Making An Informed Choice About Vaccinations
Youre trying to decide what vaccinations to get, so why cant we just give you a simple answer: take it or dont take it?
We wish we could, but often your decision will mean weighing up different chances and risks. There are still things we dont know about the immune system, MS, DMTs and vaccines and how they all interact. And your circumstances wont be exactly like other peoples.
Thats why we can tell you what we know, but not what you should do and why its good to get input from your doctor or MS nurse.
If youve got a question that doesnt seem to be answered here, you can contact our MS Helpline for more help.
How To Protect Yourself
Before you get any shots, youâll need to:
Make sure your health is OK. Are you having an MS flare-up that makes it hard to get through your day? Hold off on any vaccines. Unless your doctor says something different, youâll need to wait 4 to 6 weeks after the day that your relapse first started.
Talk to your doctor about which shots to have and when. If you do need a vaccine that contains a live virus, your doctor will need to take into account the MS medications that you take or that you may need in the future. Follow the recommended vaccination schedule, too, so that the vaccine works as well as it should.
If you canât get a certain vaccine because of your MS, you can still take steps to protect your health. Try to:
Keep away from germs.Wash your hands often.
Be careful about what you eat. Avoid food and water that may not be clean or safely prepared.
Stay away from people who are sick. In some cases, your doctor may also suggest that you keep your distance from others whoâve just had a live-virus vaccine.
Plan ahead. If you plan to travel outside the U.S. to a country where thereâs not a good health care system, make a list of contacts you may need if you get sick. This can include local doctors, hospitals, or an embassy.
Stick to good habits. Get enough rest. Manage your stress. Drink plenty of water, and aim to have fruits and vegetables every day. All these things will help your body defend against sickness.
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Q: Do Any Of The Dmts We Use Have An Effect On The Safety Or Efficacy Of Vaccination
A: Corticosteroids, particularly long term daily use, might have an impact on the efficacy or response to vaccination. However, organ transplantation patients on long term steroids do not show an impairedimmune response to influenza or pneumococcal vaccinations . The response has not been evaluated in MS patients, but generally corticosteroids are not used in an ongoing fashion other than as intermittent pulse therapy in MS. When patients with MS are treated with a course of steroids, at the Mellen Center we recommend deferring immunization until 6 weeks after steroids are completed.
Interferons do not seem to interfere with immune responses in MS patients and may have an antiviral effect. In a prospective study of 88 MS patients treated with interferon beta-1a and 77 untreated patients with MS, similar proportions developed protective immune responses after receiving seasonal influenza vaccination . There is no evidence that glatiramer acetate affects the safety or efficacy of vaccination .
There is no evidence of an effect of natalizumab on the safety or efficacy of vaccination.
See below for specific discussions of fingolimod and alemtuzumab. Other than specific recommendations for certain DMTs, there is no overall increase in safety risk for MS patients from vaccinations.
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How Ms Treatment May Impact Live And Live
Live and live-attenuated vaccines, including the live-attenuated flu vaccine, arent recommended for people with MS who take certain types disease-modifying therapies , because the vaccines effectiveness may be reduced by these drugs, according to the National MS Society.
However, this isnt a reason to avoid vaccination altogether, Bar-Or says, if live and live-attenuated vaccines are your only option, as some protection is better than no protection.
In some cases, however, DMTs may weaken the immune system, meaning those people injected with live or live-attenuated vaccines may be at risk for getting sick from the viruses the vaccines are designed to prevent, the society adds.
The Best Flu Vaccines For People With Ms
According to Bar-Or, all recombinant flu vaccines those made synthetically, without use of the flu virus are safe for people with MS, even those on DMTs.
Similarly, inactivated vaccines are generally considered safe for people with MS, including those taking a disease-modifying therapy, according to the Cleveland Clinic.
Other commonly used drugs in the treatment of MS including the muscle relaxant baclofen, the stimulant modafinil , and low-dose naltrexone dont affect the flu vaccine, or its safety, in any way, according to the National MS Society.
Still, you should talk to your doctor about which flu vaccine is best for you, given the medications you take for your MS or for any other medical condition you may have.
In addition, although its fine to get the vaccine at a doctors office, pharmacy, or clinic just like anyone else you should mention to whoever is administering the vaccine that you have MS to make sure you get the correct product, Bar-Or advises.
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Baseline Demographics And Pre
We enrolled 20 pwMS treated with DMF and 15 age-matched controls. The mean age of the MS cohort was 37.6 years , with a median EDSS at BL of 1.0 . Patients had received DMF on average for 19.2 months . The demographics and vaccine distribution of the two cohorts and the EDSS score of the MS cohort are displayed in Table 1. The time from vaccination to the follow-up visit was longer for HCs .
At BL, seroprotection was more frequent among HCs in three of the four influenza strains . Across all strains, the proportions of patients vs. controls who met the criteria for seroprotection was 41% vs. 53% , respectively. The cut-off was evident in patients vs. controls in 55% and 66% for Apdm09, in 20% and 47% for A, in 80% and 60% for B/Vic, and in 10% and 40% for B/Yam.
