Vaccinations against infectious disease are commonly offered in the UK. You may have undergone a routine series of vaccinations during childhood or been offered vaccinations before traveling abroad. If you became high risk for disease due to lifestyle factors, you may have been offered additional vaccinations.
Multiple sclerosis is an autoimmune disease, and since vaccination changes the immune system, it is reasonable to look for possible interaction between vaccines and autoimmune diseases. Given that almost everyone receives vaccinations at some point, it is really important for public trust in vaccination that any possible link is thoroughly checked. Vaccines are rigorously tested and continually monitored for safety.
Can vaccination cause MS?
Numerous studies have investigated a possible link between having a vaccination and later developing multiple sclerosis or another autoimmune disease. In 2018, researchers collected all the published data together on HPV (human papillomavirus vaccine) and Hepatitis B vaccine and found no association between these vaccines and MS or other autoimmune disease.
Other researchers have looked at the vaccines for influenza, MMR (Measles, mumps and rubella), polio, typhoid fever and the BCG vaccine for tuberculosis. None of these vaccines resulted in an increased risk of developing MS. The BCG vaccine may delay progression from CIS to full MS. The diphtheria and tetanus vaccinations may be associated with a decreased risk of MS.
The current evidence does not suggest that vaccinations are a cause of MS.
Are vaccines effective for people with MS?
Vaccines work by priming your immune system to be ready to respond to an infection. Some DMDs (disease modifying drugs) for MS alter the immune system and may make your body less good at responding appropriately to vaccines.
A study reviewing all of the research into flu vaccination and MS found that vaccination was effective in people with MS and offered them protection from flu infection. Although disease modifying drugs affect the immune system, most did not stop the vaccination from being protective against flu infection.
Are vaccines safe for people with MS?
You may be concerned that having a vaccination may make your MS worse or trigger a relapse. A study in Argentina published in 2011 carried out a systematic review of the research into the effect of various vaccinations in people with MS. The study looked at vaccinations including BCG (tuberculosis), MMR (measles, mumps and rubella), Hepatitis B, Influenza, Polio and Typhoid fever. The study found no evidence that these vaccinations increased the short-term risk of a relapse.
In exceptionally rare cases, having any vaccination can trigger complications. However, people with MS have no greater risk of complications than the general population. On the other hand, getting an infection strongly increases the risk of a relapse. People with MS are advised to protect themselves from infectious disease by having the vaccines that are recommended.
- If you are unwell, for example experiencing a relapse, you may be advised to defer vaccination until you are better. This is because it will be difficult to tell the difference between the symptoms of the relapse or other illness and a bad reaction to the vaccine.
- If you are on a therapy that suppresses the immune system, such as mitoxantrone, azathioprine, methotrexate, cyclophosphamide or steroids, you should not receive 'live' or live-attenuated vaccines as you may be at greater risk for developing the disease.
Make sure that your doctor is aware of all the medications you are taking.
Are there different kinds of vaccine?
There are different kinds of vaccine, with different implications for people with MS.
Live or live-attenuated vaccines (LAV) are created by weakening the disease virus or bacteria in the laboratory. It should then be unable to cause disease, while still stimulating your immune system to mount a defensive response. This method of creating vaccines produces very effective vaccines that generally do not require boosters. However, in people with reduced immune systems, even the weakened form in a vaccine can cause the disease.
Examples of live-attenuated vaccines are: Tuberculosis (BCG), the oral Polio vaccine, Measles, Mumps, Rubella, Chicken Pox, Smallpox, Rotavirus and Yellow Fever. The seasonal flu vaccine delivered as a nasal spray is also a live-attenuated vaccine, although the injected flu vaccine is not.
If you have MS and are taking a disease modifying drug (DMD) that affects your immune system, then you are generally advised to not take live-attenuated vaccines. You can check the information pages on our website for specific information for your drug.
Vaccines may also be created from dead or fragmented parts of the bacteria or viruses that cause disease, or from the substances that the bacteria themselves create. These do not carry a risk of causing the disease in immune-suppressed people, and so you may be able to take these vaccines even if you have MS and are taking a DMD. However, they may not always provide effective protection without booster doses.
These vaccines might be described as inactivated, subunit or toxoid vaccines. Examples include: Pertussis (wP or aP) Inactivated Polio, Haemophilus influenza type B (Hib), Cholera, Plague, Pneumococcal disease, Meningococcal disease, Hepatitis B and Influenza (injected).
- Pharmacol Res 2018 Apr 14:132:108-118 Summary Human papillomavirus vaccine and demyelinatingf diseases: a systematic review and meta-analysis
- Neurology 2002;59(12):1837-1843. Full article Immunization and MS: a summary of published evidence and recommendations.
- Acta Neurol Scan 2017 Nov:136 Suppl 201:49-51 Summary Vaccines and multiple sclerosis
- Journal of Neurology 2011;258(7):1197-1206. Summary Immunizations and risk of multiple sclerosis: systematic review and meta-analysis.
- Archives of Neurology 2011;68(10):1267-1271. Full article Yellow fever vaccination and increased relapse rate in travelers with multiple sclerosis.
- Neurol Neuroimmunol Neuroinflamm. 2018 Jan; 5(1): e409. Full article Immune response to vaccines is maintained in patients treated with dimethyl fumarate
- JAMA Neurology 2014;71(12):1506-1513. Summary Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases.
- Vaccine. 2018 Mar 14;36(12):1548-1555 Summary Hepatitis B vaccination and the putative risk of central demyelinating diseases - A systematic review and meta-analysis.
- Eur J Neurol. 2018 Mar;25(3):527-534. Summary Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy.
- New England Journal of Medicine 2001;344(5):319-326. Full article Vaccinations and the risk of relapse in multiple sclerosis. Vaccines in Multiple Sclerosis Study Group.
No link between vaccination and risk of MS
This new study found no long term association between any vaccines, including hepatitis B and HPV (human papillomavirus), and an increased risk of developing MS, for up to three years following vaccination.
Hepatitis B vaccine
Research into a possible role of the hepatitis B vaccination in increasing risk for the onset of multiple sclerosis has been inconclusive. Find out more in this A-Z entry.
The flu jab
NICE guidelines say people with MS should be offered immunisation against influenza, as flu infections can cause worsening symptoms or may trigger relapse.
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