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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. In general, it is recommended that people with MS receive vaccines according to the standard vaccine schedule.

General recommendations

Experts from the American Academy of Neurology (AAN) reviewed the available scientific evidence on infections and vaccine use in multiple sclerosis and made recommendations in Practice Guideline: Infections and Vaccine use in Multiple Sclerosis. Key messages from the Guideline include:  

  • Preventing infections through vaccine use is a key part of medical care for people with MS.
  • People with MS should receive vaccines according to standard vaccine guidelines.
  • Before receiving any vaccine, you should talk with your healthcare provider about any MS medicine you are using.
For specific recommendations on vaccinations, view the Center for Disease Control and Prevention’s Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2020.  

Special considerations

  • People who are experiencing a relapse should delay vaccination until the relapse symptoms are no longer worsening or have resolved.
  • Live and live-attenuated vaccines are generally not recommended for people with MS who take a disease modifying therapy (DMT).
  • A person should not receive a live-virus vaccine following a course of Lemtrada®.
  • Any required live and live-attenuated vaccinations should be administered at least 4 weeks before a person starts treatment with Ocrevus® or Kesimpta®. No live-attenuated or live vaccines should be given during treatment or following treatment until your healthcare providers tells you that your immune system is no longer weakened. When possible, a person should receive any non-live vaccines at least 2 weeks before you start treatment with Ocrevus or Kesimpta. If you would like to receive any non-live (inactivated) vaccines, including the seasonal flu vaccine, while being treated with Ocrevus or Kesimpta, talk to your healthcare provider. If you are pregnant or planning to become pregnant, talk to your healthcare provider about vaccinations for your baby, as some precautions may be needed.
  • You should avoid receiving live vaccines during treatment with Mayzent®. Mayzent should be stopped 1 week before and for 4 weeks after receiving a live vaccine. If you receive a live vaccine, you may get the infection the vaccine was meant to prevent. Vaccines may not work as well when given during treatment with Mayzent.
  • You should avoid receiving live vaccines during treatment with Zeposia®, for at least 1 month before taking Zeposia and for 3 months after you stop taking Zeposia. Vaccines may not work as well when given during treatment with Zeposia.
  • You should not receive live or live attenuated vaccines within the 4 to 6 weeks preceding your treatment with Mavenclad®. You should not receive these types of vaccines during your treatment with Mavenclad and until your healthcare provider tells you that your immune system is no longer weakened.
  • 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 their healthcare provider how best to handle this situation. 
  • Additional guidance on vaccines specific to each disease modifying therapy can be found in the medication guide.

Information about Specific Vaccines

2020-2021 Seasonal Flu Vaccine 
The composition of US influenza (flu) vaccines is reviewed annually by the Centers for Disease Control and Prevention (CDC) and updated each year to match circulating flu viruses.

  • Routine annual influenza (seasonal flu) vaccination is recommended by the CDC for everyone over 6 months of age who does not have a specific reason they cannot get the vaccine. The AAN recommends that people with MS should receive the annual influenza vaccine unless they have a specific reason they cannot get it.
  • The FluMist® (nasal spray) vaccine for the seasonal flu is a live vaccine. The AAN recommends against using live vaccines in people with MS who are currently taking a DMT. For some DMTs, there are also restrictions from the US Food and Drug Administration (FDA) for the timing of a live vaccine after discontinuing a DMT. Prior to receiving a live vaccine, discuss the risks, benefits and appropriate timing with your MS healthcare provider.
  • A high-dose inactivated flu vaccine (Fluzone High-Dose) is available for people over age 65. The CDC has not expressed a preference for any flu vaccine for people 65 and older. The high-dose vaccine has not been studied in people with MS of any age.
  • There are many vaccine options for this flu season. The CDC has no preference for one vaccine over another. Providers will work with their patients to determine the option that is most appropriate for them.

To learn more about the 2020-2021 seasonal flu vaccine, please visit the CDC website.

Hepatitis B vaccine

  • The hepatitis B vaccine is recommended for all children, adolescents and adults at risk of contracting this potentially life-threatening disease. Note: Reports of an increase in MS cases in France following vaccination for hepatitis B frightened many people into avoiding hepatitis B vaccinations. However, these reports confused a temporal relationship (diagnosis of MS following the vaccine) with a causal relationship (the vaccine caused MS). MS experts are in agreement that the vaccine does not cause MS to occur. Hepatitis B is a serious illness that can safely be prevented with the hepatitis B vaccination.
  • Individuals at risk include anyone working in a job that involves contact with human blood, those who have diabetes and are under age 60, those who have sex with or live in the same house as a person with hepatitis B virus infection, and those who have sex with more than one partner. Additionally, people who live or travel outside the country for more than 6 months a year are also advised to get this vaccine.
  • 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. A 2017 systematic review of vaccine safety in MS concluded that the hepatitis B vaccine does not increase a person's risk of developing MS.

Human papillomavirus vaccine (Gardasil®)

  • This vaccine is designed to prevent the HPV 6, 11, 16 and/or 18-related cervical cancer, cervical dysplasias, vulvar and vaginal dysplasias, and condyloma acuminate in females ages 9 to 26.
  • One case report (Waldemann et al., 2009) described the onset of acute disseminated encephalomyelitis following the second immunization with Gardasil, 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). However, a recent large-scale study of patient registries in Denmark and Sweden (see below) found no increased risk of developing MS among nearly 800,000 who received this vaccine. Use of Gardasil should be preceded by a discussion between patient and physician regarding benefits and risks.

Pneumococcal vaccines (Pneumovax® 23 - PPSV23) and Prevnar® 13-PCV13)

  • PCV13 protects against 13 types of pneumococcal bacteria; PPSV23 protects against 23 types of pneumococcal bacteria.
  • One dose of PPSV23 is recommended for all adults 65 years or older.
  • Both pneumococcal vaccines are inactivated and safe for people with MS.
  • According to the American Academy of Neurology recommendations on immunizations for people with MS, pneumococcal vaccine should be considered for individuals with compromised pulmonary function, including those who use a wheelchair on a full-time basis or are bed-bound.

Shingles vaccine (Shingrix®)

  • The CDC recommends Shingrix, a non-live vaccine for the prevention of herpes zoster (shingles) and related complications. The vaccine, which is given in two doses separated by 2 to 6 months, is recommended over Zostavax® (the previously approved vaccine for shingles). Shingrix is approved for adults 50 years and older:
    • whether or not they have had a prior episode of herpes zoster or have had a dose of Zostavax
    • who have a chronic medical condition, unless there is a specific reason why the individual should not have it
    • who are getting other adult vaccines such as influenza and pneumococcal (pneumonia) vaccines
  • No studies of Shingrix have been done in people with MS. However, in two clinical studies with Shingrix, there was no increase in immune-mediated conditions.
  • The CDC indicates that a person who is taking a low-dose immunosuppressive therapy or is going to begin taking an immunosuppressive medication can take Shingrix. It is very important to discuss this vaccine with the healthcare provider who is treating your MS to ensure that it is appropriate for you.

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 certain MS medications.  After getting the vaccine, the length of time you will have to wait before starting these medications varies – talk to your healthcare provider to learn more about the waiting period.

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