Do People With MS Need a 3rd Vaccine Shot?

Ed Tobias avatar

by Ed Tobias |

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Now that a third COVID-19 vaccine shot has been approved in the U.S. for immunocompromised people, and vaccine boosters are expected to be available to the general public sometime after Sept. 20, Walgreens and CVS have lost no time in offering the additional shot to those who qualify.

Like their previous policies for vaccine shots and COVID-19 tests, the stores require people to make appointments online, and they’ll be happy to jab you.

But should you get that extra shot? For now, it depends on how immunosuppressed you are.

The U.S. Centers for Disease Control and Prevention (CDC), which recommended the third dose for immunocompromised people last week following special authorization for it by the U.S. Food and Drug Administration, said that people with compromised immune systems “may benefit from an additional dose to make sure they have enough protection against COVID-19.” The CDC, however, doesn’t specifically mention multiple sclerosis in their guidance, and not all people with MS have compromised immune systems.

In its guidance, the CDC stressed the importance of a third shot particularly for organ transplant recipients, stem cell transplant recipients, patients receiving cancer treatment, people with HIV, and others. 

Additionally, in an announcement on Wednesday, the administration of U.S. President Joe Biden announced plans to offer booster shots to anyone who had received the two-shot Pfizer or Moderna vaccines eight months ago, starting with nursing home residents, healthcare workers, and emergency workers, The New York Times reported. 

Recommended Reading
developing severe COVID-19/multiplesclerosisnewstoday.com/no increased risk with DMT use

Risk of Severe COVID-19 Not Raised by Immunosuppressive DMTs

Which people with MS are immunocompromised?

By itself, MS doesn’t suppress the immune system. It’s actually the opposite. MS shifts the immune system into overdrive, hyping up cells that attack parts of the nervous system. Several disease-modifying therapies (DMTs), however, do suppress the immune system, which is how they halt those cellular attacks.

When you read that a third COVID-19 vaccine shot may be recommended for people with MS, it refers to the people whose immune systems are suppressed by one of these DMTs.

And as Chicago’s ABC7 pointed out, for immunocompromised people, a third shot isn’t really a booster, which is for people whose immunity has dissipated over time. Immunocompromised folks weren’t sufficiently protected in the first place by the initial two shots, ABC7 noted.

Immunosuppressive DMTs include Lemtrada (alemtuzumab), Mavenclad (cladribine), Gilenya (fingolimod), Ocrevus (ocrelizumab), and rituximab. It’s important to understand that each of these DMTs suppresses the immune system a bit differently and for different lengths of time.

For example, to be effective, Ocrevus needs to keep certain immune cells suppressed continuously. But these cells repopulate after about six months. That’s why Ocrevus treatment is required twice a year.

Lemtrada works differently. Some of those cells rebound quickly, while others may take a year or longer after a second Lemtrada treatment.

Ask MS doctors

Dr. Aaron Boster, an MS neurologist, noted that people who have been treated with immunosuppressant DMTs should be candidates for an extra dose of the vaccine.

(Screenshot via Twitter)

Dr. Brendon Beaber, who also is well respected in the MS community, added a few more DMTs than I’ve mentioned:

(Screenshot via Twitter)

No 3rd jab for me yet

In my case, over three years have passed since I was last treated with Lemtrada. I haven’t been treated with another DMT since then, and my immune system should be back to full strength. A blood test last April showed that my antibody levels after two shots of the Moderna vaccine should provide robust protection from COVID-19.

As my neurologist told me in an email, “You have a phenomenal response to the vaccine.” She said my Lemtrada treatments are no longer suppressing my immune system, so I don’t need a third vaccine shot yet.

Nevertheless, given the Biden administration’s announcement this week, I will revisit this issue about eight months after having my second dose of the Moderna vaccine. 

If you’ve been treated with a DMT, one question you might want to ask your neurologist is, “Has my DMT suppressed my immune system, and is it still suppressed?” If the answer is yes, your neurologist might suggest you head out soon for a third shot. If not, stay tuned for more news in late September. 

For those who received the one-shot Johnson & Johnson vaccine, studies are ongoing regarding the need for, and effectiveness of, a booster shot. More information could become available as early as next week, according to news reports.

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.

Comments

tracey kennedy kennedy avatar

tracey kennedy kennedy

I don't need a third sot. I need everyone else to get it.

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Brenda Constance Hall avatar

Brenda Constance Hall

Is Fampridina a DMT?

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Anonymous avatar

Anonymous

I have not been on any DMT since 2009. I had no problem obtaining my third Pfizer vaccination at my local pharmacy. The fact that I have MS was sufficient.

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Shalini monga avatar

Shalini monga

I am on REBIF subcutaneous injection thrice a week since Nov 2004.i.e BETA INTERFERON 1A . I live in New Delhi, India, Do I need the booster dose

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Paul Gilpatrick avatar

Paul Gilpatrick

So, here's my question that nobody can seem to answer for me. My DMT is Rituxan and my immune system is compromised. I understand that we are cleared to get the 3rd Moderna shot now. However, I've read from multiple sources this statement "Immunocompromised folks weren’t sufficiently protected in the first place by the initial two shots, ABC7 noted."

