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Vaccinations

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Overview

Many people with MS have concerns about the safety of routine vaccinations and vaccinations required for travel to other countries. The information about each vaccine is based upon the best-available evidence.

General recommendations

The Academy of Neurology, in collaboration with the Immunization Panel of the Multiple Sclerosis Council for Clinical Practice Guidelines, published a summary of evidence and recommendations regarding immunizations and MS. They concluded that:

  • The evidence supports strategies to minimize the risk of acquiring infectious diseases that may trigger MS relapses (also called attacks or exacerbations).

  • The influenza, hepatitis B, varicella and tetanus vaccines are safe for people with MS.

Decisions about the potential benefits and risks of any given immunization should be made in consultation with your healthcare providers, including your family physician and neurologist.

Special considerations

  • People who are experiencing a serious relapse that affects their ability to carry out activities of daily living should defer vaccination until 4-6 weeks after the onset of the relapse.
  • Inactivated vaccines are generally considered safe for people with MS, including those who are taking an interferon medication (Avonex®, Betaseron®, Extavia®, Rebif®), Aubagio®, Copaxone®, Gilenya®, Novantrone, Tecfidera® or Tysabri®. 
  • Live, attenuated vaccines are generally not recommended for a person with MS because their ability to cause disease has been weakened but not totally inactivated.
  • People on therapies that suppress the immune system, such as Cytoxan, Imuran®, Novantrone, Rheumatrex® and/or chronic corticosteroid therapy, should consult their neurologist before taking any live-virus vaccine. 
  • MS experts are not in agreement about the risks for a person with MS whose close family member receives a live-virus vaccine. The family should discuss with the neurologist how best to handle this situation. 

Specific recommendations for people with MS

2013-2014  Injectable Seasonal Flu Vaccine (includes H1N1) 

  • The 2013-2014 seasonal influenza (flu) immunization is a single injection that provides immunity to three different flu virus strains: the H3N2 virus, influenza B, and this year's H1N1. It is recommended by the Centers for Disease Control and Prevention (CDC) for everyone over 6 months of age. The seasonal flu vaccine has been studied extensively in people with MS and is considered quite safe, regardless of the disease-modifying therapy they are taking.

  • FluMist® is a live-virus flu vaccine (sometimes called LAIV for "live attenuated influenza vaccine”) that is delivered via a nasal spray. This live-virus vaccine is not recommended for people with MS.

  • A high-dose flu vaccine is available for people over age 65. The Centers for Disease Control does not recommend the high-dose vaccine for the general population and it has not been studied in people with MS of any age.

Hepatitis B vaccine. Recommended for all children, adolescents, and adults at risk of contracting this potentially life-threatening disease. In 2002 the National Academy of Sciences’ Institute of Medicine (IOM) determined that there is no association between hepatitis B vaccination and the onset of MS.

Human papillomavirus vaccine (Gardasil®). Designed to prevent the HPV 6, 11, 16 and/or 18-related cervical cancer, cervical dysplasias, vulvar and vaginal dysplasias, and condyloma acuminate in girls and women ages 9 to 26. A recent case report described the onset of acute disseminated encephalomyelitis following the second immunization with Gardasil (Waldemann et al., 2009) and Sutton et al. (2009) reported five patients who presented with multifocal or atypical demyelination syndromes within 21 days of the second or third immunization (three of whom had previously experienced clinical isolated episodes of neurological dysfunction). Use of Gardasil should be preceded by a thorough discussion between patient and physician of the possible benefits and risks.

Shingles vaccine (Zostavax®). A live-virus vaccine to prevent shingles. MS neurologists do not recommend live-virus vaccines for people with MS because these vaccines can lead to an increase in disease activity. However, Zostavax is an exception because most people have had chicken pox earlier in their lives and therefore already have the virus in their bodies. Each person needs to discuss the potential benefits and risks of this vaccine with her or his healthcare provider.

Smallpox vaccine. While this vaccine has not been studied in people with MS, it should be made available to any person with MS directly exposed to smallpox as the risks associated with not getting vaccinated would be too great.

Varicella vaccine. This vaccine should be considered by people with MS who have never had chicken pox, lack evidence of prior immunity, and are considering starting an MS medication that has the potential to suppress cell mediated immunity – for example, Gilenya® (fingolimod). The vaccine should be taken well before starting the MS therapy.

Studies of Vaccine Safety and Effectiveness in People with MS

Some, but not all, immunizations have been evaluated for safety and efficacy in people with MS:
  • A study by the Vaccines in Multiple Sclerosis Study Group published in 2001 in the New England Journal of Medicine found that vaccination for tetanus, hepatitis B or influenza  did not appear to increase the short-term risk of relapses (also called attacks or exacerbations) in people with MS.
  • A study by the National Immunization Program of the Centers for Disease Control and Prevention, published in the Archives of Neurology in 2003, found that vaccination against hepatitis B, influenza, tetanus, measles, or rubella did not increase a person’s risk of developing MS or optic neuritis (which is often a first symptom of MS). 
  • A small, unblinded study, published in the Archives of Neurology in 2011, of people with relapsing-remitting MS who received the yellow fever vaccination prior to travel, found a significantly increased risk of MS relapses during the six weeks following the  vaccination when compared to the remainder of the two-year follow-up period. For people with MS who must travel to areas where yellow fever is common, the increased relapse risk needs to be carefully weighed against the likelihood of exposure to yellow fever – which is a potentially fatal illness.
  • Other immunizations, such as those for pneumonia, meningitis, typhoid, polio, hepatitis A, human papillomavirus (HPV) and pertussis, do not have published studies addressing their safety in MS. 

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