Many people with MS have concerns about the safety of routine vaccinations. Information is now available from a variety of sources that most vaccines are safe for people with MS.
A study published in the Archives of Neurology in 2003, indicated that vaccinations for influenza (flu), hepatitis B, tetanus, measles and rubella (German measles) are safe for people with MS and are not associated with an increased risk for the development of MS or optic neuritis.
The study evaluated data on vaccinations and other risk factors from medical records and telephone interviews with 440 people with multiple sclerosis or optic neuritis and 950 control subjects without neurologic disease.
Guidelines for Immunizations for Adults with MS
Immunizations and Multiple Sclerosis, a clinical practice guideline published by the Multiple Sclerosis Council for Clinical Practice Guidelines in 2001, presents conclusions based upon available research data. The expert panel used the recommendations of the Centers for Disease Control and Prevention (CDC) as a foundation for the development of its guideline. The CDC has developed guidelines for immunizations for all adults (www.cdc.gov). The consensus of the panel, based on available research data, was that people with MS should not be denied access to health-preserving and potentially-life saving vaccines because of their MS, and should follow the CDC guidelines for any given vaccine.
For example, an annual flu shot is recommended for:
- Adults 50 years of age and older
- Residents of long-term care facilities
- Individuals with chronic heart or lung conditions or other chronic diseases, such as diabetes, or renal dysfunction.
- Women who will be in their second or third trimester of pregnancy during influenza season.
- Groups, including household members, and caregivers, who can infect high-risk persons.
The CDC also encourages the flu shot for any person who wants to reduce their chances of catching influenza.
The following vaccines have been evaluated in people with MS:
- Influenza
- Hepatitis B
- Varicella
- Diphtheria/Tetanus—Routine
Other vaccinations, such as those for pneumonia, meningitis, typhoid, polio, yellow fever, hepatitis A, human papillomavirus (HPV), and pertussis, do not have published studies addressing their safety in MS. Nevertheless, the clinical practice guideline recommends that people with MS who meet the CDC criteria for any particular vaccination should be given it. CDC criteria can be viewed at: www.cdc.gov/ncidod/guidelines/guidelines_topic_vaccination.htm.
Who should not be vaccinated?
Your doctor will know the general contraindications for each vaccine. For example, people with allergies to eggs may not receive the flu vaccine. However, people with MS have specific 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 relapse.
- People who have received immune globulin preparation in the past three months should not receive live attenuated virus vaccinations, such as varicella or MMR (measles, mumps, rubella). Live attenuated vaccines are those whose biological activity has been reduced so that their ability to cause disease has been weakened but not totally inactivated.
- People on therapies that suppress the immune system (immunosuppressants), such as mitoxantrone, azathioprine, methotrexate, cyclophosphamide and/or chronic corticosteroid therapy should not receive live, attenuated vaccines. A person with a suppressed immune system would be at greater risk for developing the disease.
Note: Interferon medications and glatiramer acetate are not immunosuppressants; people who are taking any of these medications can be given all of the vaccines mentioned above. No information is available on how natalizumab (Tysabri®) affects the immune response that occurs when people receive vaccinations. A study is under way to determine whether natalizumab affects immune responses to vaccines. People who are taking natalizumab should discuss vaccination options with their neurologist.
Hepatitis B Vaccination
A report released by the National Academy of Sciences’ Institute of Medicine (IOM) says that there is no evidence that hepatitis B vaccination causes multiple sclerosis or triggers MS attacks in adults. Hepatitis B is a serious disease, complications of which can be fatal, and which is usually prevented by vaccination.
An IOM-appointed committee of experts examined the relationship between hepatitis B vaccine and diseases of the nervous system such as multiple sclerosis. The committee evaluated an extensive collection of published, peer-reviewed scientific and medical literature related to the association of these diseases with the vaccine. This independent study by the Institute of Medicine supports previous findings of no link between vaccinations against hepatitis B and the onset or worsening of multiple sclerosis.
Specific Recommendations Concerning the Smallpox Vaccine
The smallpox vaccine has never been studied in people with MS, and concerns about smallpox in the U.S. developed after the Clinical Practice Guideline was completed. This vaccine, however, is used to prevent a serious, generally fatal illness, and should be made available to any person with MS who is exposed to smallpox because the risks associated with not getting vaccinated would be too great. Because of the serious adverse events that can occur with this vaccine, however, it is the recommendation of the Society’s Chief Medical Officer, Dr. Aaron Miller, that no person with MS be given it unless he or she has been directly exposed to smallpox.