The American Academy of Neurology (AAN), the world’s largest association of neurologists and neuroscience professionals, has updated its 2002 guidelines regarding immunizations for people with multiple sclerosis (MS). The new guidelines, published in the August 28, 2019, issue of the journal Neurology, recommend that people with MS receive appropriate vaccinations, including an annual flu vaccine.
“We reviewed all of the available evidence, and for people with MS, preventing infections through vaccine use is a key part of medical care,” states lead guideline author Mauricio F. Farez, MD, MPH, of the Fleni Institution in Buenos Aires, Argentina, and a member of the American Academy of Neurology.
Vaccines Protect People With MS From Opportunistic Diseases
Dr. Farez notes that vaccines are important in people with MS for three reasons:
- Immunizations protect against sometimes deadly diseases and are needed according to each country’s disease distribution and policies.
- People with MS may take drugs that lower the ability of the body to fight infections, thus they are at greater risk of having a complication related to an otherwise vaccine-preventable disease.
- There is some evidence that infections can trigger disease activity, and “thus by avoiding them with vaccines, we are somehow avoiding potential relapses,” he says.
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Update Needed From 2002 AAN Guidelines
The first version of these guidelines was published in 2002. Back then, several gaps in knowledge were identified, as there was not a lot of information for many vaccines, says Farez.
“Since then, new and complex treatments were approved for MS patients. We felt it was time to give doctors and patients updated recommendations. In terms of vaccine skipping, I think what’s important to remember is that doctors and patients should discuss about vaccines at the very beginning of the diagnostic process. This is important so that MS patients feel safe and comfortable getting their recommended vaccinations after understanding that preventing infections through vaccine use is a key part of medical care,” Farez says.
Patients Should Discuss Vaccines With Their Doctors
One of the major findings of the new guidelines is that “clinicians should discuss the evidence regarding immunizations in MS with their patients and explore patients’ opinions, preferences, and questions.”
Depending on the treatment a person is receiving, some vaccines may be contraindicated (not advised). Doctors can counsel an individual on the vaccinations to receive according to local recommendations and the right time to get them.
Avoid Getting Vaccines During Symptom Flare-Ups
The guidelines note that people with MS may not want to receive their vaccines during a flare-up, or relapse, as there is not enough data to say whether vaccines can trigger or make flares worse.
“We consider, despite the lack of evidence, that during a flare, the focus should be its resolution and patient comfort. Moreover, some flares may require steroids or more aggressive measures that at the end would affect vaccine effectiveness,” says Farez.
Certain MS Medication May Reduce Vaccine Efficacy
Immunomodulatory and immunosuppressive MS drugs decrease the ability of the immune response to attack the brain and spinal cord, but they also may affect the ability to generate a good response after vaccination. Some drugs specifically contraindicate live vaccines during and after a period of drug usage.
Farez cautions, “What’s important then is to plan ahead and discuss immunizations at the very beginning of the diagnostic process.”
In some cases, people may need to be screened for and possibly treated for vaccine-preventable diseases before starting an MS disease-modifying therapy. In others, they may need to be vaccinated at least four to six weeks before starting such a therapy.