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.
Experts from the 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.
Information about Specific Vaccines
2019-2020 Seasonal Flu Vaccine
The composition of U.Sl influenza (flu) vaccines is reviewed annually by the Centers for Disease Control and updated 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 disease modifying therapy (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.
- If you are experiencing a relapse, discuss the timing of your influenza vaccine with your MS healthcare provider. The AAN recommends waiting for the relapse to resolve before receiving any vaccinations.
- 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.
To learn more about the 2019-2020 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®).
Pneumococcal vaccines (Pneumovax® 23 - PPSV23) and Prevnar® 13-PCV13)
- 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 girls and women 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.
Shingles vaccine (Shingrix®)
- PCV13 protects against 13 types of penumococcal bacteria; PPSV23 protects against 23 types of pneumococcal bacteria.
- One dose of PDV13 is recommended for all adults 65 years or older who have not previously received the vaccine. A dose of PPSV23 should be given at least one year later.
- For adults 65 and older who have already received one or more doses of PPSV23, the dose of PCV13 should be given at least one year after receiving the most recent dose of PPSV23.
- 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.
- 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.
- 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.
- 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) and Lemtrada™ (alemtuzumab).
- The vaccine should be taken six weeks 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.
- A study of nearly four million girls and women identified in nationwide patient registries in Denmark and Sweden, published in the Journal of the American Medical Association, found no increased risk of developing MS among nearly 800,000 who received quadrivalent human papillomavirus vaccine (Gardasil®), designed to prevent cervical cancer.
- A review of data from the complete electronic medical health records of Kaiser Permanente Southern California between 2008 and 20011, published in JAMA Neurology, found no long-term association of vaccines with MS or any other acquired central nervous system demyelinating disease.