In response to my last blog post about the H1N1 vaccine for people with MS, I got the following comment: “I am hoping that the person you are responding to does not take one of the current 5 choices of medicines to help control their MS. As I am sure you are aware they work by keeping the immune system busy and therefore not attacking your own body. If they are on one of these treatments, then yes they do have a weakened immune system.”
Well, kind of, but not exactly. I will try to clarify the role of some of the drugs that people with MS might be on and what is means in terms of the H1N1 and seasonal flu vaccines.
NOTE: This article is NOT meant to replace the advice of your primary care physician or neurologist. You should discuss your decision to get a flu shot (or not) with your physician.
People on These Medications SHOULD Get a Flu Shot
People receiving monthly infusions of immunosuppressants (such as mitoxantrone, cyclophosphamide, azathioprine or methotrexate) should get the flu shot. These people technically fall into the category of “immunosuppressed,” due to taking these medications.People on Solu-Medrol SHOULD Get a Flu Shot (But May Need to Wait)
The issue around Solu-Medrol and vaccines can be a little confusing. While the guidelines state that people who are getting monthly doses (pulse therapy) of Solu-Medrol should get the flu shot, the reason for this is that a regular monthly dose of Solu-Medrol can make people vulnerable to the flu because of suppression of the immune system.However, many neurologists delay the flu shot for 4 weeks after Solu-Medrol treatment for a relapse. The reason for this is that the (usually) gigantic dose of up to 1,000 mg of Solu-Medrol for 3 to 5 days 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. However, it is 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.
People on These Disease-Modifying Therapies CAN Get the Flu Vaccine
The CRAB (Copaxone, Rebif, Avonex, Betaseron) drugs are NOT immunosuppressants. Therefore, people taking them do not fall into the category of “immunosuppressed,” meaning that they are not more vulnerable to actually catching the flu than anyone else. However, due to the decreased lung function that comes along with MS, many of us are still in the high-risk group – even though our risk of catching the flu are not higher than anyone else’s, our risks of developing complications (namely pneumonia) ARE greater than that of an average person if we do happen to get the flu.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.Tysabri IS an immunosuppressant, for the record, and the CDC recommendations are that people on immunosuppressants get the shot. However, some neurologists are hesitant to wholeheartedly recommend the flu vaccine to their patients on Tysabri. As mentioned above in the section about Solu-Medrol, if you do not get the vaccine, having those in your household vaccinated (preferably with the flu shot and not the nasal mist version) against the flu is a smart precaution to take.
NOTE: People with MS should ONLY get the flu shot (as opposed to the nasal mist version of the vaccine), as it contains killed virus. The mist version contains live, attenuated (weakened) virus.
Sources: Immunizations and Multiple Sclerosis: Evidence-Based Management Strategies for Immunizations in Multiple Sclerosis Patients. Multiple Sclerosis Council for Clinical Practice Guidelines. November 2001.
