Patients with multiple sclerosis generally should receive recommended vaccinations, including yearly influenza shots, according to a new guideline from the American Academy of Neurology (AAN).

The guidelines, published online by the journal Neurology, also is endorsed by the Consortium of Multiple Sclerosis Centers and by the Multiple Sclerosis Association of America. It is an update of the 2002 AAN guideline on immunization and multiple sclerosis.

Vaccine guidelines. Source: Getty

“We reviewed all of the available evidence and for people with MS, preventing infections through vaccine use is a key part of medical care,” saidlead guideline author Mauricio F. Farez, MD, MPH, of the FLENI Institution in Buenos Aires, Argentina, and a member of the American Academy of Neurology. “People with MS should feel safe and comfortable getting their recommended vaccinations.”

The guideline includes the following major recommendations, all level B except where indicated. The document advised that clinicians should:

• Discuss the evidence regarding immunizations in MS with their patients and explore patients' opinions, preferences, and questions;

• Recommend that patients with MS follow all local vaccine standards, unless there are specific contraindications;

• Recommend that patients with MS receive the influenza vaccination annually;

• Counsel patients with MS about infection risks associated with specific Immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information (PI) and vaccinate patients with MS as needed at least 4–6 weeks before initiating patients' ISIM therapy;

• Screen for infections according to prescribing information before initiating ISIM medications (Level A) and should treat patients testing positive for latent infections;

• Screen for latent infections before starting ISIM therapy even when not specifically mentioned in prescribing information in high-risk populations (Level A) and should consult specialists regarding treating patients who screen positive for latent infection;

• Recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies; and 

• Delay vaccinating patients with MS who are experiencing a relapse. 

In terms of the patients’ role, the guideline recommends that clinicians be informed what MS medications are being used before they administer vaccines. The document points out that some evidence indicates that certain vaccinations might not work as well with certain MS medications.

In addition, the guideline recommends that patients experiencing an MS flare consult their doctor before receiving vaccinations. “After reviewing all the available evidence, we found that there is not enough information to say whether or not vaccinations trigger or worsen MS flares,” Farez said. . “Still, experts in MS urge their patients to hold off on scheduling their vaccinations if they are having an MS flare simply to avoid the potential for any complications.”