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Covid-19 vaccines and boosters for people with MS

December 2021

What are the Covid-19 vaccines?

The independent Medicines and Healthcare products Regulatory Agency (MHRA) has approved four Covid-19 vaccines for use in the UK. The first was developed by Pfizer-BioNTech, the second by Oxford-AstraZeneca and the third by Moderna. Although the three vaccines use different technology, they all work to induce an immune response to the spike protein of the coronavirus. These three vaccines are available through the NHS across the UK. The fourth vaccine developed by Janssen is currently not being used in the UK.

Everyone aged 12 and over is now entitled to a first dose of a Covid-19 vaccine. Everyone aged 16 and over can have a second dose 12 weeks after their first dose.

A booster dose is available for everyone over 18, and anyone over 16 who had their last dose more than 3 months previously.

In England, you can use the NHS England website to book an appointment at a vaccination centre or hub, and also find details of boosters and walk-in clinics near you.

In Northern Ireland, you can use the Get Vaccinated online portal for your Covid-19 vaccine as well as your flu vaccine.

In Scotland, you can register for a first dose through the NHS Scotland online self-registration portal, and also find information on boosters and walk-in vaccine clinics.

In Wales, you can use the NHS Wales website to book an appointment at a vaccination centre or hub, and also find information about boosters and walk-in clinics at specific Health Boards.

Even if you think you've already had Covid-19, you should still consider being vaccinated, as the protection from the vaccine is thought to be higher than from natural exposure, and to last longer.

Are the Covid-19 vaccines safe for people with MS?

The safety data checked by the MHRA indicates that all the vaccines are safe and effective for the majority of adults, including older adults, people with long term conditions, children over 12 and women who are pregnant, planning a pregnancy or breastfeeding. None of the vaccines are live, so they cannot cause Covid-19 itself for you, or for your unborn baby if you are pregnant.

If you had an allergic reaction to your first dose of one of the vaccines, or are allergic to any of the ingredients, you should recieve an alternative vaccine for your next dose. People with other allergies, such as food allergies, can normally have a covid vaccine.

You can check the ingredients and safety information in the patient information leaflet for each of the Covid-19 vaccines.

- Moderna (Spikevax) patient information leaflet

- Oxford/AstraZeneca (ChAd0x1 S) patient information leaflet

- Pfizer BioNTech (BNT162b2) patient information leaflet

You can read more about Covid vaccines during pregnancy on the NHS webpage on pregnancy, breastfeeding and vaccine safety.

Millions of people have now had a Covid-19 vaccination, including thousands of people with MS. This experience, added to our decades of experience with other vaccines increases our confidence that the Covid-19 vaccines are safe for people with MS to take.

Some people have mild side effects for 1 or 2 days after having a Covid-19 vaccine. These might include:

- a sore arm where the injection was given

- feeling tired or achey

- a headache or mild nausea

- a raised temperature

People with MS might find that these vaccine side effects make their MS symptoms feel temporarily worse. As you recover from the vaccine, your MS symptoms should also improve back to your normal level. If you are still struggling after a few days, do speak to your MS team.

The NHS webpage on Covid-19 vaccine side effects and safety has more information.

Are the Covid-19 vaccines effective for people with MS?

All the Covid-19 vaccines are thought to be just as effective for people with MS as they are for the wider population. The exception is those people who are taking a medication that suppresses their immune system. Some, but not all, of the MS disease modifying drugs (DMDs) fall into this category.

If you are taking one of the drugs that suppresses your immune system, your MS team will likely have already contacted you and discussed how and when it would be best for you to receive a Covid-19 vaccination.

Taking a medication that suppresses your immune system can mean that you are considered clinically vulnerable to Covid-19. This is because you are unlikely to get the same degree of protection from the vaccines that you receive.

If you are taking Aubagio, Avonex, Betaferon, Brabio, Copaxone, Rebif, Plegridy, Tecfidera or Tysabri, these DMDs do not suppress your immune system in a way that affects your response to vaccines. You are likely to be as well protected by the Covid-19 vaccines as anyone else. The Association of British Neurologists (ABN) has looked at the evidence and agrees that you can continue to take these DMDs as normal, and have Covid-19 vaccines as normal for your age.

If you are taking Lemtrada or Mavenclad, or planning to have HSCT you should discuss when to have your vaccines or boosters with your MS team. This is because these treatments can affect how well a vaccine might work for you, so the timing of your infusions and vaccine will be important. This might mean ensuring you have your Covid-19 vaccine doses and booster well before your next infusion. If timed carefully, the ABN considers that you are likely to still get good protection from Covid-19 vaccines .

If you are taking Gilenya, Ocrevus, Mayzent, Zeposia or Rituxan, you will also need to discuss the timing of your vaccine and booster doses with your MS team. Even if they can be given at the optimal time, the ABN considers that you are unlikely to get full protection from the Covid-19 vaccines. It makes sense to take the vaccines and boosters, as any increased protection against Covid-19 infection is still worth having.

If you are planning to start or switch to a new disease modifying drug, your MS team may encourage you to get your vaccinations, including boosters for Covid-19, up to date first.

Your immunity takes a few days to build to a maximum after you have had a Covid-19 vaccination. This means that you are not fully protected until at least 7 days after your injection. If you are immunosuppressed then you make take several weeks to build immunity. You should continue to take sensible precautions such as wearing a mask and keeping a safe distance from people outside your household. No vaccines are 100% protection from infection, and so taking other precautions helps to keep you and those around you safe.

Third dose or booster - what's the difference?

A third dose is an extra ‘top-up’ dose for those people who may not have generated a full immune response to their first two doses, and is classed as part of your primary course of vaccinations. In contrast, a booster dose is a later dose to extend the length of protection from your primary course of vaccinations - which may be two or three doses depending on your circumstances.

This means that people with severely weakened immune systems should have a third vaccine dose as part of their primary course of vaccinations, and then a booster dose later on, making four injections in all. Some people with MS may be eligible for a third dose, if they are taking one of the DMDs listed above that suppress their immune response.

If you are eligible to have a third dose, your GP or MS specialist should contact you to let you know, and how you can access the third dose where you live. You may also get a letter from the NHS advising that you may be eligible. The decision on the timing of the third dose should be made by your specialist. As a general guide, the third dose will usually be at least eight weeks after your second dose, but there is flexibility to adjust the timing so that, where possible, immunosuppression is at a minimum when the third dose is given. This will enable a better immune response to be generated.

The JCVI advises that for adults aged 18 and older, either the Pfizer-BioNTech or Moderna Covid-19 vaccines be administered for the third dose, as a number of studies have reported an increased immune response in some immunosuppressed people after a third dose of an mRNA vaccine. For those aged 12 to 17, the Pfizer-BioNTech vaccine is preferred.