From the Guidelines
Most individuals with multiple sclerosis (MS) can safely receive most vaccines, but the type of vaccine and timing are crucial considerations. When it comes to vaccination in MS patients, the primary concern is the potential impact of live attenuated vaccines and the interaction between vaccines and disease-modifying therapies (DMTs) [ 1 ]. People with MS should generally receive all recommended inactivated vaccines, including influenza, pneumococcal, hepatitis B, HPV, and COVID-19 vaccines. However, live attenuated vaccines (such as live MMR, chickenpox, or the live nasal flu vaccine) require caution, especially for those on certain immunosuppressive MS medications like alemtuzumab, cladribine, ocrelizumab, rituximab, fingolimod, or high-dose corticosteroids [ 1 ].
Some key considerations for vaccination in MS patients include:
- The type of vaccine: inactivated vaccines are generally safe, while live attenuated vaccines may pose a risk [ 1 ]
- The timing of vaccination: ideally, vaccines should be administered at least 4-6 weeks before starting immunosuppressive therapy or during periods of medication stability [ 1 ]
- The potential impact of DMTs on vaccine effectiveness: some medications may reduce the antibody response to vaccination [ 1 ]
- The risk of vaccine-induced adverse reactions: while rare, there is a potential risk of neurologic adverse events, such as immunisation stress-related response (ISRR) or psychogenic non-epileptic seizures (PNES) [ 1 ]
It is essential for individuals with MS to discuss their specific medication regimen, disease status, and vaccination needs with their neurologist and primary care provider to create an individualized vaccination plan. This will help ensure that they receive the necessary vaccinations while minimizing potential risks and interactions with their MS medications [ 1 ].
From the FDA Drug Label
5.9 Immunizations
The FDA drug label does not answer the question.
From the Research
Vaccine Eligibility for Individuals with Multiple Sclerosis
Individuals with multiple sclerosis (MS) can receive various types of vaccines, but certain considerations must be taken into account.
- The type of vaccine: live attenuated vaccines are contraindicated in patients already undergoing immunosuppressive treatment 2.
- The patient's immunity status: vaccines included in the routine adult vaccination schedule, as well as some specific ones, are recommended depending on the pre-existing immunity status 2.
- The type of MS treatment: some disease-modifying therapies (DMTs) may impact immune responses to vaccines, while others may not significantly impair the response to vaccination 3.
Types of Vaccines and MS
Several studies have investigated the safety and efficacy of various vaccines in MS patients, including:
- Influenza, hepatitis B, tetanus, human papillomavirus, measles, mumps, rubella, varicella zoster, tuberculosis, yellow fever, and typhoid fever vaccines: no correlation has been found between these vaccinations and the risk of MS 4.
- COVID-19 vaccines: treatment with fumarates does not appear to result in blunting of humoral responses to vaccination, and COVID-19 vaccines impart a similar degree of protection against severe COVID-19 infection for MS patients on fumarates as in the general population 5.
- BCG vaccination: one study showed a reduced risk of developing MS after BCG vaccination following the first demyelinating event 6.
Vaccine Response and Safety
The vaccine response in MS patients treated with fumarates has been assessed, and the evidence indicates:
- Antibody responses similar to those of healthy recipients for COVID-19 vaccines, particularly RNA-based vaccines 5.
- No significant blunting of T-cell responses 5.
- Adverse reactions following vaccination are generally consistent with those observed in the wider population, and no additional safety signals have emerged in those on fumarates 5.
- No increase in relapse has been observed in MS patients following vaccination 5.