Vaccine Safety When You Have MS
Which Ones Are Safe and Which Ones Are Not
By Colleen Doherty, MD
Updated June 25, 2019
Medically reviewed by Andy Miller, MD
While there is no evidence that infections can cause you to develop MS, you are more prone to having an MS exacerbation if you become sick with an infection. This makes vaccinations, which prevent infections, especially important. If you have multiple sclerosis (MS), most vaccines are safe for you. However, a few might not be.
When planning your vaccinations, it is best to first have a conversation with your doctor about the safety of the vaccine before receiving it.
MS Treatment and Your Immune System
Vaccines are given to trigger your body's immune response, resulting in immunity. Once you have vaccine-induced immunity, then you shouldn't become sick with an infection if you are exposed to the contagious organism in the future. The treatment of MS, however, complicates this process, as some MS medications can interfere with your immune system.
Immunosuppressive medications are, in fact, designed to do just that. They are used in MS because they reduce your immune function, which modifies the complex process of inflammation and demyelination in MS. While that effect is beneficial, decreased immune function makes it harder for your body to build the intended immunity from some vaccines, essentially making the vaccines less useful. Even worse, immunosuppressive MS medications can make you more susceptible to developing an infection from the vaccine itself.
Some MS therapies, including steroids and disease-modifying therapies like Lemtrada (alemtuzumab), Tysabri (natalizumab), and Gilenya (fingolimod), are associated with diminished effectiveness of vaccines and a risk of infection as well. If you can plan ahead of time to get your vaccines before you start these medications, you are more likely to mount a strong immune response and to stay safe.
That said, many disease-modifying medications for MS don't affect the immune system. For example, Copaxone, Rebif, Avonex, and Betaseron don't prevent you from building immunity, and they don't make you more likely to become sick from any vaccines.
Safe Vaccines if You Have MS
Vaccines that contain inactivated infectious organisms (viruses or bacteria) or antigens (real or artificial protein portions of infectious organisms) trigger an immune response, and you cannot become infected from them.
The biggest problem with these is that some of them may not be effective if you take medication that weakens your immune system.
Injectable Flu Vaccine
Injectable flu shots do not contain live virus. The Centers for Disease Control and Prevention (CDC) recommends an annual flu vaccine for every person six months and older. Getting the annual flu shot is especially important if you take immunosuppressants, like chronic steroids. While it's best to get your flu shot in early during flu season (which is generally October through as late as May), later is better than never.
Studies show that flu vaccines produce a good immune response in people with MS, especially if taking interferons or Aubagio (glitramer acetate).
If you take Lemtrada, be sure to get your flu shot six weeks prior to your infusion. This will optimize your body's ability to form antibodies against the flu virus.
Pneumovax 23 and Prevnar 13 Pneumococcal Vaccines
Both pneumococcal vaccines protect against Streptococcus pneumoniae, a common bacteria that may cause pneumonia, a serious and sometimes lethal lung infection. These vaccines are inactivated and are considered safe if you have MS.
The American Academy of Neurology recommends the vaccines for people with MS who have lung problems, and/or use a wheelchair all the time or are bed-bound.
Patients on biologic agents need to discuss with their doctor whether to get the vaccines when younger than 65 years old. All patients older than 65 years of age (with or without MS) need these vaccines.
Which Pneumonia Vaccine Do I Need?
Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine
You probably received a Tdap vaccine as a child. This is a combination vaccine that doesn't contain any live organisms and that stimulates immunity to:
Tetanus: An infection caused by the bacteria Clostridium tetani, and it causes life-threatening muscle tightening, jaw cramping, seizures, and problems swallowing
Diptheria: A potentially life-threatening bacterial infection that typically affects the respiratory tract
Pertussis: Another bacterial infection that is most well-known as whooping cough
The CDC recommends a tetanus booster every 10 years, and you may also receive one if you have a serious injury producing an open wound.
Others who need Tdap include pregnant women and new grandparents.
Essential Facts About the Tdap Vaccine
Hepatitis B Vaccine
Hepatitis B vaccine is an inactivated vaccine containing a killed virus that is given as three to four shots over a six-month time frame. Most people have been vaccinated during infancy. It is recommended that all children and adolescents who have not received the vaccine get vaccinated.
For adults who have not been vaccinated, the CDC recommends vaccination in specific populations:
People who travel to areas where there are increased rates of hepatitis B
People who work in healthcare facilities
People who have a partner with hepatitis B
People with chronic liver disease, kidney disease, HIV, or diabetes
And anyone who wants a hepatitis B vaccination can receive it, including those with MS.
