Multiple sclerosis (MS) is an autoimmune condition, meaning that a person’s immune system attacks their own body. Specifically, MS targets the coating of their nerves, called myelin, in the brain, spinal cord, and optic nerves.
Common symptoms of MS include numbness, weakness, visual impairments, bladder problems, and fatigue. Most people with multiple sclerosis initially have relapses, but eventually the disease may result in progressive disability. MS treatment can help decrease this immune attack on the nervous system, but may impact routine vaccinations.
Many people living with MS are confused about whether they should get vaccinations. “I have heard that people with MS should not get the flu shot,” one member of MyMSTeam wrote. “Has anyone ever gotten the flu shot?” Another member said, “I was advised to definitely get the flu shot.”
To learn more about this issue, MyMSTeam talked with Dr. Barry Singer. Dr. Singer is the director and founder of The MS Center for Innovations in Care at Missouri Baptist Medical Center in St. Louis. His award-winning MS website, MS Living Well, launched in 2007 and has been a valuable resource in more than 190 countries. He is also the host of the MS Living Well Podcast, available on Apple Podcasts and Spotify.
It is generally recommended that people with multiple sclerosis get vaccinated according to the same standard immunization schedules as the general population. According to the American Academy of Neurology, preventing infections with vaccines is a crucial element of care for people with MS. It’s very important for people living with MS to talk to their health care providers before scheduling vaccinations.
There are some caveats to this recommendation, however. For instance, if you’re experiencing a relapse and being treated with certain intravenous drugs, the vaccinations may be less effective. Always speak with your physician about the timing of your vaccines.
Many people with MS take disease-modifying therapies (DMTs) to treat the condition, and some may wonder whether those drugs are safe to take at the same time as they take a live vaccine. A live vaccine, also known as a live attenuated vaccine or a live-virus vaccine, keeps a disease-causing organism alive while reducing its virulence, which means that it weakens the pathogen’s ability to do damage to the person it infects.
This type of vaccine is different from the inactivated variety, which uses a killed germ to fight infections. The influenza vaccine, or flu vaccine, is a typical example of an inactivated treatment, while live vaccines include the yellow fever vaccination, smallpox, and varicella (chickenpox) treatments, as well as the measles, mumps, and rubella (MMR combined) vaccine.
Live vaccines tend not to be recommended for people with MS because the pathogens used in them, while weakened, are still alive and could potentially harm people who are on MS treatments that suppress their immune systems. On the other hand, inactivated vaccines are considered mostly safe for people with multiple sclerosis who are taking DMTs.
Subunit vaccines, which use only a small portion of a live pathogen, include the hepatitis B vaccine, human papillomavirus (HPV) vaccine, and the pneumococcal vaccine. Also known as recombinant vaccines, these have been shown to be mostly safe for use by people with MS, although further study is needed.
The Centers for Disease Control and Prevention (CDC) recommend a vaccination for seasonal influenza for every person over the age of 6 months. This includes people with MS, and you should talk to your health care team about the timing of your flu vaccine and how it might interact with any medications you’re taking.
“I think it's a great idea to get the flu vaccine,” Dr. Singer said, noting that he doesn’t recommend the nasal spray version of the vaccine for people with MS. “The FluMist is a live-attenuated virus, which should be avoided. Flu shots are inactivated, or recombinant vaccines, that are fine on all the DMTs.”
People over the age of 50 should get vaccinated for herpes zoster, commonly known as shingles. For example, Shingrix (recombinant varicella zoster virus), which was approved by the Food and Drug Administration (FDA) in 2017, is not a live vaccine.
“Some people living with MS on disease-modifying therapies have an increased risk of getting shingles,” Dr. Singer said. “Several of our medications have an increased risk of herpetic infections, and herpes zoster is one of those types of infections. So we want to vaccinate with Shingrix, which will protect you from shingles. Shingles is reactivation of the chickenpox virus that can linger for decades in our nerve cells.”
Before starting some DMTs, your doctor may want to screen you for chickenpox (varicella) immunity. If you have never been vaccinated for chickenpox or you have not been exposed to chickenpox, you may require vaccination with a live-attenuated varicella vaccine first. Generally, a varicella antibody blood test lets your doctor know if you have been exposed to or vaccinated against chickenpox.
By joining MyMSTeam, the social network and online community for those living with multiple sclerosis, you gain a support group of over 164,000 people who want to better understand how any disease-modifying therapies that they take may interact with vaccines.
Has your neurologist found the right treatment for your multiple sclerosis symptoms? Are you concerned about vaccine safety? Share your tips and experiences in a comment below, or start a conversation on MyMSTeam.