Flu Shots and MS

Flu season is upon us, and people with multiple sclerosis (MS) are once again debating whether or not to get vaccinated. According to the National Multiple Sclerosis Society (NMSS), they absolutely should.

“The injectable flu vaccine, which is an ‘inactivated’ vaccine, is recommended for everyone over six months of age,” the NMSS states, “It has been studied extensively in people with MS and is considered quite safe.

"The injectable flu vaccine may be taken by people who are taking an interferon medication, glatiramer acetate, mitoxantrone, natalizumab, or fingolimod. However, it is not yet know whether the vaccine is as effective for those taking natalizumab or fingolimod.”

There is no chance of catching the flu from the injectable vaccine because it uses a dead virus. This is unlike the FluMist® nasal spray, which uses a live, replicating virus. The NMSS does not recommend the nasal spray for MS patients.

“When thinking about having the flu vaccine, you should talk to your neurologist to see if the MS medicine that you are on may make your body less responsive to the vaccine,” explains Daniel Kantor, M.D., the former president of the Florida Society of Neurology and the Medical Director of Neurologique, in an interview with Healthline.

“For the self injectables (the beta interferons and Copaxone), there is no bad interaction between the flu vaccine and the medications," he says. "For some of the newer medications, the flu vaccine may not be as effective as it would be otherwise. This is why it is a good idea to have a plan with your neurologist and primary care doctor about what you will do in the flu season.”

Even though the flu shot cannot cause the flu, some people with MS may feel lousy for a few days after they receive it. “If your body temperature gets increased after the vaccine, you may have an uncovering of older MS symptoms,” explains Kantor.

MS patients are often more susceptible to high temperatures because of a process called Uhthoff's Syndrome.

Read More About Heat Sensitivity and MS

A Few Caveats 

Although a flu shot is recommended, there are times when getting one might not be a good idea. “If a person is in the middle of another infection or in the middle of an MS relapse,” says Kantor, “I would probably [postpone] getting a flu vaccine. Also, if a person is allergic to any of the components of the flu vaccine then they shouldn't be vaccinated.”

While the shot is safe for those taking any of the MS disease modifying therapies (DMTs), getting vaccinated while taking steroids is something you should discuss with your doctor.

Vaccines work by introducing small amounts of a substance (in this case, the dead influenza virus) into a person’s system. The immune system then recognizes it as an invader and creates antibodies to attack it. These antibodies are then ready to prevent the infection from taking hold if you are exposed to someone who's sick.

Steroids are often given to MS patients who are relapsing in order to calm the immune system down. But because steroids work by halting the immune response, getting vaccinated during steroid use may not work. The immune system has to respond to the vaccine, and if the immune systems is dormant, antibodies won't form.

However, not being vaccinated and developing the flu while on steroids is a potential risk that also needs to be weighed. “Steroids can suppress your immune system and so put you at greater danger of getting the flu from people around you,” warns Kantor, “thus making vaccination even more important. Steroids can also prevent your body from fighting off the flu virus and so you may be sicker from the virus.”

“This is a perfect example of why medical care is best when it is done in a clinical setting within the doctor-patient relationship,” Kantor adds. “Your doctors can help you weigh the risks vs. benefits of being vaccinated while on steroids, which will also depend on the dose of the steroids and how long you are on steroids for.”

Debunking the Myths

The decision whether or not to vaccinate has been the subject of much debate in the MS community. “Some people are scared of vaccines in general because of a mixture of real risks and conspiracy theories,” Kantor says. “The flu vaccine is probably a good idea for most MS patients, as catching the flu can be disruptive to your life, and the flu vaccine does a fairly good job of helping you avoid the flu.”

Learn Where to Get Free or Discounted Flu Shots

Whether you get the vaccine or not, according to the Centers for Disease Control and Prevention (CDC), you can reduce your chances of catching or spreading the flu virus with some simple, common sense health tips:

  • Avoid people who are sick.
  • Cover your mouth and nose when coughing or sneezing to prevent the spread of germs.
  • Wash your hands frequently with soap and water, or use an alcohol-based hand sanitizer.