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.
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.
Vaccines work by priming your immune system to be ready to respond to an infection. Some disease modifying drugs (DMDs) 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.
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.
Exceptions
- 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.
There are different kinds of vaccine, with different implications for people with MS.
Live-attenuated vaccines
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)
- oral Polio vaccine
- Measles
- Mumps
- Rubella
- Chicken Pox
- Smallpox
- Rotavirus
- 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.
Other vaccines
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
- Influenza (injected)