Vaccine efficacy to influenza immunization in multiple sclerosis patients on dimethyl fumarate and healthy controls. Pre- and post-vaccine seroprotection rates, defined by a strain-specific anti-influenza titer of 1:40. Vaccine responder rates among the two cohorts. Vaccine response was defined by seroconversion and/or significant specific titer increases in 2/4 influenza strains. Increases in strain-specific antibody titers among the two cohorts at 34.1 days post-vaccination compared with baseline. Dotted lines indicate the cut-off titer for seroprotection.
At BL, average A titers were higher in the control group , while no significant differences were found among the other strains.
Should I Get Immunizations
Our physicians currently recommend that when possible people with MS should not receive live attenuated vaccines. Infection is known to be a trigger for both MS exacerbations as well as worsening of MS symptoms without new lesions . When possible we prefer people not receive the zoster vaccine, influenza nasal vaccine, yellow fever vaccine, typhoid vaccine, rotavirus, or oral polio vaccine. The MMR vaccine is a live attenuated vaccine however several studies have not detected increased relapse risk following its administration. However, MMR vaccine and the other above live/attenuated vaccines should be avoided in patients who are receiving immunosuppressive therapy as they may trigger harmful infection or chronic carrying of the weakened organism. The risk of infection and complications of infection must be balanced with other risks and should be discussed individually with your personal physicians, should live vaccine use be considered appropriate.
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Had A Shot And Still Had The Flu
Ive read about that a lot, online, as a reason people give for not getting a flu shot. Some think the vaccine actually gave them the flu. The CDC says you wont catch the flu from a shot, but you might catch the flu even if youve been vaccinated.
Its possible you may have been hit with the flu bug during the two weeks that it takes the flu vaccine to become fully effective. There have also been some years where the vaccine hasnt been a good match for the strain of flu that was prevalent in those years.
Q: Should Any Vaccines Be Used Before Starting Dmts And If So Under What Circumstances
A: Fingolimod , a sphingosine 1-phosphate receptor modulator approved for relapsing MS, may increase the risk of dissemination and potentially life threatening varicella zoster . At theMellen Center we check for VZV antibodies before initiating fingolimod therapy. If immunity is not demonstrated by elevated VZV titers, we initiate chicken pox vaccination prior to initiating fingolimod. Optimally checking for the development of VZV antibodies prior to beginning medication would be prudent. Having elevated VZV titers does not guarantee against developing zoster infections . At the Mellen Center we recommend waiting 1 month after last VZV immunization to initiate fingolimod.
Alemtuzumab is a humanized monoclonal antibody directed against CD52. CD52 is a cell surface antigen present on T and B cells. Alemtuzumab depletes circulating T and B cells for variable amounts of time over months T and B cell lines repopulate, with B cells usually repopulating over 6 months and T cells over 12 months. Because of this profound immunological effect, LIVE Attenuated Vaccines should not be used after initiation of alemtuzumab due to an increased risk of infection. Live attenuated vaccines include: Live Attenuated Flu Vaccine , MMR, chickenpox, and Zostavax . Vaccines which are not live include: tetanus toxoid boosters and injectable influenza vaccine.
One study showed retained immune competence related to prior vaccination after treatment with alemtuzumab .
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What Is Multiple Sclerosis
When a person suffers from multiple sclerosis, their immune system attacks the myelin that protects nerve fibers causing problems for the brain communicating with the rest of the body. The exact cause of MS is unknown though certain types of viral infections or environmental conditions are thought to be potential triggers for MS. Multiple sclerosis is usually diagnosed between the ages of 20 and 40, and affects women more often than men.
Q What About Specific Vaccinations For Travel
A: The CDC does not have specific recommendations for travel vaccination for the MS patient. Care should be taken with patients on strong immunosuppressing regimens similar to that for bone marrowtransplant patients. Most patients with MS will not conform to this designation. Reviewing the data for travel immunization in immunocompromised individuals may be helpful in those patients on alemtuzumab, cyclophosphamide, rituximab, daclizumab or other major immunosuppressing medication regimens. At the Mellen Center we advise our patients travelling to at risk countries to seek infectious disease counselling before travelling.
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Tetravalent Influenza Vaccine Is Not Associated With Neuroaxonal Damage In Multiple Sclerosis Patients
- 1Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
- 2Department of Laboratory Medicine, Paracelsus Medical Center, Salzburg, Austria
- 3Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- 4Center for Virology, Medical University of Vienna, Vienna, Austria
- 5Department of Neurology, Medical University of Graz, Graz, Austria
- 6Hermesoft, Statistics, Graz, Austria
- 7Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
Background: Efficacy of vaccines and disease activity linked to immunization are major concerns among people with multiple sclerosis .
Objective: To assess antibody responses to seasonal influenza antigens and vaccine-associated neuroaxonal damage utilizing serum neurofilament light chain in pwMS receiving dimethyl fumarate .
