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Ms And Vaccines

Guest allanopie

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Guest allanopie

Multiple Sclerosis Foundation

MS and Vaccines


MS and Vaccines



One woman with MS wonders what will happen if her husband, a military man, is required to get a smallpox vaccine, which the Centers for Disease Control and Prevention (CDC) warn, contains a live virus. Will his vaccination affect her MS? What precautions will she need to take? Another woman worries about her doctor's recommendation that she receive a flu shot. Won't that aggravate her MS symptoms?

As with so many concerns regarding MS, the answers are often ambiguous and elusive. But recent research has produced some basic guidelines.


Concerns about the safety of the smallpox vaccine for people with MS and their family members arose recently following the release of information from the CDC.

According to the CDC, some people are at greater risk for serious side effects from the smallpox vaccine. Individuals who have any of the following conditions, or live with someone who does, should NOT get the smallpox vaccine unless they have been exposed to the smallpox virus:

  • Eczema or atopic dermatitis.
  • Skin conditions such as burns, chickenpox, shingles, impetigo, herpes, severe acne, or psoriasis.
  • Weakened immune system. (Cancer treatment, an organ transplant, HIV, or medications to treat autoimmune disorders and other illnesses that can weaken the immune system.)
  • Pregnancy or plans to become pregnant within one month of vaccination.
  • Those who are allergic to the vaccine or any of its ingredients.
  • Those younger than 12 months of age. The Advisory Committee on Immunization Practices advises against non-emergency vaccination in children under the age of 18.
  • Those with a moderate or severe short-term illness. (Wait until completely recovered.)
  • Currently breastfeeding.

    The question arises, do individuals with MS have a 'weakened immune system'? In reality, those with MS have an overactive immune system, not a weakened one. But when the immune system is suppressed by treatment with high-dose corticosteroids, Novantrone®, or other immunosupressing agents, it seems weakened when confronted with the smallpox vaccine.


    These and other concerns were addressed, although absolute conclusions were not always reached, in a special article entitled, "Immunization and MS" in the December 2002 issue of Neurology. This article was a collaborated effort by Oliver T. Rutschmann, MD, MPH; Douglas C. McCrory, MD, MHSc; David B. Matchar, MD; and the Immunization Panel of the MS Council for Clinical Practice Guidelines.

    The authors searched MEDLINE (1966 to January 2001; U.S. National Library of Medicine, Bethesda, MD), HealthSTAR, and Cumulative Index to Nursing and Allied Health Literature database.

    All available data was pooled and analyzed, whereupon the authors asserted that, "There is strong and consistent evidence that infections - even common upper respiratory tract infections such as colds - are associated with an increased risk of MS exacerbations. Therefore, it seems reasonable to promote any healthcare strategy that may reduce the risk of acquiring infections. Immunizations are health care strategies that can reduce the risk of some infections."

    With smallpox, two case reports were identified. The first showed an exacerbation of MS after immunization, and the second reported an improvement of MS symptoms after repeated smallpox vaccine injections. Thus, there is insufficient evidence to support or reject an increased risk of exacerbation after smallpox vaccine.


    For other vaccines there is also insufficient evidence to form any absolute conclusions. However, evidence does support strategies to minimize the risk of acquiring infectious disease that may trigger exacerbations of MS, and the safety of using influenza, hepatitis B, varicella, tetanus, and Bacille Calmette-Guerin (BCG) vaccines in patients with MS.

    It should also be noted that, "this review identified strong, reassuring evidence that influenza vaccine is safe and is not associated with a significant increased risk of MS exacerbation."

    Currently, there is not enough evidence to determine if vaccines are as effective in the MS population, as in the general population. More research is needed to determine their efficacy for people with MS. But, current information indicates that vaccination is advisable where there is risk of acquiring serious illness.


    Based on the researchers' results, the Immunization Panel of the MS Council for Clinical Practice Guidelines recommends that:
    • Patients with MS should follow CDC indications for immunizations http://www.cdc.gov/nip/recs/adult-schedule.pdf
    • Vaccination should be delayed during clinically significant relapses, until patients have stabilized or have begun to improve from the relapse, typically four to six weeks after the start of the relapse. For patients requiring tetanus vaccination after a wound, however, the panel recommends not to delay, even in the midst of relapse.
    • Potential risks and benefits of vaccination should be discussed individually with your doctor.
    • Pneumococcal vaccine should be considered for patients with compromised pulmonary function, such as wheelchair-dependant or bed-bound patients.


    What You Need To Know:

    Because the smallpox vaccine contains a live virus, (called vaccinia) it does present special concerns. The primary concern is for people who have close, physical contact with someone who has gotten the vaccine because the vaccinia virus can be spread from the vaccination site. This can cause mild to severe rash, head and body aches, and fever.

    Vaccinated persons can spread vaccinia to other people by touching a vaccination site before it has had the chance to heal, or by touching clothing, bandages, or other material contaminated with the live virus. In the past, this was reported between 20 to 60 times out of one million primary vaccinees, often involving children.

    General Guidelines from the CDC:

    [*]Do not touch the vaccination site or any materials that might be contaminated with live virus from the site (bandages, towels, clothing, washcloths)

    [*]If you accidentally come in contact with the vaccine site, wash immediately with soap and water.

    [*]If you share a bed with someone who has been vaccinated, be sure that they wear a gauze bandage held in place with medical tape. As an extra precaution, a shirt or pajamas may be worn over the bandaged vaccine site. If not, you may choose to sleep separately.

    [*]Keep a separate laundry hamper for clothing, towels, or bedding that have come in direct contact with the vaccine site or drainage from the site. Launder with warm water, detergent and/or bleach, and wash carefully afterwards.

    [*]The person who got the vaccine must follow site care and hand washing instructions. If their hand is contaminated, and they touch you, you can contract vaccinia.

    For more information, visit the CDC website at http://www.bt.cdc.gov/agent/smallpox/vaccination/

    © Copyright 2000-2003 Multiple Sclerosis Foundation - All Rights Reserved.

Edited by allanopie
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