Multiple Sclerosis, the Flu Vaccine and the Newer DMTs

By |2018-10-29T16:47:40+00:00November 1st, 2018|
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The latest on flu vaccination and MS treatments.

Last year’s flu season was so terrible that it was the first labeled as “high severity across all age groups” by the Centers for Disease Control and Prevention. Hospitalizations were also sky-high, and it’s estimated 80,000 people died from the flu or flu-related illnesses, surpassing a decades-old previous record of 56,000.

For people with multiple sclerosis, catching the flu carries an extra risk of setting off an exacerbation. “Any of these infections can provoke an MS relapse, and as you get older, your ability to fight some of these infections becomes diminished,” says Kathy Costello, associate vice president of healthcare access for the National MS Society. Both the NMSS and United Spinal Association are members of the MS Coalition.  “Your immune system doesn’t respond as [robustly] as when you’re younger.”

But given that our immune systems are compromised because of MS, we have a few extra considerations when lining up at the grocery store for our vaccine.

Choose the Deactivated Dose

First, the long-standing advice that people with MS should avoid a live, or attenuated, dose still stands. “Since most of the shots are inactivated, or dead, this isn’t hard to do,” says Costello, who also sees people with MS as a nurse practitioner at John Hopkins. While the risk of a relapse from a live dose is very small, “the inactivated flu vaccine has not been identified as a cause of MS or relapse.” She names known risk factors such as genetic predisposition, exposure to Epstein-Barr, being around smoking, low vitamin D — but vaccines do not make the list.

If you have any concerns about either type of vaccine, bring it to the attention of your health care provider. The bottom line is the risk with the inactivated vaccine is very low, and the risk of a flu-triggered relapse is higher. The live vaccine is not recommended because there is a slight risk that it could provoke the immune system, causing an exacerbation.

Vaccines May Interact with Certain MS Drugs

Although inactivated flu vaccines are considered safe for people with MS, if you’re taking one of the newer disease-modifying therapies, you’ll want to double-check with your neurologist. “All of our knowledge has to be looked at in light of what DMT someone is taking because of the powerful affect some of these have on MS,” says Costello. “Some vaccines may actually be dangerous.” Vaccines should be taken six weeks before starting Lemtrada, as well as Ocrevus.

She says the advice has changed because of the power of these newer treatments, some of which suppress the immune system and are also used to fight forms of cancer. “With interferons, the timing didn’t matter, but now that we have treatments that have bigger effects on the immune system, it’s very important to pause and ask.”

This all sounds daunting — should people with MS get the flu vaccine or not? Well, yes, you should get it. Unless you’re on or starting a new treatment, in which case you ought to speak with your neurologist about it.

“These are important rules to follow,” says Costello. “You don’t need to remember the rules, but if you’re on a DMT, or going on a DMT, you need to have a conversation with your prescribing neuro.”

All of this information and more is available on the National MS Society’s website at nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Vaccinations.