Management of Multiple Sclerosis in the Era of COVID-19 Pandemic - Episode 5

MS Guideline Recommendations for Vaccines

Dr Schmierer discusses the general guideline vaccination recommendations for patients with MS.

Klaus Schmierer, MB BS, PhD, FRCP: When we're talking about vaccinations in people with MS [multiple sclerosis] in general, I think the first point to make is that live vaccinations are generally not recommended in people with MS. However, virtually all other vaccinations can be given in people with MS. That is, I think, a fundamental rule. There was concern for some time, and I think it sort of comes up from time to time with yellow fever vaccination. But the study on which this concern is based is very small; therefore the general rule is very much that we're in favor of vaccinations. Ideally, particularly when we're looking at B-cell depleters but also with cladribine [and] alemtuzumab, some of the vaccinations we would complete prior to starting treatment to ensure we get a good immune response.Pneumovax 23 [pneumococcal vaccine polyvalent] would be one of them. We would make sure that MMR [measles, mumps, and rubella] immunity is preserved, and we would always give the flu vaccine. I think the pandemic has highlighted a concern here for which there was evidence from previous studies related to fingolimod and ocrelizumab, that the vaccine response is reduced. But obviously, when the flu season is out there, you need to try and mitigate the risk, and on a population level, it's always better to vaccinate. So even if you don't get a good response, there's no evidence for an increased risk with the vaccination, independent of the question whether or not the response is really good.

There's no evidence that vaccination either triggers MS or makes MS worse. We obviously know that, and that is actually the first description of the Uhthoff's Phenomenon. That is essentially temperature- or immunization- associated decline in function, which is very temporary. That first emerged, or was first described, in the context of a BCG [Bacille Calmette-Guérin] immunization, I think in the 1920s. But in terms of triggering the disease; making it sort of consistently worse, triggering progression, or so on, there's no evidence for that. So I think this is very important to keep in mind.

This transcript has been edited for clarity.