COVID-19 Vaccine and Booster Schedules

Updated: March 31, 2022

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The National MS Society continues to track the latest research on MS and vaccine boosters and additional doses. The following guidance is based on the data currently available from studies and expert consensus opinion.

The vaccine and booster schedules from Centers for Disease Control and Prevention (CDC) vary based on age and whether you are immunocompromised. Healthcare providers have flexibility in determining the type of vaccine, number of doses and schedule for people who are immunocompromised. If you have MS, select the Pfizer or Moderna vaccine if available.

Having MS does not automatically mean that you are immunocompromised. However, some disease modifying therapies (DMTs) used to treat MS do alter your immune system and certain groups of people with MS are more susceptible to having a severe case of COVID-19.

Studies of the COVID-19 vaccine responses in people living with MS have shown a reduced or absent antibody response to the vaccine among those who use certain DMTs. Based on the CDC guidance, people with MS using the following DMTs may be considered immunocompromised:

• Sphingosine 1-phosphate receptor modulators (Gilenya®, Mayzent®, Zeposia®, Ponvory™) 
• Alemtuzumab (Lemtrada®)
• Anti-CD20 monoclonal antibodies (Ocrevus®, Kesimpta®, Rituxan® and biosimilars)

Decisions about your vaccination schedule are best made in partnership with your healthcare provider. Refer to the CDC schedules below and talk to your MS healthcare provider to determine what is best for you.

Recent studies of people with MS who use certain B cell depleting DMTs showed a better antibody response when the vaccine was administered three months or more after the last dose of DMT. Review our vaccine timing considerations, and work with your MS healthcare provider to determine the best time to get your additional dose or booster.

Antibody tests are helpful to determine if someone may have been exposed to the SARS-CoV-2 virus (the virus that causes COVID-19), but antibody tests are not recommended by the FDA to determine immunity or protection against COVID-19. Learn more from the FDA.

A third dose of the mRNA vaccines produces more robust immune responses against the SARS-CoV-2 virus. These responses can include an increase in antibodies (produced by B cells) as well as an increase in the immune cellular responses (T cells) — both of which offer protection from serious illness due to COVID-19.

People who lack B cells, such as those on B cell depleting therapies, may have reduced or even absent antibody responses to booster doses, though other aspects of their vaccine response (T cells) are likely to be increased. Recent studies of people with MS who had a reduced or absent antibody response to the COVID-19 vaccine showed increased T cell responses. This finding shows the importance of vaccination for all people with MS regardless of the anticipated antibody response.

Discuss monoclonal antibody treatment options to prevent and treat COVID-19 with your healthcare provider. Learn how to access these treatments.    

Science has taught us that the best protection against COVID-19 infection is a combination of vaccination and physical protection measures. Until more is learned about the protection of those using immunocompromising DMTs, continue to take precautions against COVID-19, like mask wearing, hand washing, physical distancing and avoiding crowds and poorly ventilated indoor spaces. Also, encourage those close to you to get vaccinated.

Each state offers the vaccines and boosters at different locations and has different requirements for showing proof of eligibility. Visit vaccines.gov to learn more and find a location near you.

MS neurologists and experts

• Nancy Sicotte, MD, FAAN — Chair, National MS Society’s National Medical Advisory Committee, Cedars-Sinai Medical Center, USA
• Brenda Banwell, MD — Chair, MS International Federation International Medical and Scientific Advisory Board (IMSB),  University of Pennsylvania, USA
• Amit Bar-Or, MD, FRCPC — President, International Society for Neuroimmunology, University of Pennsylvania, USA
• Jorge Correale, MD — Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina
• Anne Cross, MD, FAAN — Washington University and Secretary of Board of Governors of the Consortium of MS Centers, USA
• Jaime Imitola, MD, FAAN — University of Connecticut, UConn Health, USA
• Dorlan Kimbrough, MD — Duke University, USA
• Avindra Nath, MD — National Institutes of Health/National Institutes of Neurological Disorders and Stroke, USA
• Scott Newsome, DO, MSCS, FAAN, FANA — Johns Hopkins University and President of the Board of Governors of the Consortium of MS Centers, USA
• Penny Smyth, MD, FRCPC — University of Alberta, Canada
• Rachael Stacom, MS, ANP-BC, MSCN — Independence Care System, USA

• Julie Fiol, RN, MSCN — National MS Society, USA
• Pamela Kanellis — MS Society of Canada
• Julie Kelndorfer — MS Society of Canada
• Hope Nearhood, MPH, PMP — National MS Society, USA
• Leslie Ritter — National MS Society, USA