrelizumab. Clin Immunol 2021;223:108554.
33. Fine AJ, Sorbello A, Kortepeter C, Scarazzini L. Central nervous system herpes simplex and varicella zoster virus infections in natalizumab-treated patients. Clin Infect Dis 2013;57:849-852.
34. Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003;348:518-527.
35. Demarco M, Hyun N, Carter-Pokras O, et al. A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs. EClinicalMedicine 2020;22:100293.
36. Human papillomavirus reference clones. Stockholm; International Human Papillomavirus Reference Center Available from: https://www.hpvcenter.se/ human_reference_clones/ accesed August 2022.
37. List of prequalified vaccines. Geneva: World Health Organization Available from: https://extranet.who.int/gavi/PQ_Web/.
38. Sutton I, Lahoria R, Tan I, Clouston P, Barnett M. CNS demyelination and quadrivalent HPV vaccination. Mult Scler 2009;15:116-119.
39. 39. Wildemann B, Jarius S, Hartmann M, Regula JU, Hametner C. Acute disseminated encephalomyelitis following vaccination against human papilloma virus. Neurology 2009;72:2132-2133.
40. Menge T, Cree B, Saleh A, et al. Neuromyelitis optica following human papillomavirus vaccination. Neurology 2012;79:285-287.
41. 41. Wraith DC, Goldman M, Lambert PH. Vaccination and autoimmune disease: what is the evidence? Lancet 2003;362:1659-1666.
42. Wucherpfennig KW, Strominger JL. Molecular mimicry in T cell-mediated autoimmunity: viral peptides activate human T cell clones specific for myelin basic protein. Cell 1995;80:695-705.
43. 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.
44. Scheller NM, Svanström 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.
45. Grimaldi-Bensouda L, Guillemot D, Godeau B, et al. Autoimmune disorders and quadrivalent human papillomavirus vaccination of young female subjects. J Intern Med 2014;275:398-408.
46. Triplett J, Kermode AG, Corbett A, Reddel SW. Warts and all: Fingolimod and unusual HPV-associated lesions. Mult Scler 2019;25:1547-1550.
47. Monath TP. Yellow fever: an update. Lancet Infect Dis 2001;1:11-20.
48. Barnett ED. Yellow fever: epidemiology and prevention. Clin Infect Dis 2007;44:850-856.
49. Centers for Disease Control and Prevention. Search for Yellow Fever Vaccination Clinics. Available from: https://wwwnc.cdc.gov/travel/yellow- fever-vaccination-clinics/search.
50. Monath TP. Review of the risks and benefits of yellow fever vaccination including some new analyses. Expert Rev Vaccines 2012;11:427-448.
51. World Health Organization. Accessed on March 02, 2022. Search for vaccination against yellow fever. Available from: https://www.who.int/news- room/fact-sheets/detail/yellow-fever
52. T.C. Sağlık Bakanlığı, Seyahat Aşıları. Accessed on March 02, 2022. Available from: https://www.seyahatsagligi.gov.tr/Site/Asilar
53. Chen RT, Pless R, Destefano F. Epidemiology of autoimmune reactions induced by vaccination. J Autoimmun 2001;16:309-318.
54. Papeix C, Mazoyer J, Maillart E, et al. Multiple sclerosis: Is there a risk of worsening after yellow fever vaccination? Mult Scler 2021;27:2280-2283.
55. Farez MF, Correale J. Yellow fever vaccination and increased relapse rate in travelers with multiple sclerosis. Arch Neurol 2011;68:1267-1271.
56. Huttner A, Eperon G, Lascano AM, et al. Risk of MS relapse after yellow fever vaccination: a self-controlled case series. Neurol Neuroimmunol Neuroinflamm 2020;7:e726.
57. Reyes S, Ramsay M, Ladhani S, et al. Protecting people with multiple sclerosis through vaccination. Pract Neurol 2020;20:435-445.
