Oct 06, 2009
Regular flu shot: As in previous years, the National MS Society recommends a regular flu shot as a safe and effective vaccination for people with MS. The flu shot—which is a de-activated or “killed” vaccine—can safely be taken by individuals who are on any of the disease-modifying medications (Avonex®, Betaseron®, Copaxone®, Rebif®, Novantrone®, or Tysabri®).
FluMist Intranasal®: In 2003, the FDA approved a flu vaccine nasal spray “for healthy children and adolescents, ages 5-17, and healthy adults, ages 18-49.” According to Dr. Aaron Miller, the Society’s Chief Medical Officer, FluMist—which is a live, weakened vaccine—is not recommended for use by people with MS, and should specifically be avoided by any person with MS who is on an immunosuppressive medication such as mitoxantrone (Novantrone®), cyclophosphamide (Cytoxan®), azathioprine (Imuran®), or methotrexate.
• Live-virus vaccines are more likely than de-activated-virus vaccines to cause an increase in disease activity in people with MS.
• A person taking an immunosuppressive medication is more susceptible to developing an infection with the vaccine strain of the virus—an infection that may be particularly severe because the person’s immune system is suppressed.
• The interactions between live vaccines and the disease-modifying medications are not known.
H1N1 (Swine Flu) vaccine: On September 15, the U.S. Food and Drug Administration (FDA) approved four vaccines for the H1N1 flu virus. The vaccines are manufactured using similar processes by four different companies. An adult over the age of nine being vaccinated against H1N1 influenza will receive one dose of one of these vaccines. Children under nine will receive two doses.
Three of the H1N1 vaccines are de-activated or “killed” vaccines that are administered by injection. These de-activated vaccines are considered safe for people with MS. One is a live, attenuated vaccine that is administered by nasal spray. This live, nasal spray vaccine, which will be the first vaccine to become generally available, should be avoided by individuals with MS. By mid-October, both the live and de-activated vaccines are expected to be available in limited quantifies
The initial supply of H1N1 vaccine will not be adequate to vaccinate everyone. The CDC has indicated that five groups will initially be targeted for vaccination:
o Pregnant women
o Persons who live with or provide care for infants under 6 months of age
o Healthcare and emergency services personnel
o Children and young adults aged 6 months to 24 years of age
o Persons aged 25-64 who have medical conditions that put them at higher risk for influenza-related complications.
It is important to note that people with disabilities (including people with MS) are not necessarily considered by the CDC to be part of this high-priority group. However:
The flu virus (like any other virus) can precipitate MS exacerbations.
A person with advanced MS or someone with less severe disease (Kurtzke less than 6.0) who has reduced pulmonary function or has any difficulty with breathing is considered at risk for complications and a good candidate for the H1N1 vaccine.
We recommend that people talk with their MS doctor to determine if they are a good candidate for the de-activated H1N1 vaccine.
• People with MS should consult with their physician about obtaining a regular flu shot as soon as possible.
• They should also discuss with their neurologist whether they should get the de-activated H1N1 vaccination because (1) catching the flu would put them at greater risk of an exacerbation, or (2) their MS symptoms are severe enough to put them at risk for flu complications.
• The FluMist nasal spray vaccine and the live, attenuated nasal spray version of the H1N1 are not recommended for people with MS.
We will update this Web site when new information is forthcoming. You can read information from the Centers for Disease Control (CDC) about the regular flu vaccine at http://www.cdc.gov/flu/protect/keyfacts.htm and the H1N1 vaccine at http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm. Comprehensive information is also available at www.flu.gov.