Multiple Sclerosis

To the Editor: We are troubled by the suggestion in the review article on multiple sclerosis by Noseworthy and colleagues (Sept. 28 issue) 1 that hepatitis B vaccine should be administered only to persons at substantial risk for exposure to the virus. The concern that hepatitis B vaccine may cause multiple sclerosis stems from case reports of demyelination beginning within months after vaccination. The World Health Organization and the Viral Hepatitis Prevention Board have reviewed preliminary results from ongoing controlled studies and other evidence. They have concluded that a causal association between hepatitis B immunization and demyelinating diseases of the central . . .