58. Rolfes L, Pawlitzki M, Pfeuffer S, et al. Fulminant MS reactivation following combined fingolimod cessation and yellow fever vaccination. Int J Mol Sci 2019;20:5985.
59. Kernéis S, Launay O, Ancelle T, et al. Safety and immunogenicity of yellow fever 17D vaccine in adults receiving systemic corticosteroid therapy: an observational cohort study. Arthritis Care Res (Hoboken) 2013;65:1522- 1528.
60. Pauli G, Blümel J, Burger R, et al. Orthopox viruses: infections in humans. Transfus Med Hemother 2010;37:351-364.
61. Frey SE, Wald A, Edupuganti S, et al. Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects. Vaccine 2015;33:5225-5234.
62. Pekmezovic T, Jarebinski M, Drulovic J. Childhood infections as risk factors for multiple sclerosis: Belgrade case-control study. Neuroepidemiology 2004;23:285-288.
63. Kurtzke JF, Hyllested K, Arbuckle JD, et al. Multiple sclerosis in the Faroe Islands. 7. Results of a case control questionnaire with multiple controls. Acta Neurol Scand 1997;96:149-157.
64. Alter M, Speer J. Clinical evaluation of possible etiologic factors in multiple sclerosis. Neurology 1968;18:109-116.
65. Bansil S, Singhal BS, Ahuja GK, et al. Multiple sclerosis in India: a case- control study of environmental exposures. Acta Neurol Scand 1997;95:90- 95.
66. Andersen E, Isager H, Hyllested K. Risk factors in multiple sclerosis: tuberculin reactivity, age at measles infection, tonsillectomy and appendectomy. Acta Neurol Scand 1981;63:131-135.
67. Casetta I, Granieri E, Malagù S, et al. Environmental risk factors and multiple sclerosis: a community-based, case-control study in the province of Ferrara, Italy. Neuroepidemiology 1994;13:120-128.
68. Sabin AB. Oral poliovirus vaccine: history of its development and use and current challenge to eliminate poliomyelitis from the world. J Infect Dis 1985;151:420-436.
69. Estívariz CF, Pallansch MA, Anand A, et al. Poliovirus vaccination options for achieving eradication and securing the endgame. Curr Opin Virol 2013;3:309-135.
70. Pallansch MA. Ending use of oral poliovirus vaccine - a difficult move in the Polio Endgame. N Engl J Med 2018;379:801-803.
71. McBean AM, Thoms ML, Albrecht P, Cuthie JC, Bernier R. Serologic response to oral polio vaccine and enhanced-potency inactivated polio vaccines. Am J Epidemiol 1988;128:615-628.
72. Berek K, Deisl P, Bichler M, et al. Immunization status in patients with multiple sclerosis: a cross-sectional, monocenter study in Austria. Eur J Neurol 2023;30:1400-1408.
73. Langhorst SE, Frahm N, Hecker M, et al. Vaccination coverage against tetanus, diphtheria, pertussis and poliomyelitis and validity of self- reported vaccination status in patients with multiple sclerosis. J Pers Med 2022;12:677.
74. Farez MF, Correale J. Immunizations and risk of multiple sclerosis: systematic review and meta-analysis. J Neurol 2011;258:1197-206.
75. Hapfelmeier A, Gasperi C, Donnachie E, Hemmer B. A large case-control study on vaccination as risk factor for multiple sclerosis. Neurology 2019;93:e908-e916.
76. Hughes AM, Ponsonby AL, Dear K, et al. A childhood infections, vaccinations, and tonsillectomy and risk of first clinical diagnosis of CNS demyelination in the Ausimmune Study. Mult Scler Relat Disord 2020;42:102062.
77. Giovannoni G. Disease-modifying treatments for early and advanced multiple sclerosis: a new treatment paradigm. Curr Opin Neurol 2018;31:233-243.
78. Croce E, Hatz C, Jonker EF, et al. Safety of live vaccinations on immunosuppressive therapy in patients with immune-mediated inflammatory diseases, solid organ transplantation or after bone-marrow transplantation - A systematic review of randomized trials, observational studies and case reports. Vaccine 2017;35:1216-1226.
79. Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med 2001;344:1378-1388.
80. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020;69:1-41.
81. World Health Organisation. Available from: www.who.int/immunization/ diseases/meningitis
82. Pollard AJ, Perrett KP, Beverley PC. Maintaining protection against invasive bacteria with protein-polysaccharide conjugate vaccines. Nat Rev Immunol 2009;9:213-220.
83. Sağlık Bakanlığı Yetişkin Aşılama. Available from: https://asi.saglik.gov.tr/ asi-kimlere-yapilir/liste/30-yetiskin-a%26
84. Klimik Aşı takvimi. Available from: https://asi.klimik.org.tr/asi-takvimi/ at-1
85. Centers for Disease Control and Prevention (CDC). Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June-July 2005. MMWR Morb Mortal Wkly Rep 2005;54:1023- 1025.
86. Velentgas P, Amato AA, Bohn RL, et al. Risk of Guillain-Barré syndrome after meningococcal conjugate vaccination. Pharmacoepidemiol Drug Saf 2012;21:1350-1358.
87. 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.
88. Hansen J, Zhang L, Klein NP, et al. Post-licensure safety surveillance study of routine use of quadrivalent meningococcal diphtheria toxoid conjugate vaccine. Vaccine 2017;35:6879-6884.
89. Monschein T, Hartung HP, Zrzavy T, et al. Vaccination and multiple sclerosis in the era of the COVID-19 pandemic. J Neurol Neurosurg Psychiatry 2021;92:1033-1043.
90. Zlobin VI, Pogodina VV, Kahl O. A brief history of the discovery of tick- borne encephalitis virus in the late 1930s (based on reminiscences of members of the expeditions, their colleagues, and relatives). Ticks Tick Borne Dis 2017;8:813-280.
91. Phipps LP, Johnson N. Tick-borne encephalitis virus. J Med Microbiol 2022:71.
92. Kaiser R. Tick-borne encephalitis: clinical findings and prognosis in adults. Wien Med Wochenschr 2012;162:239-243.
93. Lani R, Moghaddam E, Haghani A, et al. Tick-borne viruses: a review from the perspective of therapeutic approaches. Ticks Tick Borne Dis 2014;5:457- 465.
94. Taba P, Schmutzhard E, Forsberg P, et al. EAN consensus review on prevention, diagnosis and management of tick-borne encephalitis. Eur J Neurol 2017;24:1214-1261.
95. No authors listed. Vaccines against tick-borne encephalitis: WHO position paper. Wkly Epidemiol Rec 2011;86:241-256.
96. Hubálek Z, Rudolf I. Tick-borne viruses in Europe. Parasitol Res 2012;111:9-36.
97. Loew-Baselli A, Konior R, Pavlova BG, et al. Safety and immunogenicity of the modified adult tick-borne encephalitis vaccine FSME-IMMUN: results of two large phase 3 clinical studies. Vaccine 2006;24:5256-5263.
98. Ehrlich HJ, Pavlova BG, Fritsch S, et al. Randomized, phase II dose-finding studies of a modified tick-borne encephalitis vaccine: evaluation of safety and immunogenicity. Vaccine 2003;22:217-223.
99. Schöndorf I, Beran J, Cizkova D, et al. Tick-borne encephalitis (TBE) vaccination: applying the most suitable vaccination schedule. Vaccine 2007;25:1470-1475.
100. Baumhackl U, Franta C, Retzl J, Salomonowitz E, Eder G. A controlled trial of tick-borne encephalitis vaccination in patients with multiple sclerosis. Vaccine 2003;21(Suppl 1):56-61.
101. Winkelmann A, Metze C, Frimmel S, et al. Tick-borne encephalitis vaccination in multiple sclerosis: a prospective, multicenter study. Neurol Neuroimmunol Neuroinflamm 2020;7:664.

