Flu Shots

What do I need to know about the flu vaccine?

  • The 2016-2017 inactivated seasonal influenza (flu) immunization is a single injection that provides immunity to three or four different flu viruses.
  • The 2016-2017 inactivated seasonal flu immunization is recommended by the Centers for Disease Control and Prevention (CDC) for everyone over 6 months of age.
  • The seasonal flu vaccine has been studied extensively in people with MS and is considered quite safe, regardless of the disease-modifying therapy they are taking.
  • A high-dose inactivated flu vaccine (Fluzone High Dose) is available for people over age 65. The high-dose vaccine has not been studied in people with MS of any age. For these reasons, we recommend that only the standard dose of the influenza vaccination (flu shots) be used for  people with MS.
  • Getting vaccinated before flu season begins is the most effective way to prevent flu. For these reasons, the CDC recommends that people get a flu vaccine by the end of October, if possible. However, getting vaccinated later can still be beneficial. The CDC recommends ongoing flu vaccination as long as influenza viruses are circulating, even into January or later.
  • Hard Immunity – If you can’t get vaccinated for some reason, make sure people in your immediate family and household are vaccinated.

Are their specific studies that show the flu vaccine is safe for MS patients?

  • A study by the Vaccines in Multiple Sclerosis Study Group published in 2001 in the New England Journal of Medicine found that vaccination for tetanus, hepatitis B or influenza did not appear to increase the short-term risk of relapses (also called attacks or exacerbations) in people with MS.
  • A study by the National Immunization Program of the Centers for Disease Control and Prevention, published in the Archives of Neurology in 2003, found that vaccination against hepatitis B, influenza, tetanus, measles, or rubella did not increase a person’s risk of developing MS or optic neuritis (which is often a first symptom of MS).

If I am on a specific disease modifying therapy, will the vaccine be effective?

  • A study published in Neurology in 2015, evaluated the effectiveness of the flu vaccine in fingolimod-treated patients. Researchers found that most fingolimod-treated patients with MS were able to mount immune responses with the vaccine, and the majority met criteria indicating seroprotection. However, response rates were reduced compared with placebo-treated patients.  Overall, there was some decrease in vaccination-induced immune responses among the fingolimod treated patients. Despite this, we still recommend that patients on Fingolimod receive a flu vaccine. http://www.neurology.org/content/84/9/872.short
  • A study, published in Neurology in 2013, investigated the effect of teriflunomide on the efficacy and safety of the influenza vaccine and found that teriflunomide-treated patients generally mounted effective immune responses to seasonal influenza vaccination. Researchers concluded that teriflunomide generally does not adversely impact the ability of MS patients to mount immune responses to influenza vaccination.  http://www.neurology.org/content/81/6/552.short
  • A small case-control study, published in Neurology in 2013, assessed immunocompetence in patients after alemtuzumab treatment by measuring antibody responses to several vaccines before and after treatment.  Researchers concluded that serum antibodies against common viruses remained detectable after treatment, and there was retained ability to mount an immune response against new antigens after treatment with alemtuzumab. http://www.neurology.org/content/81/10/872.short We recommend that patients on Lemtrada (Alemtuzumab) get their flu vaccine about 6 weeks before their infusion.
  • If you are taking interferon beta 1a (Avonex, Rebif), glatiramer acetate (Copaxone), or natalizumab (Tysabri), the flu vaccine is likely effective.  This is based on these medications’ mechanisms of action.
  • There is limited data on the efficacy of the flu vaccine for dimethyl fumarate (Tecfidera) and ocrelizumab.