Neuros Say that Flu Shots and Other Vaccines Are OK for Those with MS

Ed Tobias avatar

by Ed Tobias |

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This is the time of year when my wife and I start thinking about getting our flu shots. We’ve already had the pneumonia and the older shingles vaccine and hope to soon update with the new shingles vaccine, Shingrix (recombinant zoster vaccine).

These vaccines are OK with my neurologist and my primary care doctor. They’re also OK with the American Academy of Neurology. The academy has updated its vaccine guidelines for multiple sclerosis (MS) patients to make it clear that, with very few exceptions, the benefits of vaccines for people with MS far outweigh any risks.

The NEJM Journal Watch’s summary of the guidelines leaves no doubt in my mind that getting these vaccinations is the right thing for me to do.

“Vaccinations remain important for preventing illnesses and hospitalization in patients with MS. Vaccinations are known to have benefits, and no consistent evidence exists that they cause harm in MS patients. As patients are often subject to much disinformation regarding vaccines in MS through the Internet and social media, these guidelines will be a valuable resource for clinicians and patients.”

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Do vaccinations trigger MS flares?

The AAN recommendations say there’s no evidence that getting a vaccination will kick off an exacerbation. In fact, a vaccination may even help prevent a flare by preventing an illness that might spike a fever. Additionally, the guidelines report that some vaccines, including those against the human papilloma virus (HPV) and tetanus (TT), may even reduce the possibility of a person contracting MS. They state that “Vaccinations against HPV, TT, pertussis, and smallpox were associated with a lower likelihood of a subsequent MS diagnosis.”

Flu vaccine recommendations

The revised recommendations specifically looked at the flu vaccine, and their advice was firm: “Clinicians should recommend that patients with MS receive the influenza vaccination annually, unless there is a specific contraindication (e.g., previous severe reaction).” The guidelines also contain some cautions:

  • A flu shot may not work as well as expected for some people who are receiving particular disease-modifying treatments, such as Gilenya (fingolimod), Copaxone (glatiramer acetate) and mitoxantrone.
  • MS patients should delay scheduling a vaccination during a relapse to avoid the potential that the vaccine might trigger complications.
  • Do not use the nasal spray flu vaccine, FluMist, as it contains a “live attenuated” virus, which isn’t recommended for people with MS.

This season’s flu vaccine

Most flu vaccines protect against three or four influenza viruses. For the 2019–20 flu season, according to the Centers for Disease Control and Prevention, all vaccines are designed to protect against the H1N1, H3N2, and Victoria lineage strains. Some vaccines add a fourth strain called Yamagata.

The CDC says that getting vaccinated against the flu is particularly important for people who are considered at high risk for flu complications. Those with a neurological disorder or weakened immune system are included in this high-risk group. Some MS disease-modifying therapies compromise the immune system for some time.

Thank you, AAN

Naturally, which vaccines to get and when to get them is a patient-doctor decision. But for those of us with MS, it’s useful to know that the American Academy of Neurology, with very few exceptions, says “yes” to vaccines.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.


Robert Zinn avatar

Robert Zinn

How long before or after Ocrevus infusion is it appropriate to be vaccinated?

Ed Tobias avatar

Ed Tobias

Hi Robert,

Sorry for taking so long to respond. Here's what the National MS Society says. Note that flu vaccine shots are live-attenuated. The flu nasal spray, however, IS a live vaccine and people with MS should not use it.

"Any required live and live-attenuated vaccinations should be administered at least 4 weeks before a person starts treatment with Ocrevus®. No live-attenuated or live vaccines should be given during treatment or following treatment until your healthcare providers tells you that your immune system is no longer weakened. When possible a person should receive any non-live vaccines at least 2 weeks before you start treatment with Ocrevus. If you would like to receive any non-live (inactivated) vaccines, including the seasonal flu vaccine, while being treated with Ocrevus, talk to your healthcare provider.


Joyce avatar


Thanks. I always feel better after reading you

Tom H avatar

Tom H

I agree with Joyce, love your articles Ed! Keep informing us and we will keep fighting. I am also on Ocrevus and have been debating the risk/reward of getting the flu shot. Leaning towards getting the shot, since the risk of getting the actual flu with a weakened immune system, due to the Ocrevus, is too high.

Ed Tobias avatar

Ed Tobias

Hi,Tom -

Everything I've read over the years, from health care folks and from people who've had the flu, tells me that getting a flu vaccination is the right thing to do. It may not be as effective due to your suppressed immune system, but if it just reduces the severity of the flu illness it's worth it.

Thanks for your kind words and taking the time to send a comment. Keep reading and I'll keep writing. Oh, and I'm working on a book. Stay tuned!


Jody Williams avatar

Jody Williams

Hi, I see two weeks before treatment and 4 weeks before treatment (for flu vaccine).
Which is the predominant guideline?
Thank you for your time,

Ed Tobias avatar

Ed Tobias

Good question, Jody. I think it depends on the DMT you're being treated with, so it's best to ask your neuro's advice.



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