The MS Immune System: Suppressed, Compromised, or What?

by Ed Tobias | March 19, 2021

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Lately, I’ve seen a lot of incorrect information on social media about how multiple sclerosis affects our immune system. Some of it seems to be prompted by concerns that MS makes someone more susceptible to COVID-19, or confusion about whether people with MS can safely receive a COVID-19 vaccine.

Here are a couple examples:

Immunosuppressed or immunocompromised?

One person with MS wrote online that he is “immunosuppressed.” But MS does not weaken the immune system. Some disease-modifying therapies (DMTs) are designed to do that, however.

Another thinks she should be in a priority group for the COVID-19 vaccine because her immune system is “immunocompromised.”

Nope. MS isn’t on the U.S. Centers for Disease Control and Prevention’s list of medical conditions that increase the risk of infection with the novel coronavirus. That’s because MS doesn’t reduce the ability of the immune system to fight off a viral or bacterial attack. MS attacks the central nervous system, not the immune system. In fact, our immune systems are a bit super active.

We are immune-mediated

MS is an autoimmune disease. It’s among a group of about 80 illnesses in which the immune system mistakenly attacks a part of the body. Rogue immune cells target healthy tissue as if it were a harmful virus, bacteria, or cancer. In MS, the targets of this attack are the brain, the nerves along the spine, or both. The U.S. National Multiple Sclerosis Society refers to this as being immune-mediated.

Believing in “KISS” (“Keep it simple, stupid”), my nonscientific description of people with MS is that our immune system is messed up, or our nerves are literally frayed.

DMTs are designed to control this abnormal activity. Some attempt to disrupt the activation of unruly immune cells, some try to reduce the number of these cells, and others try to block the movement of these cells into the central nervous system from the circulatory system.

Because DMTs are designed to reduce the activity of immune system cells, scientists think some may also reduce the ability of the immune system to fight the coronavirus. So, although MS isn’t on the CDC’s list of conditions that increase COVID-19 risk, it’s recommended that people with MS coordinate the timing of some treatments if a COVID-19 vaccination is planned.

That’s good advice, no matter how you label your disease.

You’re invited to visit my personal blog at www.themswire.com.

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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, and are intended to spark discussion about issues pertaining to multiple sclerosis.

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About the Author

Ed Tobias People say to write what you know and Ed Tobias knows about MS. He's lived with the illness since 1980, when he was 32 years old. Ed's a retired, award-winning broadcast journalist and his column combines his four decades of MS experiences with news and comments about the latest in the MS community. In addition to writing his column, Ed is one of the patient moderators on the MS News Today Facebook, Twitter, and Instagram sites. He’s also the author of “The Multiple Sclerosis Toolbox: Hints and Tips for Living with M.S.” Ed and his wife split their time between the Washington, D.C. suburbs and Florida’s Gulf Coast, trying to follow the sun.

Comments

Hannah

I haven't seen these examples but I'm not convinced that people aren't aware of this distinction. MS does not compromise the immune system but a great number of people with RRMS are on immune system modifying therapies that increase their risk of infection. This includes upper and lower respiratory infections similar to COVID. Someone on this type of medication is correct in saying that they are immunosuppressant. Maybe some people don't understand that it is the medication causing this and not MS itself but the examples don't really show that.

Ed Tobias

Hi Hannah,

You're absolutely correct about some DMTs reducing the ability of our immune system to fight some infection, at least for period of time. As you write, some people (I'd say many people) are confused about immunosuppression, what causes it and how long it may last. It's a discussion that their neuros should have with their MS patients but I think that too many fail to have it, or aren't clear in their explanation.

Thanks for commenting,

Jessie Wiebe

yes I agree Hannah. I personally have RRMS - and do daily injections of Copaxone. When I read this article and it says we must strategically coordinate the timing - [it’s recommended that people with MS coordinate the timing of some treatments if a COVID-19 vaccination is planned.]....my question is how do I coordinate the timing when I do DAILY injections of Copaxone. AND I do not believe studies have been done to test how these 2 medications will interact. Why should I become yet another guinea pig?? When clealy the lab studies are not completed before immunization of this Vaccine is given for a mutating virus. Really?? Who is missing some brain cells here???

Ed Tobias

Thanks for your comments, Jesse.

Here's what the National MS Society says about getting a COVID vaccine:

The science has shown us that the COVID-19 vaccines are safe and effective. Like other medical decisions, the decision to get a vaccine is best made in partnership with your healthcare provider. Most people with relapsing and progressive forms of MS should be vaccinated. The risks of COVID-19 outweigh any potential risks from the vaccine."

The guidance about timing is aimed at the DMTs that significantly reduce the immune system for a period of time:

"Some DMTs may make the vaccine less effective but it will still provide some protection. For those taking Kesimpta, Lemtrada, Ocrevus, or Rituxan—you may consider coordinating the timing of your vaccine with the timing of your DMT dose. Work with your MS healthcare provider to determine the best schedule for you."

Copaxone isn't among those. Regarding it and similar glatiramer acetate medications the NMSS says:

"Do not delay starting one of these medicines for your vaccine injection. If you are already taking one of these DMTs, no adjustments of your DMT administration are recommended."