APA	Tuncer a, Piri Cinar B, BİLGE N, Bünül S, Gozubatik-Celik R, Derle E, Genc G, KARAMAN B, Kılıç a, SARITEKE A, Seferoğlu M, SIVACI A, Tiftikcioglu B, TUNÇ A, UNCU G, yavaş i, Yetkin M, Efendi H, Siva A (2023). Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. , 85 - 94. 10.4274/tnd.2023.16984
Chicago	Tuncer aslı,Piri Cinar Bilge,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,Genc Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,SIVACI Ali Özhan,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. (2023): 85 - 94. 10.4274/tnd.2023.16984
MLA	Tuncer aslı,Piri Cinar Bilge,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,Genc Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,SIVACI Ali Özhan,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. , 2023, ss.85 - 94. 10.4274/tnd.2023.16984
AMA	Tuncer a,Piri Cinar B,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,Genc G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,SIVACI A,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. . 2023; 85 - 94. 10.4274/tnd.2023.16984
Vancouver	Tuncer a,Piri Cinar B,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,Genc G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,SIVACI A,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. . 2023; 85 - 94. 10.4274/tnd.2023.16984
IEEE	Tuncer a,Piri Cinar B,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,Genc G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,SIVACI A,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II." , ss.85 - 94, 2023. 10.4274/tnd.2023.16984
ISNAD	Tuncer, aslı vd. "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II". (2023), 85-94. https://doi.org/10.4274/tnd.2023.16984

APA	Tuncer a, Piri Cinar B, BİLGE N, Bünül S, Gozubatik-Celik R, Derle E, Genc G, KARAMAN B, Kılıç a, SARITEKE A, Seferoğlu M, SIVACI A, Tiftikcioglu B, TUNÇ A, UNCU G, yavaş i, Yetkin M, Efendi H, Siva A (2023). Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. Türk Nöroloji Dergisi, 29(2), 85 - 94. 10.4274/tnd.2023.16984
Chicago	Tuncer aslı,Piri Cinar Bilge,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,Genc Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,SIVACI Ali Özhan,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. Türk Nöroloji Dergisi 29, no.2 (2023): 85 - 94. 10.4274/tnd.2023.16984
MLA	Tuncer aslı,Piri Cinar Bilge,BİLGE NURAY,Bünül Sena Destan,Gozubatik-Celik Rabia Gokcen,Derle Eda,Genc Gencer,KARAMAN BEDRİYE,Kılıç ahmet kasım,SARITEKE ALP,Seferoğlu Meral,SIVACI Ali Özhan,Tiftikcioglu Bedile Irem,TUNÇ Abdulkadir,UNCU GÜLGÜN,yavaş irfan,Yetkin Mehmet Fatih,Efendi Hüsnü,Siva Aksel Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. Türk Nöroloji Dergisi, vol.29, no.2, 2023, ss.85 - 94. 10.4274/tnd.2023.16984
AMA	Tuncer a,Piri Cinar B,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,Genc G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,SIVACI A,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. Türk Nöroloji Dergisi. 2023; 29(2): 85 - 94. 10.4274/tnd.2023.16984
Vancouver	Tuncer a,Piri Cinar B,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,Genc G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,SIVACI A,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II. Türk Nöroloji Dergisi. 2023; 29(2): 85 - 94. 10.4274/tnd.2023.16984
IEEE	Tuncer a,Piri Cinar B,BİLGE N,Bünül S,Gozubatik-Celik R,Derle E,Genc G,KARAMAN B,Kılıç a,SARITEKE A,Seferoğlu M,SIVACI A,Tiftikcioglu B,TUNÇ A,UNCU G,yavaş i,Yetkin M,Efendi H,Siva A "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II." Türk Nöroloji Dergisi, 29, ss.85 - 94, 2023. 10.4274/tnd.2023.16984
ISNAD	Tuncer, aslı vd. "Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II". Türk Nöroloji Dergisi 29/2 (2023), 85-94. https://doi.org/10.4274/tnd.2023.16984