Recommended Routine Vaccinations for those with Multiple Sclerosis

The National Multiple Sclerosis Society and our clinic recommend influenza vaccinations, as well as other routine vaccinations in for those with multiple sclerosis.

Please see the National Multiple Sclerosis Society for a complete list of vaccine recommendations.

Does vaccination contribute to the onset of multiple sclerosis?
In a study of 440 people with multiple sclerosis (Arch Neurol. 2003;60:504) the risk of having multiple sclerosis was not influenced by prior immunizations. There was no increase in multiple sclerosis in those receiving vaccinations anytime in the past, within the past 1-5 years, or within the past year. Vaccinations for hepatitis B, influenza, tetanus, measles, and rubella were studied. Vaccinations do not cause multiple sclerosis.

Does vaccination cause attacks in those already diagnosed with multiple sclerosis?
In a large European study (New Engl J Med 2001;344:319) vaccination in the past 1, 2 or 3 months was not associated with an increased risk of multiple sclerosis attacks. This study looked at tetanus, hepatitis B and influenza vaccines. In another study of 104 patients (NEUROLOGY 1997;48:312) multiple sclerosis patients who received influenza vaccination had the same rate of multiple sclerosis attacks in the following 6 weeks as those receiving placebo. There is no evidence that tetanus, hepatitis B or influenza vaccines cause multiple sclerosis attacks.

Are there risks if I don’t get the vaccination?
Those who are not vaccinated have an increased risk of getting the flu. For most people, this is an inconvenience with no major health consequences. In some cases, a viral infection can trigger an multiple sclerosis attack. Those who do not get vaccinated risk having an multiple sclerosis attack from an infection.

Are some multiple sclerosis patients at special risk?
Those with weakness of breathing muscles or swallowing difficulty are at risk of complications from colds, flus and pneumonias because of limited coughing. People over age 50, those living in group settings, or women in the last 6 months of pregnancy are also at increased risk.

Effect of multiple sclerosis treatments on vaccination
Interferons (Avonex, Betaseron, Rebif) and glatiramer (Copaxone) have no adverse effect on vaccination. Natalizumab (Tysabri) has no know effect on vaccination, but many recommend using only inactivated vaccines with this medications. Immunosuppressive medications (mitoxantrone, azathioprine, methotrexate, cyclophosphamide, rituximab, IVIG, long-term steroid use) should be treated with inactivated vaccines rather than live vaccines.

Live versus inactivated vaccines
Some vaccines have live but weakened virus. These have no known harm in multiple sclerosis, but nevertheless many experts recommend avoiding them in the setting of multiple sclerosis. This includes nasal influenza vaccines (injected vaccines are acceptable), MMR (measles, mumps, rubella), oral polio and others. Check with your medical provider.