I've written about all of this in earlier columns but perhaps you haven't seen those. I hope the information is useful.

Ruth Hoham

My neurologist suggested that our immune systems are “super-charged” and may in fact make us less likely to be affected by the virus. That makes sense to me, but I’m not relying on it - got fully vaccinated recently!
Highly recommended!!

Ed Tobias

Hi Ruth,

Super-charged is another good description but, like you, I don't expect it to super-protect me from anything. I'm two and a half weeks post Moderna shot number two and I'm very glad I got those jabs.

Paula Kulp

I’m receiving conflicting advice as to how soon I can have my Rituxan treatment after I receive the 2nd COVID vaccine.
Any thoughts?

Ed Tobias

Hi Paula,

Here's what the National MS Society says about Rituxan and Ocrevus:

"If you are about to start Ocrevus or Rituxan, consider getting fully vaccinated* 2-4 weeks or more prior to starting the infusions. If you are already taking Ocrevus or Rituxan, consider getting vaccinated 12 weeks or more after the last DMT dose3. When possible, resume Ocrevus or Rituxan 4 weeks or more after getting fully vaccinated*. This suggested scheduling is not always possible and getting the vaccine when it becomes available to you may be more important than timing the vaccine with your MS medicine. Work with your MS healthcare provider to determine the best schedule for you."

I hope this info helps but, of course, you should discuss this with your neuro.

Jan

I discovered this site for the first time today. I have Secondary progressive MS after an initial diagnosis of RRMS 27 years ago. But my symptoms began when I was a teenager 53 years ago when there were no MRIs or other diagnostic tools. In all that time, I have never seen or heard a clearer explanation of the effect of MS on the immune system Thank you for your clarification.

Ed Tobias

Hi Jan,

I'm sorry for the delay in seeing your comment. I'm so glad you thought the explanation was clear. What you wrote made my day.

Leanne Broughton

Though I have been off Ocrevus for 11 months before my 1st vaccine, my neuro said I may be a candidate for a booster as my immune system may not have fully recouped so the vaccine may not have been fully effective.

Ed Tobias

Hi Leanne,

Yes, I understand that pharma and health officials are considering a booster for people who were treated with CD-20 suppressing treatments such as Ocrevus.

Kenneth "John" Bateman

I had an MS diagnosis at 40 (now 58) the ONLY time I EVER got sick like normal/healthy people was when I was on DMT's. I dropped them all many years ago and almost never get sick from flu, cold etc... I hydrate, avoid stress like the Plague and try to stay active. Do do this, I got on disability. I'm not sure I have ever gone this long without serious Cold/Flu. Almost 10 years now. Only very minor symptoms and very rarely.

I do believe my Immunity is better than most people without MS or those who have MS using DMT's.

Ed Tobias

Hi John,

I've heard the same from a number of people with MS over the years. I hope you'll be able to continue without using a DMT but it seems as if MS eventually progresses if some sort of medication isn't used. Keep an eye on yourself.

Cheryl Johnson

My Daughter has MS and has her Tysabri infusion every 28 days
She had both doses of the phiser vaccine. And has had Covid 19
Back in December. She was sick but nothing terribly bad .
She did have a relapse after taking the second dose of the vaccine that she had not had in 3 years.
My question is how do we time the booster that she will have to have 8 months after her second vaccine. To prevent another relapse . Also I’m very confused on if Tysabri infusions make her more subseptical to the virus . Thanks so much

Ed Tobias

Hi Cheryl,

I'm not a health care professional, but all of the information I've read reports that being treated with Tysabri has no impact on the severity of the virus.

I'm sorry that your daughter had COVID, but I'm glad it was a mild case. I'm also sorry she had a relapse after her second vaccine dose. Other people have also reported relapses and they appear to be related to the brief fever the vaccine may cause. Any fever can trigger a relapse and the relapse usually subsides when the fever eases. This was the case in with these people. So, timing of the vaccine should be irrelevant with Tysabri but please discuss all this with your daughter's neurologist.

Steve

Hey Ed, Im not suggesting do or don't get the vaccine, I have MS too, but if the vaccine is so safe why isn't it FDA approved it per CVS website as of Aug 12, 2021 ? Also there are many warnings of side effects of all of the current vaccines, having MS for 15 yrs and the issues I have had, this scares the hell out of me. Im not trying to advise anyone on what to do here, I am personally considering getting it now because my employer is trying too mandate it or get tested every week, or get fired. All of which I understand are not lawful. It states per CVS website, Pfizer COVID 19 is an unapproved vaccine to prevent COVID 19. Im sorry, Im very frustrated . Why should we trust this vaccine , considering our medical history ?

Ed Tobias

Hi Steve,

I hope you've seen that the FDA has now given full approval to the Pfizer vaccine and I expect that same sign-off will be given to the others before too much longer. I don't know exactly how all of the i's are dotted and t's are crossed but, having three relatives who work for the government I know that the approval wheels move slowly. It's amazing, and pleasing to me, that they moved very quickly to get COVID vaccines to people.

