MS and vaccines

Dear Dr. Roach: I have multiple sclerosis. I have been told not to get the shingles vaccine by one doctor, and I have been told to get the shot by another. I had the shingles twice a long time ago. Does the fact that it is a live culture have an effect on the recommendation? — D.M.

Answer: Multiple sclerosis is an autoimmune disease that may be triggered by the increase in the immune system response following some vaccinations. That has to be balanced against the benefits of not getting the disease. There remains controversy about this, and you must, of course, discuss it with your neurologist.

However, the National Multiple Sclerosis Society has made some recommendations, with which I agree. It concluded that influenza, hepatitis B, varicella and tetanus vaccines are safe for people with MS. Most live, attenuated vaccines are not recommended. These include the live flu vaccine (given by nasal spray; flu shots are not live vaccines, and flu shots are generally considered safe) and yellow fever vaccine, which is controversial. The current shingles vaccine Zostrix, even though it is a live, attenuated vaccine, is considered safe, because almost everybody in the age group of MS has had chickenpox and thus has the virus already in the body.

There is a new shingles vaccine called Shingrix, hopefully available soon. It is a subunit vaccine, made without any infectious virus. The MS society has not written about the new vaccine, but based on the biology of MS and shingles, I think that the benefit of the new vaccine greatly outweighs any small risk of an exacerbation. Again, this needs to be individualized with your doctor.

You can read the MS society’s recommendations here: http://bit.ly/2AIa7DK.