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Department of Neurology
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Which Vaccines Are Safe If You Have MS?

Due to prior concerns that certain vaccines could induce a multiple sclerosis relapse, many people have naturally adopted a wary attitude when it comes to getting immunizations.

The truth is that scientific studies either show no link between being immunized with a vaccine and having an increased risk of an MS exacerbation, or there are simply no studies that have been done to prove such a link. So any "concern" is purely speculative without any scientific support.

In fact, vaccines are critically important in preventing infections, some of which can be life-threatening for those with MS. This is because a person with MS may have a weakened immune systems from taking steroids and/or certain disease-modifying medications. Of course, getting an infection can also trigger an MS relapse—a double whammy on your body.

While your doctor should know which vaccines you can and cannot have, it is always best to have the knowledge yourself, as there are still some misconceptions (even within the medical community).

Simply stated, understanding the truth behind vaccine safety can be life-saving for you or your loved one.

Vaccines That Are Safe for People With MS
Injectable Flu Vaccine

The Centers for Disease Control and Prevention (CDC) recommends an annual flu vaccine for every person six months and older. Getting the annual flu shot is especially important for people with multiple sclerosis taking immunosuppressants (like chronic steroids or certain disease-modifying therapies like Novantrone).

While it's best to get your flu shot in October, later is better than never.

The reason that any person with MS (regardless of what disease-modifying medication they are taking) can get the injectable flu shot is because it contains no live virus. The only exception is that people on Lemtrada (alemtuzumab) should ensure they receive the flu shot six weeks prior to their Lemtrada infusion.

This will optimize the ability of their immune system to properly form antibodies against the flu virus.

The FluMist flu vaccine and Fluzone high dose flu vaccine are not recommended for people with MS. The FluMist contains a live attenuated virus (meaning the virus is altered so it's weakened, but it is still live). So this is not advised for people with weakened immune systems, as it may make them sick.

It's interesting to note that the CDC is currently not recommending FluMist for any person (regardless of their immune system strength) due to concerns about its effectiveness.

The Fluzone is an inactivated (so contains no living virus) vaccine but is generally recommended for those ages 65 and older, as it contains four times as much antigen. This is supposed to create a stronger immune response in people receiving it, since the immune system naturally weakens with age.

That being said, the National MS Society does not recommend Fluzone for people with MS, as there is currently no research examining its effect in people with MS.

Pneumovax 23 and Prevnar 13 Pneumococcal Vaccines

The pneumococcal vaccines (there are two) protect against types of bacteria that may cause pneumonia, which is a serious lung infection. Both of these vaccines are inactivated and considered safe for people with MS. While the CDC recommends both vaccines in adults ages 65 years or older (whether or not they have MS), the American Academy of Neurology also recommends the vaccines for those with MS who have lung problems, and/or those who use a wheelchair all the time or are bed-bound.

Tdap (Tetanus, diphtheria, pertussis)

Tetanus is an infection caused by the bacteria Clostridium tetani, and it can cause painful muscle tightening, jaw cramping, seizures, and problems swallowing. The tetanus vaccination is recommended for everyone and contains no live virus. In adults, the vaccine is either given in combination with diphtheria (Td) or in combination with diphtheria and pertussis (Tdap). The pertussis vaccine protects against the bacteria infection called whooping cough.

The CDC recommends that all adults nineteen years or older receive a dose of Tdap if they never received one, regardless of when the last Td dose was. A Td dose is recommended every ten years.

Hepatitis B Vaccine

Hepatitis B vaccine is an inactivated (killed) vaccine that is given as three to four shots over a six-month time frame. Babies are now given their first dose of hepatitis B at birth, and it is recommended that all children and adolescents who have not received the vaccine, get vaccinated.

For adults who have not been vaccinated, the CDC recommends vaccination in specific populations of people like

  • People who travel to areas where there are increased rates of hepatitis B
  • People who work in healthcare facilities
  • People who have a partner with hepatitis B
  • People with chronic liver disease, kidney disease, HIV, or diabetes

There are a number of other populations of people who are at risk, but anyone who desires a hepatitis B vaccination can and should receive it—including those with MS.

Vaccines That Are Probably Safe for People With MS
There are a number of vaccines that are considered probably safe in people with MS. In these cases, if you or a loved one have MS, it's best to first have a conversation with your doctor about the safety of the vaccine before receiving it.

  • Varicella vaccine
  • Measles-Mumps-Rubella vaccine
  • Rabies
  • Zoster vaccine
  • Human Papillomavirus Vaccine (HPV)
  • Polio

Varicella is the virus that causes chickenpox. You may be surprised to learn that the varicella vaccine ( a live attenuated virus) is actually required for people who are going to take Gilyena (fingolimod) or Lemtrada (alemtuzumab) unless a person has already been exposed to chicken pox. Doctors can check whether a person has been exposed (like in childhood) by drawing a blood sample of the varicella antibody. If there is no immunity, the varicella vaccine is administered six weeks prior to starting the medication.

The measles-mumps-rubella vaccine is a live attenuated vaccine, so it's reasonable to initially be wary about it. That being said, according to the National MS Society, this vaccine is probably safe for people who are not taking a medication that suppresses their immune system (like chronic corticosteroids or certain disease-modifying therapies). Again, it is best to follow the advice of your neurologist, as a live virus can cause disease.

The rabies vaccine protects against the virus rabies, which is a virus that can be transmitted if a person is bitten by an infected animal (bats are the most common source). The rabies vaccine is an inactivated or killed vaccine so getting it cannot give you rabies.

This vaccine is only given to people who are at a high risk of getting the disease like veterinarians or people traveling to countries where rabies is common. It can also be given if a person is already exposed to a potential rabies source.

Since rabies is almost always fatal, the risk of any harm from the vaccine likely outweighs the benefit.

The zoster vaccine (which helps prevent both shingles and a painful shingles complication called postherpetic neuralgia) is a live vaccine, so doctors are often cautious in giving it. That being said, it is considered probably safe for any adult who has had chickenpox, as the body has already developed some immunity to it. The CDC recommends the zoster vaccine in adults 60 years of age or older.

The HPV vaccine is recommended for children ages 11 or 12 years old. It can be given up through age 26 in women and age 21 in men or age 26 if a man has sex with other men or has HIV/AIDS. The HPV vaccine protects against genital warts, cervical cancer, and other forms of cancer like vaginal, penile, anal, and mouth/throat.

Polio is a virus that affects the nervous system. Most people do not need the polio vaccine because they were vaccinated as children. International travelers may need a booster dose if traveling to areas where polio is still present.

Yellow Fever Vaccine May Not be Safe for People with MS
One small study of seven people with relapsing-remitting multiple sclerosis found an increased risk of relapse in the six-week period following vaccination with yellow fever, an infection transmitted by mosquitoes in certain parts of South American and Africa. 

For this reason, the National MS Society recommends weighing the risk of being exposed to yellow fever while traveling with the person's risk of having an MS flare. This is a tricky and individualized decision that needs to be carefully discussed with a person's neurologist.

A Word From Verywell
More vaccine research on people with MS would be helpful, especially larger studies that examine the true benefit of certain vaccines in people with MS versus those who are healthy (like whether a person with MS can build as robust of an immune response to a vaccine as a healthy person).

Of course, this is complicated because it depends on a number of factors like the disease-modifying therapy the person is taking or the timing of when the vaccine is administered.

Story Source: The above story is based on materials provided by VERYWELL
Note: Materials may be edited for content and length

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