When you have multiple sclerosis (MS), you know how important it is to avoid triggers that could cause a flare-up. Stress, smoking, and fatigue are well-known culprits. Coming down with a cold or the flu can worsen your symptoms, as can certain medicines. Also on that short list are some vaccines.
But you shouldn’t avoid getting all shots. You need vaccines to protect you from severe and sometimes fatal diseases. Getting a disease or a sickness that could have been prevented with the vaccine is more likely to cause a flare than getting the vaccine itself. Your doctor can help you decide which ones are best for you to have and the safest time for you to get them.
What Are the Risks?
With MS, your immune system mistakenly attacks your central nervous system. The medicines you take can help manage the amount of inflammation in your body and stave off attacks that worsen your symptoms. It’s a careful balancing act that some vaccines can upset.
Years ago, people worried that some vaccines, like those that prevent hepatitis B, caused MS. Many studies showed that this wasn’t true. Yet some shots may trigger an infection that causes you to relapse. If you get a live vaccine (which contains tiny, weakened amounts of a live virus), this is more likely to happen.
Some MS drugs, such as mitoxantrone, also change how your immune system works. If you’re exposed to a live virus while you’re taking them, you may actually get the disease that the vaccine works to prevent. Other treatments, like steroids, may curb how well the vaccine works.
Vaccine guidelines for two newer drugs given for MS are:
- alemtuzumab (Lemtrada) -- You should not receive a live or weakened vaccine after a course of this medication.
- ocrelizumab (Ocrevus)-- Any required live or weakened vaccine should be given at least 4 weeks prior to starting treatment.
- ublituximab-xiiy (Briumvi) – Live vaccines should be given 4 weeks before treatment is initiated but are not recommended while taking Briumvi. Non-live can be taken 2 weels prior.
Vaccines to Avoid
If you have MS, your doctor may advise you against getting live-virus vaccines such as:
- Influenza nasal spray (flu vaccine that’s sprayed into your nose).
- The oral vaccine for polio
- Yellow fever
These two other vaccines might be options, depending on your situation:
Fluzone High Dose: This flu vaccine contains a virus that’s been killed with heat or chemicals, so it only gives you “dead cells,” not live ones. But researchers haven’t studied its effects on people with MS.
Vaccines You Can Take
Shots that experts consider safe for people with MS to get include:
- Seasonal influenza/flu (if it’s given to you as a shot in a standard dose and contains the dead virus)
- Hepatitis B
- Varicella (chickenpox)
- Pneumococcal vaccines
- Human papillomavirus virus (HPV)
- Measles-mumps-rubella (MMR)
- Polio vaccines made with a “killed” polio virus
- Bacille Calmette-Guerin (BCG) vaccine, which is not widely used in the U.S. except in certain people who may be at risk for tuberculosis
Smallpox: While its effects on people with MS aren’t clear, the risk of getting this deadly disease far outweighs the risk of MS relapse. If there’s a chance you could be exposed to smallpox, you’ll need to have this shot.
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 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 can’t 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 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.