This information is current as of 15-April-2021
For additional information on the COVID-19 virus and the impact on patient with MS, click here.
Bottom Line: We recommend vaccination against COVID-19. Vaccination is also recommended by the National MS Society.
General information about the currently available COVID-19 vaccines:
The currently approved vaccines are mRNA vaccines produced by Pfizer and Moderna, and a modified adenovirus vector virus vaccine produced by Johnson and Johnson. We do not know which vaccine you will receive. This will depend on where you live, your insurance, and other distribution factors. The Pfizer vaccine requires two doses separated by 3 weeks, the Moderna vaccine requires two doses separated by 4 weeks, and the Johnson and Johnson vaccine is a single dose vaccine.
As of April 13th, distribution of the Johnson and Johnson vaccine has been put on hold while the CDC and FDA review an extremely rare side effect of cerebral venous sinus thrombosis (a blood clot in one of the veins in the brain) associated with low platelets. As of now there have been only 6 cases of cerebral venous sinus thrombosis, in over 6 million patients vaccinated with the Johnson and Johnson vaccine. All cases were in female patients between 18 and 48 years of age. One case was fatal. Symptoms began six to 13 days of vaccination.
Please contact your primary care provider immediately if you develop any of the following symptoms within one month of receiving the Johnson and Johnson vaccine.
- Headache that is constant, worse with positional changes (bending over), or associated with nausea, vomiting, or vision changes
- Headache that resolved within 24 hours of vaccine administration but then recurred
- Abdominal pain, leg swelling (bilateral or unilateral), chest pain, shortness of breath, or bruising/petechiae
Are the vaccines safe for patients with MS?
The vaccines were not tested in patients with MS or with other autoimmune diseases therefore we do not have information about safety specifically in MS patients. However, inactivated vaccines such as the flu, shingles, and pneumonia vaccines are generally safe and recommended in patients with MS. The COVID-19 vaccines in the general population were found to be safe. The most common adverse effects were local pain, redness, and swelling at injection sites, as well as transient fatigue, muscle pains, joint pains, chills, or fevers.
Are the vaccines effective for patients with MS?
The COVID-19 vaccines were not tested in patients with MS or with other autoimmune diseases therefore we do not have any specific information about efficacy in MS patients. We believe that having MS will not negatively impact the efficacy of the vaccines; however, receiving some disease modifying treatments might impact overall vaccine efficacy and durability. The information below is inferred based on what we know about the effectiveness of other (non-COVID-19) vaccines in MS patients on disease modifying therapies.
Table 1: Vaccine efficacy studies in patients on MS disease modifying treatments
|Medication||Vaccine effectiveness when compared to patients not on disease modifying therapy||Further details and references|
|Copaxone (glatiramer acetate)||As effective||Patients on Copaxone receiving the flu vaccine had similar responses to healthy controls.1https://pubmed.ncbi.nlm.nih.gov/29205701/|
|Avonex, Betaseron, Plegridy, Rebif (interferons)||As effective||Patients on interferon beta-1a 44mcg three times weekly had no difference in their ability to mount an immune response to the flu vaccine compared to controls.2|
|Aubagio (teriflunomide)||As effective||Patients on Aubagio had similar responses to the flu vaccine compared to those on interferons.3|
|Tecfidera (dimethyl fumarate)
Vumerity (diroxel fumarate)
|As effective||Patients on Tecfidera mounted similar immune responses to pneumococcus, meningococcus and tetanus vaccines as those on interferons.4https://pubmed.ncbi.nlm.nih.gov/29159204/|
|Possibly less effective||Most patients on Gilenya were able to mount immune responses to the flu vaccine but response rates were less than patients not on Gilenya.5 Patients on Siponimod also had lower response rates to the flu vaccine compared to controls.6|
|Tysabri (natalizumab)||Possibly less effective||A lower proportion of patients on Tysabri responded to tetanus vaccines compared to controls though this was not a statistically significant difference.7
Smaller studies have shown that fewer patients on Tysabri responded to the H1N1 vaccine8 and flu vaccine1 compared to controls.
|Possibly less effective||A study on tetanus, pneumococcus, and flu vaccines showed that those on Ocrevus did mount immune responses to all three vaccines, but to a lesser degree than patients not on disease modifying therapy or on interferons.9|
|Mavenclad (cladribine)||Unknown||No studies have been reported on vaccine responses in patients on Mavenclad|
*No data is available for Vumerity, Zeposia or Kesimpta, but these medications are grouped with those disease modifying therapies of similar classes.