I'm not sure what you mean about "considering our medical history." Do you mean we shouldn't have trusted the vaccines that were developed to prevent polio, smallpox and tetanus, horrible illnesses that are now all but wiped out? I trust my doctors and I trust the people at the FDA. I wish more people did.

Bobbi Shipman

Me too. Covid is November. Vaccines in February. Covid again now. I take Copaxone

Ed Tobias

Hi Bobbi,

Thanks for sharing and I'm sorry you got hit twice with COVID. I hope you'll do better soon, with your COVID and MS.

Leanne Broughton

Though my last dose of Ocrevus was 11 months prior to my 1st vaccine, my neuro says my immune system has not fully recovered and I would likely need a booster vaccine. I am no longer on any DMT.

Ed Tobias

Hi Leanne,

I suspect your neuro is right. It apparently can take quite a while for it to recover. BTW, I plan on a booster in November, when I reach 8 months after my second Moderna vaccine, even though my antibodies zoomed to over 2,500.

Leslie

Hi, Ed. I just discovered your blog... I've had MS for about 30 years, and seem to be slowly progressing. Taking Tysabri regularly for the past 4 yrs, and mostly just hoping for the best. But I'm wondering what you were referring to when you mentioned antibodies zoomed to 2500? I want to look into that for myself too. I've taken two vaccines and one booster for Covid. Moderna for the first two shots and Pfizer for the booster.
Thank you!

Ed Tobias

Hi Leslie -

It's great to have you as a new reader. The antibodies I referred to were those that protect someone from a COVID-19 infection. After my second Moderna vaccine in June, 2021 I had a test that measured a level of 2500.This was considered a robust response to the vaccine. Does it indicate a high level of protection? Maybe. Here's something I wrote about it at the time: http://multiplesclerosisnewstoday.com/columns/2021/06/15/my-covid-19-antibody-report/

Hope this is useful.

Emmett “Jeff” Williams

This is not about COVID or vaccine, but my brother has MS and over a year he got shingles he when to the ER Dr. told him it was just shingles and sent him home, that night ambulance brought him back. Shortly after he got encephalitis and then a stroke. Do you think the ms with shingles could have caused the encephalitis?He is now in a nursing facility can only move his right hand slightly and move his head some. Can’t talk or feed through mouth. Really bad shape. Got to see him about a month ago and kind of wish I hadn’t. Thanks for opinion on shingles with ms.

Ed Tobias

Hi Jeff,

I'm so very sorry about your brother. I'm not a health care professional so I really have no idea of whether there could be the connection you suggest. I can only tell you that I've had two Moderna shots and also a shingles vaccine (not the illness) with no serious side-effects. A neurologist would be a much better person to ask about this than me.

Kristina Mallion

Thank you so much for your post and comments answering questions. I was diagnosed with MS 7 years ago and I am taking Aubagio which increases my risk of infections. I have had 2 doses of the Moderna and had only slight side effects. Due to me taking Aubagio, I am assuming I will need a 3rd shot right?

Ed Tobias

Hi Kristina,

I'd ask your neurologist to be sure but, as I understand it, Aubagio is one of the DMTs that works by reducing the number of B and T cells in your immune system. So, I'd think a third shot would be advised.

Robin Matez

Thank you for sharing all of this info!!! I have relapsing-remitting ms and take a copaxone injection 3 times a week. I have had 3 covid vaccines and am awaiting to get the 4th. As a school teacher I feel it necessary. I had covid at the very beginning of us learning about it and was VERY VERY sick for quite some time. Hang in there fellow mser's we will beat this too!!!! Happy, Healthy New Year to you all!!!!

Ed Tobias

Thank for sharing, Robin. I'm glad you protected yourself with the vaccine, especially being in a classroom.

A happy and healthy new year back to you.

carla crombie

I have had MS for 37 years and have only taken Amantadine (Symmetrel} was used for Influenza A and SARZ-Co V-2 .
I have never received a flu shot nor a shingles shot and have never have had either. I am not taking any DMT meds. I got 2 Pfizer Covid shots and 1 booster. Following the booster I got severe Vertigo that I am still battling 11 months later and my walking and balance worsened. I do not know if the vaccine had anything to do with my symptoms but I will not be getting a 4th vaccine shot. My neurologist is trying to convince me to try Ocrevus which I am not willing to try....nor any of the DMT medications. I was always doing fairly well before my booster having no negative reactions to the initial 2 vaccine shots. Am I being foolish? I do believe in the science of all of this but feel the Amantadine was enough for me.

Ed Tobias

Hi Carla,

Thanks for taking the time to comment and I'm sorry for the trouble you've had following the COVID-19 booster. I had only very minor reactions to the four Moderna shots that I've had, but we're all different. I've been treated with four DMTs over my 42 years with MS and I think each has helped slow my progression. Ocrevus is a bit different, however, as it relates to the COVID-19 vaccines. It and other B-cell depleting DMTs seem to reduce the efficacy of those vaccines.

I wonder why your neuro is now suggesting Ocrevus, since you've had MS for so long without any DMT use. Have your mS symptoms suddenly increased? Is it possible he or she thinks your vertigo is the result of your MS, rather than the COVID booster.

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