Protecting yourself from illness is important, especially when you live with multiple sclerosis.
Being ill when you have MS can mess with your body. When you have an infection, fever, or become overheated, it can cause a temporary pseudo-exacerbation. Until your body temperature returns to normal or the infection is resolved, MS symptoms can wreak havoc with your ability to function, much in the same way a relapse would.
One way to protect yourself from getting sick this winter is to get the annual flu vaccine. It contains inactivated (killed) influenza viruses that are specifically chosen each season to protect against three or four of the most highly anticipated flu viruses. Once you get a flu shot, it takes about two weeks for the body to develop antibodies to be able to fight the viruses.The flu vaccine can also come in a nasal spray form, the flu mist, which contains live attenuated viruses. People with MS, people who are immunosuppressed, children with asthma, and pregnant women are some of those who should NOT receive the nasal vaccine. Further, for the 2016-2017 season, the Center for Disease Prevention and Control (CDC) recommends that no one use the flu mist due to concerns with its effectiveness.
Another type of flu vaccine is available this year that does not use the influenza virus or chicken eggs during manufacturing. Instead, the vaccine production technology uses recombinant DNA. The recombinant flu vaccine has a slightly shorter shelf life, so check expiration dates carefully before using it.
Getting a head start on this year’s flu season, vaccines have been available at many pharmacies since early August. I received my own shot in September.
Is the flu vaccine safe for MS patients?
A report from 1990 suggested that the risk of developing MS was increased following influenza vaccination. However, the study had serious methodological limitations and was flawed (Baghbanian 2016). More recent studies have debunked this theory and indicate that there is NOT an increased risk of MS or MS relapse associated with the flu shot.
The risks of the flu are greater and carry more consequences than the risk of the flu vaccine in people with MS. Studies have shown increased risk of influenza-related hospitalizations, mortality, morbidity, and MS relapse in patients with relapsing-remitting MS. In a way, the flu vaccine has a protective effect on MS patients by reducing the risk of relapse due to flu and does not seem to exacerbate or worsen neurological status.
Do MS medications or treatments affect the flu vaccine?
Several research studies have looked at whether patients with MS receive the full benefit of the flu vaccine if they use certain MS-related medications. Research has shown that some treatments lower the effectiveness of the flu vaccine, while others have no or little effect. One reason I received my shot early this year is because I wanted to get the vaccine a few weeks before I went in for Rituxan infusions, so that I might develop some immunity before treatment reduces my body’s ability to do so.
Patients using Avonex (interferon beta-1a), Aubagio (teriflunomide), or steroids should not worry. Research shows that corticosteroids, teriflunomide, and interferon-beta (INF-β) therapies do not impair the immune response following influenza vaccination. Patients using these treatments benefit from the flu shot as much as healthy persons do who are not on disease-modifying medication.
The vaccine appears to be safe and protective in patients using Tysabri (natalizumab). There is no data available regarding Tecfidera (dimethyl fumarate) and the influenza vaccination. The vaccine is shown to be safe and effective in patients using Gilenya (fingolimod), but a booster dose may be needed for maximum benefit.
Treatments that lower the immune response to the flu vaccine include Copaxone and Glatopa (glatiramer acetate), Novantrone (mitoxantrone), IVIG (intravenous immunoglobulin), and Rituxan (rituximab). In patients using pulse corticosteroid therapy, it is recommended that the flu vaccine be delayed at least two weeks following treatment. In patients using immunosuppressive therapy, antibody testing is recommended four weeks following the vaccination. If the antibody titers failed to rise, revaccination should be considered.
It’s very important for MS patients to protect themselves by getting the annual flu vaccine. Your primary care doctor may have vaccines available in the coming weeks, but pharmacies nationwide are ready now and well supplied to meet the demand for vaccinations.
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- Baghbanian SM. Influenza vaccination in patients with multiple sclerosis is possible with some considerations. Iran J Neurol. 2016;15(2):109-110.Jeffery DR. The Use of Vaccinations in Patients with Multiple Sclerosis. Infect Med. 2002;19(2).Frequently Asked Flu Questions 2016-2017 Influenza Season. Centers for Disease Control and Prevention. Accessed September 13, 2016.