What to Know About the Hepatitis B Vaccine
The rabies vaccine protects against rabies, a virus that is transmitted through a bite from an infected animal (bats are the most common source). Rabies infection is almost always fatal. The rabies vaccine is an inactivated or killed vaccine, so it cannot give you rabies.
You would only need this vaccine if you are at high risk of getting the disease. Veterinarians or people who work closely with animals may need the vaccine, for example. You can also get the vaccine if you have already exposed to a potential rabies source.
Rabies Causes and Risk Factors
Vaccines That Are Probably Safe if You Have MS
There are a number of vaccines that are considered probably safe in people with MS. The primary concern is that many of these are live attenuated (weakened) viruses or bacteria, which means that there is a small chance they could cause an infection if you are taking powerful immunosuppressants.
As with the safe vaccines, your body might not be able to mount the intended immunity if you are taking immunosuppressants.
Varicella is the virus that causes chickenpox. Varicella vaccine is a live attenuated virus, so there is a small chance that the virus can result in an infection.
If you have not had a chickenpox infection or been vaccinated for chicken pox, this vaccine is required six weeks prior to starting Gilyena or Lemtrada.
And don't worry if you can't remember whether you have had chicken pox. Your doctor can check whether you have immunity by drawing a blood sample.
Chicken Pox Vaccine Recommendations
Measles, Mumps, Rubella Vaccine
The measles-mumps-rubella (MMR) vaccine is a live attenuated vaccine. According to the National MS Society, this vaccine is probably safe if you are not taking a medication that suppresses your immune system.
Your risk of contracting these illnesses from the community should be weighed against your chances of becoming infected from the vaccine. If you have already been vaccinated as a child, this should not be an issue, because you will not need a booster or another vaccination as an adult.
Make sure to state to discuss MMR with your doctor, since the medicine may be too immunosuppressive for safe MMR administration.
All About the MMR Vaccine
The new vaccine (Shingrix), which is not a live virus vaccine, is more effective and probably safe in MS patients, although data on patients with immunocompromised systems isn't available yet.
Human Papillomavirus (HPV) Vaccine
The HPV vaccine is recommended for children ages 11 or 12 years old. It can be given up through age 26 in women and age 21 in men, or age 26 if a man has sex with other men or has HIV/AIDS. The HPV vaccine protects against genital warts, cervical cancer, and other forms of cancer like vaginal, penile, anal, and mouth/throat.
Gardasil vs. Cervarix for HPV Vaccination
Polio is a virus that affects the nervous system. Most people do not need the polio vaccine because they were vaccinated as children. International travelers may need a booster dose if traveling to areas where polio is still present.
A large review of the literature showed that there is no increased risk of MS relapse after vaccination with hepatitis B virus, HPV, seasonal influenza, MMR, varicella, tetanus, Bacillus Calmette-Guérin (BCG), polio, or diphtheria.
Vaccines That May Not be Safe if You Have MS
Several vaccines are not considered safe if you have MS. A few flu vaccine alternatives have been reconsidered due to safety and efficacy concerns, and yellow fever has been associated with MS flares.
FluMist and Fluzone
The FluMist flu vaccine and Fluzone high-dose flu vaccine are not recommended for people with MS.
FluMist contains a live attenuated virus, so it is not advised if you have a weakened immune system for any reason.
The Fluzone is an inactivated vaccine, and it is generally recommended for those ages 65 and older, as it contains four times as much antigen as other flu vaccines. This is supposed to create a stronger immune response since the immune system naturally weakens with age.
That being said, the National MS Society does not recommend Fluzone for people with MS, as there is currently no research examining its effect on people with MS.
In addition, efficacy of FluZone may be lower in people taking biologic agents or with increased age or immunodeficiency.
Those with any of these conditions may benefit from consulting with their doctors on the different types of flu shots, including those with higher doses or re-vaccinations—although scientific data is no complete for all patient groups. Experts currently aren't sure of the best approach for people in these groups.
One small study of seven people with relapsing-remitting multiple sclerosis found an increased risk of relapse in the six-week period following vaccination with yellow fever, an infection transmitted by mosquitoes in certain parts of South America and Africa.
For this reason, the National MS Society recommends weighing the risk of being exposed to yellow fever with the risk of having an MS flare. This is a tricky and individualized decision that needs to be carefully discussed with your neurologist.
A Word From Verywell
Maintaining updated vaccinations is an important part of staying healthy if you have MS. Figuring out which vaccines are expected to be safe and effective for you is an added nuance to managing your MS that you need to discuss with your doctor. You can use our Doctor Discussion Guide below to help you start that conversation.