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However, concerns arise regarding potential pathogen reversion to virulence, which is particularly risky for immunocompromised individuals, contraindicating their administration in multiple sclerosis (MS) patients under modified disease treatments due to the possibility of triggering infections, or stimulating the immune system, precipitating new exacerbations. On the contrary, these vaccines offer enduring immunity that is crucial for protecting MS patients from endemic infectious diseases, leading to severe complications if contracted. These concerns underscore the complex balance between vaccination benefits and the risks of exacerbating MS in patients residing in regions with endemic diseases. This review explores the challenges and considerations associated with their use in MS patients, aiming to maximize benefits while minimizing risks.<\/jats:p>","DOI":"10.1177\/13524585241305956","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T03:54:01Z","timestamp":1734494041000},"page":"131-139","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Live-attenuated vaccines for multiple sclerosis patients living in regions with endemic infections: A complex decision"],"prefix":"10.1177","volume":"31","author":[{"given":"Jorge","family":"Correale","sequence":"first","affiliation":[{"name":"Department of Neurology, Fleni, Buenos Aires, Argentina"},{"name":"Institute of Biological Chemistry and Physical Chemistry (IQUIFIB), National Scientific and Technical Research Council (CONICET), University of Buenos Aires, Buenos Aires, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4142-8375","authenticated-orcid":false,"given":"Mariano","family":"Marrodan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fleni, Buenos Aires, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"bibr1-13524585241305956","volume-title":"Adverse effects of vaccines: Evidence and causality","author":"Committee to Review Adverse Effects of Vaccines, Institute of Medicine","year":"2011"},{"key":"bibr2-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30481-1"},{"key":"bibr3-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-015-0226-2"},{"key":"bibr4-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000233834.09743.3b"},{"key":"bibr5-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf098"},{"key":"bibr6-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008157"},{"key":"bibr7-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1177\/13524585231168043"},{"key":"bibr8-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1016\/j.virol.2015.03.032"},{"key":"bibr9-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-023-05969-z"},{"key":"bibr10-13524585241305956","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62352-5"},{"key":"bibr11-13524585241305956","unstructured":"World Health Organization (WHO). 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