Ask the Expert – COVID-19 and Flu Vaccines

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of Barry A. Hendin, MD

Question: For individuals with MS who are taking a disease-modifying therapy (DMT) and plan to get both a COVID-19 vaccine as well as a seasonal flu vaccine, do they need to wait a certain amount of time between taking their DMT and between receiving each vaccine?

Answer: We recommend vaccination for COVID-19 and for flu for most people with MS after appropriate discussion with your doctor or primary care provider. The risk of COVID-19, as well as the risk of becoming sick from the flu, generally outweigh any risks associated with vaccination. We also recommend continued safety precautions including masking, handwashing, and avoidance of large indoor gatherings.

You can take the flu vaccine and COVID-19 vaccine on the same day. Trying to time your vaccination and disease-modifying therapy (DMT) relates primarily to the initiation of immunosuppressive DMTs. With some of these therapies, timing may be considered in order to optimize the effect of the vaccination.

For Gilenya® (fingolimod), Kesimpta® (ofatumumab), Lemtrada® (alemtuzumab), Mavenclad® (cladribine), Mayzent® (siponimod), Ocrevus™ (ocrelizumab), Ponvory (ponesimod), Rituxan® (rituximab), and Zeposia® (ozanimod), it’s generally recommended that vaccination be initiated two to four weeks before starting therapy, when possible. When Ocrevus and the experimental MS-therapy Rituxan have already been started, optimal vaccination response appears to occur when vaccination is given approximately four weeks before the next infusion. However, such timing may be difficult, and therefore in many instances, vaccination can be performed when available.

In addition, the COVID-19 vaccine and most flu vaccines are non-live vaccinations, and as noted above, these should be performed at least two to four weeks before starting immunosuppressive therapies if possible. While we generally do not recommend live vaccinations to individuals with MS if they can be avoided, live vaccinations should be performed at least four to six weeks before initiation of immunosuppressive therapies.

Barry A. Hendin, MD, is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.

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MS and the Flu Shot

MS and the FluIt’s that time of year again when the leaves start falling off the trees in earnest, the weather turns cooler, and the sniffles start to spread around offices and schools. Welcome to cold and flu season. When it comes to preventing the common cold or the flu, there are different strategies Continue reading

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I have MS – Can I Still Get a Flu Vaccine?

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Colorful foliage, the scent of pumpkin spice, football games…Ah, there are so many things to love about the cooler weather! Unfortunately, the approaching flu season is not one of them. Around this time of year and throughout the fall and winter seasons, we often encounter individuals with multiple sclerosis who wonder if they can still protect themselves from the influenza virus by getting a vaccine.

In most cases, “yes,” although anyone considering a flu shot should check with his or her doctor in advance. Also, if you have MS, you should first consider the following points before getting a flu vaccine:

Make sure you are getting the injected type of vaccine: Flu vaccines usually come in two forms – injected and intranasal. Because the intranasal variety contains a live rather than inactive virus, it is not recommended for people with MS. If considering a vaccine containing a live virus, please consult your doctor.

Consider whether you are currently having a relapse: People experiencing an MS relapse are often advised to wait a period of time before receiving a vaccine. Talk to your doctor to find out if this waiting period applies to you.

Talk to your physician first: Whether or not you are currently experiencing MS symptoms, it’s always important to consult with your physician before getting a vaccine. Discussing your plan with your doctor will ensure you are getting the right vaccination at the right time for you.

Want to learn more about MS and vaccinations? This information was adapted from MSAA’s July 2013 article, “Vaccine Safety and MS,” which was written by Susan Wells Courtney and reviewed by Jack Burks, MD, MSAA’s Chief Medical Officer.

No one wants to miss out on the fun of fall and winter because of the flu. But having MS doesn’t mean you can’t help protect yourself against influenza. For more information on preventing the flu, you can also read, “Angel’s Tips for the MS Community on Getting Prepared for Winter.”

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