When should I get the vaccines? Who should get the vaccines?
- In general, we recommend that our patients follow the vaccination program guidelines developed by the Massachusetts department of public health. https://www.mass.gov/info-details/massachusetts-covid-19-vaccine-information
- If you have MS and are in a high risk profession or have high risk exposures (i.e. health care workers, EMTs, police officers, other essential worker etc…) we would recommend you be vaccinated when it becomes available to you.
- If you are on rituximab, or ocrelizumab if possible we would recommend getting vaccinated 1-2 months prior to your NEXT infusion to maximize the effectiveness. However, if this timing is not possible, then we recommend getting vaccinated whenever feasible.
- After receiving rituximab or ocrelizumab your B cells are suppressed. B cells are a type of white blood cell important to mounting vaccine responses and providing immunity. As the rituximab or ocrelizumab wears off and your B cells start to come back, you may be more likely to mount a response to the vaccine. However, we also know that patients on B cell therapies who get COVID may be more severely affected, so the decision and timing of vaccination should be a risk/benefit discussion with your neurologist.
- If you have had vaccine related adverse reactions, or allergic reactions please consult your primary care provider prior to getting vaccinated.
Will the vaccines worsen my MS?
We do not have this information specifically for the COVID vaccines. However, results of large trials have shown that other vaccines do not cause MS, worsen MS, or cause relapses 10,11. It is important to note that fever can exacerbate preexisting MS symptoms but should not cause new symptoms. Please reach out to your doctor if you have persistent symptoms or new symptoms associated with the COVID vaccination.
Where can I get the vaccines?
COVID vaccines will NOT be distributed at the Brigham MS center. Mass General Brigham is vaccinating patients on a limited basis via lottery depending on eligibility. You will be contacted via patient gateway if you are eligible to schedule a vaccine at Mass General Brigham. We encourage you to schedule a vaccine at other vaccination sites in the state. To determine if you are currently eligible to receive a vaccine and to schedule a vaccine, please visit this website.
Will I be higher priority to get the vaccines because of my MS?
Having MS alone likely does not impact what phase you will be in for vaccine distribution; however, being on immunocompromising medications such as disease modifying therapies for MS may qualify you to be in phase two of vaccine distribution in Massachusetts. Please visit this website for Governor Baker’s Massachusetts vaccine plan for more information. Please note, starting April 19th, all Massachusetts residents age 16 and older will be eligible for the vaccine.
- Olberg HK, Eide GE, Cox RJ, et al. Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy. Eur J Neurol 2018;25:527-34.
- Schwid SR, Decker MD, Lopez-Bresnahan M. Immune response to influenza vaccine is maintained in patients with multiple sclerosis receiving interferon beta-1a. Neurology 2005;65:1964-6.
- Bar-Or A, Freedman MS, Kremenchutzky M, et al. Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Neurology 2013;81:552-8.
- von Hehn C, Howard J, Liu S, et al. Immune response to vaccines is maintained in patients treated with dimethyl fumarate. Neurol Neuroimmunol Neuroinflamm 2018;5:e409.
- Kappos L, Mehling M, Arroyo R, et al. Randomized trial of vaccination in fingolimod-treated patients with multiple sclerosis. Neurology 2015;84:872-9.
- Ufer M, Shakeri-Nejad K, Gardin A, et al. Impact of siponimod on vaccination response in a randomized, placebo-controlled study. Neurol Neuroimmunol Neuroinflamm 2017;4:e398.
- Kaufman M, Pardo G, Rossman H, Sweetser MT, Forrestal F, Duda P. Natalizumab treatment shows no clinically meaningful effects on immunization responses in patients with relapsing-remitting multiple sclerosis. J Neurol Sci 2014;341:22-7.
- Olberg HK, Cox RJ, Nostbakken JK, Aarseth JH, Vedeler CA, Myhr KM. Immunotherapies influence the influenza vaccination response in multiple sclerosis patients: an explorative study. Mult Scler 2014;20:1074-80.
- Bar-Or A, Calkwood JC, Chognot C, et al. Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: The VELOCE study. Neurology 2020;95:e1999-e2008.
- Confavreux C, Suissa S, Saddier P, Bourdès V, Vukusic S. Vaccinations and the risk of relapse in multiple sclerosis. Vaccines in Multiple Sclerosis Study Group. N Engl J Med 2001;344:319-26.
- DeStefano F, Verstraeten T, Jackson LA, et al. Vaccinations and risk of central nervous system demyelinating diseases in adults. Arch Neurol 2003;60:504-9.