Leading multiple sclerosis (MS) experts recommend people with MS get booster vaccinations against COVID-19 infection despite the slight risk the shot could trigger an MS relapse (also known as a flare, attack, or exacerbation). MyMSTeam spoke with Dr. Aaron Boster about this topic. A board-certified neurologist and president of The Boster Center for Multiple Sclerosis in Columbus, Ohio, Dr. Boster also has a YouTube channel with a full video library that covers many aspects of treating and living with MS.

“I encourage people with MS to get COVID boosters and vaccines,” said Dr. Boster. “If you get a vaccine or a booster, it can increase some symptoms temporarily. Very, very rarely, it might trigger an attack — and I mean super rare.”

He went on to explain why the potential benefits of vaccines and boosters outweigh this small risk for people living with MS. “We know that COVID can trigger attacks, and we know that people will have symptoms for much longer than if they weren't vaccinated. You can still get COVID, but you don’t get hospitalized, and you don’t die.

Read on to learn about the safety and effectiveness of COVID-19 vaccines for people with MS and the risk for multiple sclerosis relapse. Equipped with this knowledge, you and your health care team can have an informed conversation about when and if a COVID-19 vaccination is right for you.

MS, the Immune System, and COVID-19 Vaccines

Dr. Boster also discussed whether people with MS are immunocompromised — whether their immune system’s ability to fight infections is reduced — and how well vaccines might work for them. “MS by itself does not suppress your immune system,” he clarified. “You’re not immunosuppressed just because you have MS. But the vast majority of the effective medicines that we use to treat MS make the human immunosuppressed.”

The fact that some MS medications suppress the immune system points to a key reason people with MS should consider getting vaccinated against COVID-19. “I’m very keen on protecting that person, so I am of the opinion that a vaccine is a good idea.”

It’s also worth noting that the U.S. Centers for Disease Control and Prevention (CDC) recommends that anyone age 6 and older who is moderately or severely immunocompromised should receive at least one dose of an updated COVID-19 vaccine.

People With MS Who Need COVID-19 Protection the Most

According to the National Multiple Sclerosis Society (NMSS), the following groups are at a higher risk than the general population of severe COVID-19 symptoms and are especially encouraged to get vaccinated:

• Those with progressive MS
• Older individuals
• People with higher levels of physical disability
• Those with other medical conditions (sometimes called comorbidities, such as diabetes, high blood pressure, and heart and lung disease)

Disease-Modifying Treatments and COVID-19 Vaccinations

Corticosteroids (steroids) such as prednisone and some disease-modifying therapies (DMTs) can render the COVID-19 vaccine less effective because they suppress your immune system. However, immunosuppressive medications also put you more at risk for severe COVID-19 symptoms for the same reason.

While vaccines may not work quite as well for these people, they still offer some protection. You shouldn’t change the timing of your DMTs nor stop taking them without first speaking with your doctor, as doing so could worsen your MS symptoms. The NMSS recommends that people coordinate the timing of their vaccination if they’re taking any of the following:

• Alemtuzumab (Lemtrada)
• Ocrelizumab (Ocrevus)
• Rituximab (Rituxan)
• Ublituximab (Briumvi)
• Cladribine (Mavenclad)
• High-dose steroids

For other DMTs, the NMSS didn’t recommend making any changes in the medication schedule around getting a COVID-19 vaccination. These include:

• Dimethyl fumarate (Tecfidera)
• Teriflunomide (Aubagio)
• Glatiramer acetate (Copaxone, Glatopa)
• Beta interferons such as Avonex and Betaseron

COVID-19 Vaccinations and MS Relapses: What Are the Risks?

A systematic review and meta-analysis study published in 2024 looked at the risk of flare or relapse after COVID-19 vaccination in people with immune-mediated diseases, including multiple sclerosis. The researchers found that overall, the risk of having a disease flare after a COVID-19 vaccination was 6.28 percent.

Among people with neurologic conditions, such as MS, this risk was even lower. The researchers reported the risk for flare or relapse among those with neurologic immune-mediated diseases at 2.62 percent.

They concluded that the protective benefits of COVID-19 vaccination significantly outweigh the small potential risk of relapse, and recommend vaccination as an important part of controlling the pandemic.

Taking Extra Precautions Against COVID-19

In closing, Dr. Boster again encouraged people with MS and their loved ones to get vaccinated with up-to-date COVID-19 boosters. “I very much want my patients and their families to be vaccinated,” he said.

In addition to getting vaccinated, people with MS should consider taking the following precautions to protect themselves — particularly those who are taking a DMT or are in a high-risk group:

• Wear a high-quality mask or respirator, and make sure it fits properly.
• Steer clear of crowded spaces with limited ventilation.
• Wash your hands frequently with soap and water and/or use hand sanitizer containing at least 60 percent alcohol.
• Learn about the symptoms of COVID-19 and monitor your health for any of them.
• Take necessary precautions if you’ve been exposed to COVID-19.
• Use COVID-19 tests approved by the U.S. Food and Drug Administration (FDA) as directed.
• Know how to contact your doctor quickly, including during their off-hours.

If you contract COVID-19, contact your health care provider immediately — the sooner you begin an oral antiviral treatment, the better your outcome is likely to be. Additionally, to protect your health and to keep others safe, the CDC recommends isolating for at least 10 days.

Find Your Team

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 213,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you and your loved ones received the updated COVID-19 vaccine? What questions, concerns, or advice do you have? Share your experience in the comments below, or start a conversation by posting to your Activities page.