When you have multiple sclerosis (MS), it's important to avoid illnesses that could trigger a flare-up. Yet MS and some of its treatments make you more vulnerable to infections. That's one reason why it's important to get the vaccines your doctor recommends.
You may have heard that people with MS should avoid some vaccinations. But that's generally true only for certain vaccines, and while you're using certain treatments. Most people with MS should follow the CDC's standard vaccine schedule for adults. Your doctor can help you decide which shots are best for you to have and the safest time for you to get them.
What Are the Risks?
Years ago, people worried that some vaccines, like those that prevent hepatitis B, caused multiple sclerosis. Many studies showed that this wasn’t true.
Yet it's possible for some shots to trigger an infection that causes you to relapse. If you get a live attenuated vaccine (which contains tiny, weakened amounts of a live virus) while taking a medication that suppresses your immune system, this is more likely to happen. That's why live vaccines aren't recommended for people with MS who've recently taken steroids or are taking disease-modifying therapy (DMT) drugs.
Vaccine guidelines for some common drugs given for MS include:
- Alemtuzumab (Lemtrada) -- You shouldn't receive either a live or weakened vaccine soon after a course of this medication.
- Ocrelizumab (Ocrevus)-- Get any required live or weakened vaccine at least four weeks before starting treatment.
- Fingolimod (Gilenya) -- Avoid live vaccines while you take it and for two months afterward. Your doctor may test you for immunity to the chickenpox virus, and may recommend an HPV vaccine, before you start taking it.
- Ublituximab-xiiy (Briumvi)– Live and weakened vaccines should be given four weeks before you start treatment, but aren't recommended while taking this drug. Non-live vaccines can be taken two weeks prior.
Check With Your Doctor About These Vaccines
Especially if you've recently taken steroids or are currently taking other immune-system modifying medications for MS, your doctor may advise you against getting live-virus vaccines such as:
- Influenza nasal spray (flu vaccine that’s sprayed into your nose)
- Oral typhoid vaccine
- Yellow fever
- Measles, mumps, and rubella (MMR)
- Chickenpox (varicella)
If you need one of these vaccines, your doctor may recommend that you get it a few weeks before you start treatment with an immune-modifying drug. You should also avoid these vaccines for several weeks after having a serious flare-up.
Vaccines You Can Probably Take
Most vaccines are either inactivated or only use parts of a virus or bacteria. Vaccinations that experts generally consider safe for most people with MS include:
- Standard seasonal influenza/flu
- High-dose inactivated flu vaccine (Fluzone), usually given to older people
- Hepatitis A and B
- Tetanus
- Pneumococcal
- Human papillomavirus virus (HPV)
- Inactivated polio vaccine (IPV)
- Rabies
- COVID-19, including boosters
- RSV
- Inactivated shingles vaccine (Shingrix)
The JYNNEOS vaccine, which protects against smallpox and mpox, is also thought to be safe for people with MS even if their immune systems are compromised. But those with MS should avoid the ACAM2000 mpox vaccine.
How to Protect Yourself
Before you get any shots, you’ll 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, you’ll need to wait 4-6 weeks after the day your relapse 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 can’t get a certain vaccine because of your multiple sclerosis or its treatments, 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 who’ve just had a live-virus vaccine.
Plan ahead. If you plan to travel outside the U.S. to a country where there’s 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.