I had my 2nd Moderna shot 4 month's ago. Should I be getting this booster now or waiting for another four months to align with the 8 month suggestion for everyone else?

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GARY L. SHAMBLEN avatar

GARY L. SHAMBLEN

I'm not drunk.................MS. I'm 39 years with this disease. I was ambulatory until 16months ago and that was my slogan when someone got suspicious. Thought about getting custom T-shirts with it.
Is ocrevus ever used for SPMS?

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Terry Thompson-Manning avatar

Terry Thompson-Manning

Thank you, Ed! Colorado has one of the highest MS rates in the country. Have heard nothing but “get that third jab if your immune system is compromised” on the news, without delving into specifics. Which in turn, results in phone calls and emails from well-meaning family members that I need to address this immediately. Having MS since 1988, I’m well aware my immune system is overly active, not shut down or depleted. Explaining that to others is…impossible. I haven’t been on a DMT for several years now. But if and when my Neuro says a third jab could be helpful, I’ll do it.

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Arynne Elfenbein avatar

Arynne Elfenbein

I believe you neglected to mention
the MS Drug Tysabri…

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Val avatar

Val

Have you heard anything about there being a concern for a dangerous overreaction to a booster for those of us with MS who aren’t on any drugs that modulator our immune system?

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william dolighan avatar

william dolighan

All this discussion about full vaccination ignores the fact that Canada, and Canada only, decreed a 12-16 week delay between 1st and 2nd Pfizer shots. This is often overlooked when there is discussion about immunity. Can anyone say that this delay has no effect on protection offered by vaccines?

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Ed Tobias avatar

Ed Tobias

Hi William,

You raise an interesting point. I was recently reading that there's now some thought that a longer than 4 week delay between the first and second shots of the Pfizer and the Moderna vaccines may improve their efficacy. I didn't realize that Canada requires that longer gap.

Ed

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Tom Anderson avatar

Tom Anderson

I commend Mr. Tobias on giving people a dose of truth. I say this in the context of Ocrevus. Wanted to make this shorter, but…I studied ‘resistance to change” in the context of organizations on my way to a doctorate, and find the subject still fascinating. (for example, there are still many people betting their lives on Biotin while there are other non-prescription avenues to try which are being studied and show some potential promise). I ended my Ocrevus treatment in late 2019 when the initial wave of virus was heating up in Europe. But I’ve been following the subject closely (Facebook) and still see an abundance of excuse making about how you can be on Ocrevus and fight the virus with no problem. That’s not to say that young otherwise healthy people have more to fear from MS than the virus, and that for them, Ocrevus may still be a wise choice. But everyone should at least be presented with the facts, because the virus, as being reported, seems to be a very precarious situation for some, and a person on Ocrevus or one of the other B-cell depleters, should be made aware of their predicament so they can make an informed choice (at least before they start). Keep in mind also that the 6 months Mr. Tobias mentions as the immune system reconstitution time, is the earliest and not the average time, at least from what I read, and the opposite end of the reconstitution period is 12 to 18 months, depending on how long you’ve already been on O. So there is a “stuckness” to it, meaning there is no good option once your B-cells have been depleted, and perhaps, you might as well just stay on it. The point of all this being, again, facts are very important and my hat is off to Mr. Tobias.

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Mary avatar

Mary

A couple of people commenting on the 3rd shot have mentioned that they have not been on a DMT for quite some time. Does anyone that said this care to explain why they haven't been on a DMT? I am very curious. Have you/they had stem cell treatment or do they prefer to not be on meds? If so, I wonder have they have done without any meds? Thank you

Reply
Ed Tobias avatar

Ed Tobias

Hi Mary,

I can't speak for anyone else but I'm currently not on a DMT because I'm nearly four and a half years post Round 2 of Lemtrada and, at age 73, I consider it to be my final DMT. (I've used 3 others over the past 25 years.) The people who commented may be in a similar situation.

There are people, of course, who believe they can treat their MS with natural supplements, diet or exercise (one or a combination) and I disagree with their approach.

Ed

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Cathy avatar

Cathy

I take Ocrevus. I got the Pfizer vaccine 3 months after infusion. My primary doctor had my blood tested for antibodies before and after vaccine. I had no antibodies either times. Also I had absolutely no side effects from both vaccine shots.
So in August I got 3rd Pfizer shot. I noticed a three day really crappy feeling and figured it must have worked.
And it did!
I had another antibody test done and it came back positive. Also was rested for B and T cells after 3rd shot. Both show to be repopulated enough to allow vaccine to work.
There’s too much info and not enough understanding out there. I’m lucky to have a great doctor that did look into her patients and the meds they are taking. She decided to do follow up for everyone.

