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.”
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.