Are most travel vaccines safe for multiple sclerosis (MS) patients traveling to Africa?

Travel Vaccines for Multiple Sclerosis Patients Going to Africa

Most travel vaccines are safe for multiple sclerosis patients traveling to Africa, but live vaccines should be avoided, especially in those on immunosuppressive disease-modifying therapies.

General Recommendations for MS Patients

Travel vaccines for MS patients should follow these principles:

• Inactivated vaccines are generally safe for MS patients regardless of disease-modifying therapy (DMT) status 1
• Live vaccines are contraindicated in MS patients on certain immunosuppressive therapies 1
• Timing of vaccination should be coordinated with DMT schedule when possible 1

Specific Travel Vaccines for Africa

Safe Vaccines (Inactivated/Non-Live)

These vaccines are generally safe for MS patients:

• Hepatitis A vaccine: Recommended for most travelers to Africa 1, 2
• Typhoid injectable vaccine (inactivated): Preferred over oral live vaccine 2
• Meningococcal conjugate vaccine: Essential for travel to the "meningitis belt" in sub-Saharan Africa 1
• Polio vaccine (inactivated): Recommended for travel to certain African countries 1
• COVID-19 vaccines: mRNA vaccines are preferred 1
• Influenza vaccine: Recommended annually 1

Vaccines to Avoid (Live)

These live vaccines should be avoided in MS patients on immunosuppressive DMTs:

• Yellow fever vaccine: Live vaccine that is contraindicated in immunosuppressed individuals 1, 2
• Oral typhoid vaccine: Live vaccine; injectable form should be used instead 2

Considerations Based on MS Treatment

The safety and efficacy of vaccines depend on the specific DMT:

Safe to Vaccinate During Treatment

• β-interferons
• Glatiramer acetate
• Teriflunomide
• Dimethyl fumarate
• Natalizumab
• Sphingosine-1-phosphate receptor modulators (fingolimod, ozanimod, siponimod) 1

Timing Considerations

• Ocrelizumab: Complete vaccination at least 4-6 weeks before starting treatment or 4-6 months after the last infusion 1
• Alemtuzumab/Cladribine: Delay vaccination until at least 6 months after treatment 1
• Corticosteroids (high-dose/long-term): Delay vaccination until 4-6 weeks after treatment 1

Pre-Travel Consultation

MS patients should:

1. Consult with a neurologist about travel plans 4-6 weeks before departure 2
2. Visit a travel medicine specialist who can provide destination-specific recommendations 2
3. Discuss DMT schedule to optimize timing of vaccines 1
4. Consider alternatives to yellow fever vaccine if traveling to endemic areas:
   • Request a medical waiver letter if yellow fever vaccine is contraindicated 2
   • Consider changing travel plans to avoid yellow fever endemic areas

Common Pitfalls and Caveats

1. Yellow fever requirements: Some African countries require proof of yellow fever vaccination for entry. MS patients on immunosuppressive therapy should obtain a medical waiver letter 1, 2

2. Vaccine effectiveness: Immunosuppressive DMTs may reduce vaccine efficacy, even if the vaccine is safe to administer 1

3. Disease exacerbation concerns: While there have been reports of MS symptom aggravation (pseudo-relapse) following vaccination, vaccines are generally safe in MS patients with a low probability of acute relapse 1

4. Malaria prevention: Since malaria prophylaxis is critical for travel to many African regions, MS patients should not neglect this non-vaccine preventive measure 2, 3

5. Timing of travel consultation: Schedule vaccination appointments 4-6 weeks before travel to ensure adequate time for vaccine administration and immune response 2

By following these guidelines and consulting with both neurological and travel medicine specialists, MS patients can safely prepare for travel to Africa while minimizing health risks.