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Ed Tobias avatar

Ed Tobias

Hi Cathy,

Thanks for sharing this info. I recently read that the Pfizer vaccine was providing only half the antibody protection of the Moderna vaccine after a number of months. That, combined with your depleted B-cells, would certainly explain your initial lack of antibodies. (This has also led some scientists to believe that a third shot may not be necessary with Moderna as it is with Pfizer.)

Sounds like your doctor is on the ball!

Ed

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Raymond Carroll avatar

Raymond Carroll

Hi Mary. I'm not a Doctor but I copied the following from clinical information for Famprodina: "It works as a potassium-channel inhibitor, which improves the formation of action potentials. In other words, it improves signals that go from the brain to the muscles so as to help with the conduction of information within the central nervous system."

Fampridina was developed specifically for the improvement of gait disorders (walking speed and distance). As such, it works within the body to possibly improve one's potential for motion. It does not, however, attempt to treat any underlying disease. By strict definition Fampridina is not a disease modifying therapy.

Hope this helps.

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Ed Tobias avatar

Ed Tobias

Thanks for sharing that info with the group, Raymond, and also for citing the source of the information.

Ed

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RAYMOND A CARROLL avatar

RAYMOND A CARROLL

Hi Paul. I'm not a doctor and suggest following the advice of your neurologist. However, based on my own experience, if you were at a point in your DMT "cycle" that you know your immune system was supressed when you received your vaccination you did not receive 100% of its benefit. For sake of example, let's say you received 80% benefit.

One reason for the booster shot is to provide an additional immunological response in those who did not receive full benefit from the initial vaccination. The combined benefit of the initial vaccination and booster dose is to provide a more complete immune response. In our example you received only 80% of the intended benefit from the vaccine. A booster shot will provide an additional immune response (possibly 20%) and leave you in a place where you've received 100% benefit, or closer to it.

If you know you did not receive full benefit of the initial vaccination my suggestion is for you to proceed with a 3rd dose now (provided the recommended time has passed since your most recent dose). Doing so will ensure you are at or near the intended immunological response provided by the vaccinations.

Hope this helps. Best of luck to you!

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Helen avatar

Helen

I am on Ocrevus DMT, had infusion in August, last Thursday I had 3rd dose. I am not a Doctor but thought long & hard as my last blood test 3 weeks earlier showed I had basically no imunnity to anthing. I've never seen so many red flags on a blood test. It's a personal choice, but I didn't even get an itch.
Thanks for listening! God bless us all!

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Ed Tobias avatar

Ed Tobias

Thanks for sharing that with us, Helen. I'm glad your third jab went well.

Ed

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Eric Bodenhamer avatar

Eric Bodenhamer

Hi Paul, Yes you will want to wait the full 8 months till the 3rd vaccine. You can actually have an overdose/reaction from the vaccine if you have it too soon. That’s why CDC says wait 8 months to gets 3rd vaccine. Be careful and I pray 🙏🏽 for you!

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Cindy avatar

Cindy

Keep in mind that the references to 6 or 8 months between 2nd and 3rd vaccinations applies to otherwise healthy people. ("general public") As explained in previous posts, those with compromised immune aystems, including those on MS disease-modifying therapies like Ocrevus, likely never received full benefit from the first two doses, so a third would not "overdose," simply bring them up to full efficacy (like people without compromised immunity typically get from the first two shots).

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Ellen avatar

Ellen

Hi Mary, I have been off medication almost 3 years. I read an interesting article about coming off MS medications if over age 60 and have not had any progression or significant symptoms and had beeb on MS medication for at least 12 years. I was on Copaxone for 12 years. I showed the article to my neurologist who agreed with it, so I came off the medication and have an MRI every year. No signs of active lesions at all. No changes in my general health. There are some exceptions to the article. My daughter who after 12 years on her medication was doing so well her doctor in California told her to come off medication and that was and more than four years ago. She was in her mid thirties. She is doing fine. ( BTW I didn't know I had MS until 3 years after she had been diagnosed.)

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Ellen Lerner avatar

Ellen Lerner

I have an appointment with my internist in November which is eight months after receiving second eight months after receiving second moderna vaccine. I shall ask him at the time what he thinks about a third sho.. Right now I don't feel immunology compromised with my MS. As I explained elsewhere here. I've been off MS medication for at least couple years. For those here and also in the NextDoor neighborhood group which I belong to who have posted they went into the drug store and received the third booster, how is it one can walk to the pharmacy and get and get the booster. Doesn't it require a doctor prescription? Or do the pharmacies say the third one is valid because you got the first ones so it is okay for the third one?

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Ed Tobias avatar

Ed Tobias

Hi Ellen,

I received my first two Moderna shots at a supermarket pharmacy back in early February and March. No script was needed for those shots. I've never had to have a script for a standard flu shot, either.

As for immunocompromised...MS doesn't compromise the immune system. MS puts the immune system into overdrive, it doesn't suppress it. Some of the disease-modifying therapies that treat MS to suppress the immune system...but it's the medications that are doing this, not the MS.

Ed

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