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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 Centers for Disease Control and Prevention’s Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2022.  

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 not recommended for people with MS who have recently taken steroids or who take certain disease modifying therapies (DMT) that suppress the immune system.
  • Prior to starting any DMT, talk with your healthcare provider about any vaccines you should get or have recently received. Vaccination considerations specific to each DMT can be found in the medication guide.
  • 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.

Information about specific vaccines

2022-2023 Influenza (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.

  • The CDC has determined it is safe for you to get the influenza vaccine and other vaccines at the same time as the COVID-19 vaccine.
  • Routine annual influenza 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 is a live influenza 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.
  • The CDC recommends people over age 65 receive either the Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine or Fluad Quadrivalent adjuvanted flu vaccine.
  • Pregnant and postpartum women are at higher risk for severe illness and complications from influenza. Getting vaccinated while pregnant can help protect your baby from the flu after birth. Read more on the CDC website and work with your healthcare provider on what vaccines you should receive during pregnancy.

There are many vaccine options for this flu season. The CDC has no preference for one vaccine over another in people aged 65 and younger. Providers should work with their patients to determine the option that is most appropriate for them.

COVID-19 vaccine

Vaccination against COVID-19 is critical for public safety and, especially, the safety of the most vulnerable among us. Review our guidance to learn more about COVID-19 vaccines and MS.

Hepatitis B vaccine

Human papillomavirus (HPV) vaccine (Gardasil®)
  • This vaccine is designed to prevent cancer, cervical dysplasias, vulvar and vaginal dysplasias, and condyloma acuminate related to certain types of the human papillomavirus in females ages 9 to 26. Discuss benefits and risks of Gardasil with your healthcare provider.
  • A large-scale study of patient registries in Denmark and Sweden found no increased risk of developing MS among nearly 800,000 people who received this vaccine.
Monkeypox (updated September 13, 2022)
  • The CDC recommends vaccination for people who have been exposed to monkeypox and people who may be more likely to get monkeypox.
  • The JYNNEOS vaccine is approved for prevention of monkeypox. It is the primary vaccine being used during this outbreak in the U.S.
  • Vaccination with JYNNEOS is considered safe for people with MS, including those who are immunocompromised.
  • According to the CDC, a person offered JYNNEOS vaccine due to an exposure to monkeypox virus or disease should be vaccinated even if they have a weakened immune system.
  • The ACAM2000 vaccine is an alternative to JYNNEOS. It has been shown to have more frequent side effects than JYNNEOS and is not recommended for people with weakened immune systems.
  • JYNNEOS is being administered subcutaneously (into the fat) and intradermally (under the skin). There are no safety data on administration of JYNNEOS intradermally in people who are immunocompromised. People with MS who use the following disease modifying therapies (DMTs) should get the JYNNEOS vaccine subcutaneously:
    • Sphingosine 1-phosphate receptor modulators (Gilenya®, Mayzent®, Zeposia®, Ponvory™) 
    • Alemtuzumab (Lemtrada®)
    • Anti-CD20 monoclonal antibodies (Ocrevus®, Kesimpta®, Rituxan® and biosimilars)
Pneumococcal (pneumonia) vaccines
  • There are four pneumococcal vaccines (Prevnar 13®, Vazneuvance®, Prevnar 20® and Pneumovax23®). Which vaccine is given is determined by age or other factors.
  • Pneumococcal vaccines are inactivated. Inactivated vaccines are considered 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. Shingrix is approved for adults 50 years and older.
  • People who are age 19 or older and are taking certain MS medications should receive a Shingrix vaccine. It is important to discuss this vaccine with your MS healthcare provider.
  • 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.
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 (chicken pox) 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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