Written by Rachael Hoffman, MSNZ Clinical Lead
Vaccines play a crucial role in preventing infectious diseases and complications, particularly for people with a long-term condition like multiple sclerosis (MS) where illness and infections can exacerbate symptoms and impact their overall wellness. However, people living with MS might have vaccine concerns such as the risk of disease exacerbation, interactions with ongoing disease modifying treatments (DMTs), and the effectiveness of vaccines.
Studies have shown that vaccines do not increase the risk of MS exacerbation or relapses. Mild side effects such as soreness at the injection site, low grade fever, or fatigue are common and transient. More serious side effects are rare and should be weighed against the risks vaccine preventable diseases pose.
While vaccines are beneficial for people with MS, there are considerations to be aware of:
- Disease modifying therapies: Some DMTs, can affect the immune response to vaccines, potentially making them less effective.
- Timing: Immunisations should ideally be scheduled during periods of stability rather than during active relapses. Timing around MS treatments should be considered and discussed with your healthcare team.
- Type of vaccine: Live vaccines [eg, measles, mumps, rubella] are generally not recommended for people on immunosuppressive treatments*. Where possible, these should be administered before starting treatment. Inactivated vaccines and mRNA vaccines, such as those used for COVID-19, are considered safe and recommended for all people with MS.
- AHSCT: Those undergoing stem cell transplants should discuss a re-vaccination plan with their healthcare team following treatment.
*Not all MS DMTs are immunosuppressive.
Recommended vaccines.
The list below is not exhaustive, we recommend discussing vaccines with your GP, neurologist, or MS nurse. While recommended, some of these vaccinations are not currently funded for all high-risk groups.
Influenza vaccine.
The flu vaccine is strongly recommended for people with MS. Influenza can cause serious illness, particularly for those with comorbidities or a suppressed immune system. The annual flu vaccine is safe and effective in minimising your risk of infection and complications. As MS is a chronic health condition, the influenza vaccine should be free of charge.
COVID-19 vaccine.
Vaccination against COVID-19, including booster doses, is highly recommended. Studies indicate that mRNA vaccines like Pfizer-BioNTech and Moderna are safe for most MS patients, and they do not increase relapse rates. Covid vaccines are free for anyone over 6 months old.
Pneumococcal vaccine.
Pneumococcal vaccines protect against severe bacterial infections and are advised, particularly for those on or starting long term immunosuppressive therapy and those over 65 years.
Shingles vaccine.
The shingles vaccine is particularly important for individuals over the age of 50. MS patients on immunosuppressive therapies are at an increased risk of shingles. The recombinant zoster vaccine [Shingrix] is a non-live highly effective vaccine.
Consultation with Pharmac and the Immunisation Advisory Centre are ongoing whilst MSNZ advocates for better access to the shingles vaccine, particularly for people on or starting medication.
Varicella zoster vaccine.
The chicken pox vaccine (a live vaccine) is recommended before starting a DMT. Pre-screening blood tests or documented evidence of vaccination should be obtained, and vaccinations (if needed) completed at least 4 weeks prior to treatment.
Hepatitis B vaccine.
Hepatitis B is a non-live vaccination which can be given while on MS disease modifying therapies. A blood test, to check for active infection and immunity, is standard care before starting an MS DMT.
Measles vaccine.
The MMR vaccine is a live vaccine. It is recommended that prior to starting immunosuppressive therapy, pre-screening blood tests or documented evidence of vaccination are obtained. It’s ideal to complete these vaccinations, if needed, at least 4 weeks before starting an MS DMT. If you were born between 1969 and 2004, it’s recommended to check if you’ve had two doses of the measles vaccine. Speak to your GP or go to the Health New Zealand website and search measles for more information. Measles vaccines are free for everyone under 18years and everyone who qualifies for funded health care in New Zealand. Measles cases are rising globally, the risk of measles being brought into Aotearoa is high, so it’s important to protect yourself and your family.
Human papillomavirus vaccine.
Persistent infection with the human papilloma virus is rare but can cause abnormal changes to cells in the genitals, cervix, and throat which if left untreated can lead to cancer. The HPV vaccine (Gardasil 9) is non-live and recommended for adolescents and adults. Gardasil 9 is part of the National Immunisation Schedule and is funded for those under the age of 27 years. People over the age of 27 may still benefit from a course of vaccinations, particularly those who are on or starting an MS DMT.
Pertussis vaccine.
Pertussis, also known as whooping cough, is a highly contagious respiratory disease which can be devastating for children under 12months of age. While usually milder for adults, persistent coughing fits can lead to collapse, rib fracture, or pneumonia and the true impact is believed to be under-estimated. Pertussis vaccine is part of the National Immunisation Schedule along with diphtheria and tetanus (dTap). Boosters should be maintained 10 yearly.
Vaccination is a cornerstone of preventative health for people with MS, proactive vaccination can safeguard against infections and related complications. By staying informed and working closely with healthcare providers, people with MS can ensure their immunisations are both safe and effective.