New guidelines from the American Academy of Neurology (AAN) recommend that people with multiple sclerosis (MS) keep up with regular vaccinations, including annual flu shots, but be sure to first advise their doctor on medications they are using.
The guidelines were published in the journal Neurology, in the report “Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis.”
Vaccines work via an injection that contains small amounts of inactive or weakened disease-causing compounds or microorganisms. This way, the body’s immune system can learn to recognize the potentially harmful agent and more efficiently fight it when later encountered, preventing the person from getting sick.
Since MS is a disorder of the immune system, questions have been raised as to whether vaccines might be more risky or less effective. But the newly proposed guidelines suggest that these concerns are unwarranted.
A subcommittee of the AAN conducted a systematic review of all available scientific evidence published from 1990 to March 2018 on the safety and efficacy of vaccinations with MS.
“We reviewed all of the available evidence, and for people with MS, preventing infections through vaccine use is a key part of medical care. People with MS should feel safe and comfortable getting their recommended vaccinations,” Mauricio F. Farez, MD, MPH, said in a press release. Farez, a neurologist at the FLENI Institution in Buenos Aires, is a co-author of the new guidelines.
Many MS medications weaken the immune system; as such, they may make some vaccines less effective. Therefore, it’s important that MS patients talk to their healthcare providers about the therapies they are taking so that an informed decision can be made.
Ideally, vaccines should be administered “at least four to six weeks” before immune-suppressing drugs, the guidelines state. But even if this isn’t possible, the potential benefits (protection against deadly infections) far outweigh the risks (slim to none).
The main caveat comes for people who are experiencing active flares.
“After reviewing all the available evidence, we found that there is not enough information to say whether or not vaccinations trigger or worsen MS flares,” Farez said. “Still, experts in MS urge their patients to hold off on scheduling their vaccinations if they are having an MS flare simply to avoid the potential for any complications.”
Once flares are handled, though, vaccines should be scheduled.
The new guidelines suggest that clinicians discuss all evidence on vaccination-related risks and explore a patient’s opinions, preferences, and questions regarding immunizations to establish the most suitable strategy for each person.
Clinicians are also advised to help their MS patients follow all local vaccine standards, including the annual flu shot, except if there is a specific contraindication, such as active treatment with immunosuppressive or immunomodulating agents. Doctors should “recommend against using live-attenuated vaccines” in MS patients using such therapies, the guidelines state.