From the Guidelines
COVID-19 vaccines are generally considered safe for individuals with multiple sclerosis (MS), and vaccination is recommended as the benefits outweigh potential risks. The most recent evidence from 2022 suggests that vaccination against Covid-19 is vital for MS patients, as they are at increased risk of severe Covid-19 infection, complications, and mortality 1. While there is some concern that vaccination against SARS-CoV-2 may exacerbate MS by inducing immunological responses and triggering immunological reactions, the probability of acute relapse following vaccination is low, and vaccines are generally safe in MS patients 1.
Some key considerations for MS patients include:
- Patients with a history of autoimmune conditions, including MS, should receive mRNA Covid-19 vaccines, if not contraindicated 1.
- Disease-modifying therapies (DMTs) used to treat MS, such as β-interferons, glatiramer acetate, and teriflunomide, may reduce the antibody response following vaccination, but patients can be vaccinated at any time during their treatment 1.
- For MS patients scheduled to start ocrelizumab therapy, the two-dose vaccine regimen should be administered at least 4–6 weeks before the initiation of their treatment course, or at least 4–6 months after the treatment course last ocrelizumab infusion 1.
- Patients on high-dose or long-term corticosteroids should delay vaccination until 4–6 weeks after treatment, but if they are not on DMTs, they should receive the SARS-CoV-2 vaccine as soon as possible 1.
Overall, the benefits of COVID-19 vaccination for MS patients outweigh the potential risks, and vaccination is recommended to protect against severe Covid-19 infection and its complications. MS patients should consult with their neurologist about optimal timing of vaccination in relation to their MS medication schedule to maximize vaccine effectiveness 1.
From the Research
COVID-19 Vaccine Safety for Individuals with Multiple Sclerosis (MS)
- The COVID-19 vaccine is recommended for individuals with multiple sclerosis (MS) as it is likely safe for them 2.
- Disease-modifying therapies can influence the safety and efficacy of COVID-19 vaccines, and certain vaccines such as live-attenuated vaccines should be avoided whenever possible in treated patients 2.
- Studies have shown that COVID-19 vaccination does not increase the risk of severe relapse in patients with MS, with some studies reporting a small increase in relapse risk after a booster dose for patients with high MS activity 3, 4.
Vaccine Types and MS Relapse Risk
- RNA, DNA, protein, and inactivated vaccines are likely safe for MS patients, while viral vector vaccines may have a small risk of central demyelination 2.
- Some studies have reported MS relapses after COVID-19 vaccination, but the benefit of vaccination outweighs the risk in this population 5.
- The type of vaccine and disease-modifying therapies used can influence the risk of relapse, and coordinating vaccine timing with dosing regimens for some therapies may optimize vaccine efficacy 2, 3.
Vaccine Hesitancy and Disease-Related Beliefs
- People with MS have reported concerns about vaccine safety and efficacy, as well as disease relapse concerns following COVID-19 vaccination 6.
- Younger participants and those with shorter disease duration were less likely to be vaccinated, and unvaccinated participants reported higher vaccine complacency and lower vaccine confidence 6.
- Understanding the factors that influence vaccine hesitancy and their interplay with MS disease course and treatment concerns can inform tailored interventions and educational messages to address these concerns in people with MS 6.