Methods: In this prospective study, the 2020/2021 seasonal tetravalent influenza vaccine was administered to 20 pwMS treated with DMF and 15 healthy controls . The primary endpoints were responder rate of strain-specific antibody production increase in influenza-antibody titers for 2/4 strains) at 30 days post-vaccination and changes in sNfL levels.
Chicago Lawyer Helping Patients Nationwide Recover Compensation For Ms Injuries Due To Vaccinations
Vaccines are a foundational element of modern healthcare, and they provide people with immunity from many diseases that used to be life-threatening. However, even though most people receive multiple types of vaccines, and these vaccines are usually safe, they have been known to cause injuries or lead to medical problems that can significantly affect a person and their family. One concern related to vaccine injuries is whether certain vaccines may cause or exacerbate multiple sclerosis .
At the Kraus Law Group, LLC, our attorneys provide representation for those who have suffered vaccine-related injuries, helping them recover compensation through the Vaccine Injury Compensation Program . While we are located in Chicago, Illinois, we work with clients throughout the United States. If you suffer from MS, we can help you understand the role that vaccines may have played in your condition, and we will work with you to determine your options for receiving the compensation you deserve.
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National Ms Society Recommendations On Ms And Vaccination
General recommendations
The Academy of Neurology, in collaboration with the Immunization Panel of the Multiple Sclerosis Council for Clinical Practice Guidelines, published a summary of evidence and recommendations regarding immunizations and MS. They concluded that:
- The evidence supports strategies to minimize the risk of acquiring infectious diseases that may trigger MS relapses .
- The influenza, hepatitis B, varicella and tetanus vaccines are safe for people with MS.
Special considerations
Specific recommendations for people with MS
1. Influenza vaccine2015-2016 Injectable Seasonal Flu Vaccine
The 2015-16 inactivated seasonal influenza immunization is manufactured by several different companies under different brand names. Each is a single injection that provides immunity to three or four different flu viruses. Trivalent vaccines protect against three types of flu: the A/California/7/2009 pdm09-like virus the A/Switzerland/971/2013 -like virus the B/Phuket/3073/2013-like virus . Quadrivalent vaccines protect against the same three viruses plus an additional B virus .
FluMist is a live-virus flu vaccine that is delivered via a nasal spray. This live-virus vaccine is not recommended for people with MS.
2. Hepatitis B vaccine
3. Human papillomavirus vaccine
4. Shingles vaccine
5. Smallpox vaccine
6. Varicella vaccine
Studies of Vaccine Safety and Effectiveness in People with MS
Some, but not all, immunizations have been evaluated for safety and efficacy in people with MS:
Ms Symptoms And Treatment
Depending on which type of MS afflicts an individual, symptoms can vary significantly. In severe cases, the myelin in the brain or spinal cord may be damaged, and individuals may struggle with basic motor skills. Symptoms of MS may include:
- Numbness and tingling in different parts of the body
- Muscle spasms or weakness
- Inability to control the bladder or bowels
- Vision problems
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Find A Place To Get Your Shot
You can usually get a flu shot from your doctor or at most pharmacies. In most cases, its covered with no copay. If youre in the U.S., you can enter your zip code below to find your nearest flu clinic.
My wife and I will be getting ours before the end of September.
Youre invited to follow my personal blog at www.themswire.com.
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.
Guide To Vaccinations For People With Ms
We commonly get questions about vaccinations or immunizations for people with multiple sclerosis . Vaccinations are very important for health and have been proven to help prevent many different diseases which may in some cases cause severe illness, disability or even death. There is some information about the safety and effectiveness of many vaccines for people with MS, however information about many issues is incomplete. Concerns relate to whether vaccinations can trigger MS exacerbations, whether vaccines are effective when patients are taking certain immune medicines or steroids and whether vaccinations are safe for people with medicines that decrease immune function. In general people who are experiencing any relapse should defer vaccination until 4-6 weeks after the onset of the relapse.
It is important to recognize that vaccinations are created by different mechanisms and many types of vaccinations are made using killed organisms or using only portions of organisms and cannot cause actual infection. These are considered to be inactivated or component vaccines. Vaccinations may also be against a toxin that an organism creates and do not contain live organisms. A more concerning group of vaccines for people with MS are those that are produced using live but weakened organisms .
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Study Limitations And Strengths
Our findings regarding vaccine hesitancy in a cohort of MS patients need to be considered exploratory due to many reasons. First of all, the small sample size limited our power to draw firm conclusions on the evaluated objective. Second, more than 70 patients were excluded from our study because of missing information on vaccination status. This could have introduced biases in the evaluation of the results.
Notwithstanding these limitations, to our knowledge, this is the first study carried out in Italy to evaluate vaccination attitudes among MS patients. This is a new area of clinical investigation, considering that until recently vaccinations were not recommended for MS patients. In addition, we believe that our results should be analyzed in a broader sense, especially considering the historic pandemic moment we are going through and issues related to COVID-19 vaccinations that could potentially emerge among MS patients.