Vaccination Recommendations for Multiple Sclerosis Patients
Patients with multiple sclerosis should receive all standard vaccinations according to local immunization schedules, with special timing considerations for those on immunosuppressive therapies. 1
General Vaccination Principles for MS Patients
- All MS patients should follow local vaccine standards unless specific contraindications exist, as vaccines help prevent infections that could potentially trigger MS relapses 1
- Annual influenza vaccination is strongly recommended for all MS patients 1
- Pneumococcal vaccination is recommended due to increased risk of invasive pneumococcal disease in immunocompromised individuals 2
- Varicella zoster virus (VZV) vaccination is recommended, particularly for patients who will undergo immunosuppressive therapy, due to high risk of herpes zoster infection 2
- COVID-19 vaccination is recommended for all MS patients following national guidelines 2
Timing of Vaccinations Based on MS Treatment
For Patients Starting Immunosuppressive Therapy
- Ideally, complete all vaccinations at least 4-6 weeks before initiating immunosuppressive therapy 1
- For patients scheduled to start ocrelizumab therapy:
- Complete two-dose vaccine regimens at least 4-6 weeks before starting treatment OR
- Wait at least 4-6 months after the last ocrelizumab infusion before vaccination 2
- For patients on immune-reconstitution therapies (alemtuzumab, cladribine):
- Delay vaccination until at least 6 months after the last course of treatment 2
- For patients on high-dose or long-term corticosteroids:
- Delay vaccination until 4-6 weeks after treatment cessation 2
- For patients receiving anti-CD20 therapy (rituximab, ocrelizumab):
- Vaccination should be delayed for at least 6 months after the last dose 2
For Patients on Ongoing Therapy
- Patients on beta-interferons, glatiramer acetate, teriflunomide, dimethyl fumarate, natalizumab, or sphingosine-1-phosphate receptor modulators can be vaccinated at any time during treatment, though vaccine response may be attenuated 3
- Patients should not receive live-attenuated vaccines while on immunosuppressive therapy 1
- Delay vaccination during active MS relapse 1
Special Considerations for Patients After AHSCT
For MS patients who have undergone autologous hematopoietic stem cell transplantation (AHSCT):
- Consider these patients as "never vaccinated" and offer complete revaccination 2
- Pneumococcal vaccination: Three doses of conjugated anti-pneumococcal vaccine at 1-month intervals starting 3-6 months post-transplant, followed by one dose at 12 months 2
- Influenza vaccination: One annual dose at the beginning of influenza season, starting 3-6 months post-transplant 2
- VZV vaccination: Begin 6 months post-transplant with recombinant VZV vaccine 2
- COVID-19 vaccination: Follow standard schedule according to national guidelines 2
Vaccine Types and Safety
- Inactivated vaccines are generally safe for MS patients, including those on immunosuppressive therapy 2, 4
- Live-attenuated vaccines are contraindicated for patients on immunosuppressive therapies 2, 1
- For patients with active underlying disease, immunosuppressive therapy should be prioritized over vaccination 2
- Disease-modifying therapies (DMTs) may reduce antibody response to vaccines, but vaccination is still recommended 2, 3
Monitoring After Vaccination
- For vaccines with a correlate of protection, monitor serological response 1-2 months after the last dose, especially in patients on immunosuppressive therapy 5
- Vaccination protocols should be harmonized within regional and national MS treatment programs and updated regularly 2
Important Caveats
- There is no evidence that vaccines cause MS or trigger MS relapses 4, 6
- Systemic infections can worsen MS symptoms and potentially trigger relapses, making vaccination particularly important 4
- Vaccine-induced protection may be reduced in patients on certain immunosuppressive therapies, particularly B-cell depleting therapies 3
- Healthcare providers caring for MS patients should be fully immunized, particularly against seasonal influenza 2