September is almost over and it is time for many to get the seasonal flu shot. There remains to be debate amongst those who live with chronic illness whether it is wise or necessary to get the vaccine. The Centers for Disease Control (CDC) recommends that those who live with chronic illness, especially those who are likely to experience complications from the flu, SHOULD get an annual flu vaccine.
Living with an autoimmune disease does not mean that we have weakened immune systems. Multiple sclerosis is an immune-mediated disease where specific parts of it respond inappropriately to normally occuring antigens in the body, acting as if they were foreign. In the case of MS, it is the myelin which is attacked.
With that said, however, some of the drugs we might use to treat MS can weaken or suppress the immune system. For example, I use methotrexate to treat rheumatoid arthritis. Methotrextrate, Imuran, Cytoxan, Novantrone - all are drugs used in MS which lower the immune system. We must NOT receive a “live-virus” vaccine such as Flu Mist.
Personally, I have been getting the annual flu vaccine for several years now. I haven’t yet this year, but will as soon as this nasty cold resolves.
Recommendations from the National Multiple Sclerosis Society
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. A person being vaccinated against H1N1 influenza will receive one dose of one of these vaccines. It is anticipated that these vaccines will be available in early to mid-October.
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 should be avoided by individuals with MS.
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:
- Pregnant women
- Persons who live with or provide care for infants under 6 months of age
- Healthcare and emergency services personnel
- Children and young adults aged 6 months to 24 years of age
- 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 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 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 H1N1 vaccine.
- People with MS should consult with their physician about obtaining a regular flu shot as soon as the regular flu vaccine is available.
- They should also discuss with their neurologist whether they should get the 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.