So you make it through the heat of the summer, start enjoying the beautiful fall temperatures, then realize, in horror, that people are starting to sniffle -- it’s flu season.
Here’s the bottom line on the flu shot:
Most of us with MS should get it, unless you are in the middle of a relapse (delay it) or don’t fall into any of the categories mentioned below and really, really don’t want it. It is safe for people with MS and can prevent relapses -- besides, who wants the flu on top of everything else? I know that I roll up my sleeve mid-September and go on a frantic quest for my shot.
Now, here are the specific recommendations of the Multiple Sclerosis Council for Clinical Practice Guidelines, a mighty organization which includes the National Multiple Sclerosis Society, the American Neurological Association and the Consortium of Multiple Sclerosis Centers, among many others.
What Is The Flu Shot?The influenza vaccine (flu shot) is an inactivated vaccine. That means it contains killed virus that was originally grown in eggs for this purpose. It is given with a needle, usually in the arm. The vaccine itself is changed every year and contains three strains of the influenza virus. These are the strains that researchers, based on studies and best guesses, have determined will offer the most defense for that particular year.
IMPORTANT NOTE: People with MS should NOT get FluMist, the flu vaccine which is a nasal spray. This is a live virus vaccine, and could be harmful to people with MS, especially anyone taking an immunosuppressant drug.
Get a Flu Shot if You Meet the CDC Indications
Whether you have MS or not, you should get the flu shot if you fall into one of these categories (or come into contact with someone in one of these categories):
- People 50 years of age and older
- Residents of long-term care facilities
- Children 6 months to 5 years old
- People with chronic cardiovascular and pulmonary disorders, including asthma,)
- People with chronic metabolic diseases (including diabetes), renal dysfunction, hemoglobinopathies, or immunosuppressive or immunodeficiency disorders
- Pregnant women
- Anyone who can infect high-risk people, including household members and caregivers; anyone coming into contact with babies younger than 6 months old
- Anyone who wishes to reduce the likelihood of getting the flu
Specific Points for People with MS
Why You Should Get a Flu Shot:
- Limited Mobility Impairs Lung Function
People who spend much of their time in a wheelchair or scooter, or those who are bed-bound much of the time, should get the flu shot as such inactivity can affect pulmonary health.
- Taking Drugs Suppresses the Immune System
People receiving monthly infusions of Solu-Medrol or immunosuppressants (such as mitoxantrone, cyclophosphamide, azathioprine or methotrexate) should get the flu shot.
- The Flu Shot Can Prevent Relapes
Having the flu can bring on a relapse or make your symptoms worse, so anyone with MS could fall under the last point in the CDC recommendations (I know I do) should get the shot. However, experts are split on the idea of strongly recommending it to people with MS who simply don’t want it for whatever reason (don’t like vaccines or don’t ever get the flu, so don’t see the reason for getting the shot).
- If You Are Having a Relapse
Most neurologists do not give the flu shot to someone in the middle of a relapse for two reasons: The minor side effects of the shot (like fever) could worsen the relapse, and if you are getting major doses of Solu-Medrol at the time, it could reduce the effectiveness of the vaccine (and it would be better to wait). This does not include people with sensory symptoms only. The experts recommend that people wait about 4 to 6 weeks after their relapse started (until they “stabilize") or 4 weeks after the last dose of Solu-Medrol.
- If You Are On Tysabri (Ask Your Doctor)
Ask your doctor about getting a vaccine or flu shot while you are being treated with Tysabri. Some docs encourage it, some forbid it and some suggest that patients wait 2 to 3 weeks after their last infusion before getting the shot.
- Immunosuppressant Confusion
While the guidelines state that people who are getting monthly doses of Solu-Medrol should get the flu shot, they mention that most neurologists usually delay the flu shot for 4 weeks after Solu-Medrol treatment for a relapse. The reason for this is that a regular dose of Solu-Medrol can make people vulnerable to the flu because of suppression of the immune system.
- Disease-Modifying Therapies
The CRAB (Copaxone, Rebif, Avonex, Betaseron) drugs are NOT immunosuppressants. Therefore, people taking them do not fall into the category of “immunosuppressed.” However, there is no reason that people taking these drugs should not get a flu shot, as it's perfectly safe to give the vaccine in conjunction with use of these medications.
However, the (usually) gigantic dose that people receive to shorten relapses pretty much turns the immune system off. Vaccines need some immune response in order to work, so it is best to delay them for about a month, until your immune system starts working again. It is also extremely important that people in your house get the flu shot while you are waiting, as you will be very vulnerable to infection during that time.
One Last Thing:As brave as I talk about the flu shot, I'll have to say that I don't love getting it. I tend to feel kind of "MSy" afterwards, mainly experiencing a little dizziness and feeling "dull-headed" for a couple of days after I get the injection. I have found this eases up a little when I stay on a little Tylenol regimen, starting about an hour before the shot, then a couple times a day for the next three days.
Immunizations and Multiple Sclerosis: Evidence-Based
Management Strategies for Immunizations in Multiple Sclerosis Patients. Multiple Sclerosis Council for Clinical Practice Guidelines. November 2001.
Natalizumab Injection (Tysabri). MedLine Plus.
Immunizations and Multiple Sclerosis: Evidence-Based Management Strategies for Immunizations in Multiple Sclerosis Patients. Multiple Sclerosis Council for Clinical Practice Guidelines. November 2001.
Natalizumab Injection (Tysabri). MedLine Plus.