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Should you get a flu shot?

Learn whether doctors recommend these seasonal vaccinations for people with MS.

by Karen Appold

Cold and flu season will be here before you know it. But if you’re like many people with multiple sclerosis, you may wonder if getting a flu shot is safe for you. After all, if you have MS, your immune system has already gone a bit awry—mistakenly identifying healthy cells and tissues within the central nervous system as invaders, and causing inflammation and lesions. Will vaccinations further affect your immune system?

The answer is yes, but in a good way. Vaccination helps support your immune system, and reduces the risk of getting the flu by 50 to 60 percent in the general population. And as long as you get the injectable form, “the flu vaccine does not cause exacerbations or progression of MS,” says Dr. Lawrence Samkoff, associate professor of neurology at the University of Rochester Medical Center in Rochester, New York. In fact, the injectable flu vaccine has been studied extensively in people with MS and is considered quite safe, according to a 2002 paper published by the American Academy of Neurology.

Flee from the flu
Without vaccination, the flu (officially known as influenza) can cause its own damage. “When people with MS get influenza, their symptoms—particularly muscle weakness and spasms, imbalance, vision disturbances, tingling or burning pain in the arms and legs, and difficulty thinking—can become worse because injured nerves don’t function as well during an infection,” explains Dr. Samkoff. Such a relapse (also called an exacerbation) can be very debilitating. Therefore, physicians typically advise people affected by MS to get the flu vaccine.

Even if an individual’s MS isn’t exacerbated by a bout of influenza, it is still not an infection to take lightly. “This upper respiratory infection can become quite severe,” Dr. Samkoff says. Other complications are possible; these can include pneumonia, dehydration and low blood pressure. In worst-case scenarios, these complications could do further damage to your heart, lungs and kidneys, which could result in death.

Below: Dr. Mary Hughes answers a viewer’s question about flu shots for people with MS in this video, part of the National MS Society’s online educational webcast series.

Vaccination vagaries
Many people have heard anecdotes about people who get flu shots and then get the flu anyway. That can happen, Dr. Samkoff says, because the vaccine’s ability to prevent the flu ranges widely from season to season and from person to person. A person’s age and level of health play a role, as does the similarity or “match” between the particular strains of flu the vaccine is designed to protect against and the strains that spread in a community.

In most instances, if a vaccinated person does show symptoms of the flu, it’s a short-term reaction, typically lasting 24 to 48 hours, says Dr. Samkoff. Dr. Jonathan Howard, assistant professor of neurology and psychiatry at NYU Langone Multiple Sclerosis Comprehensive Care Center in New York City, points out that this is only a temporary inflammatory reaction that can mimic the flu, and is not the flu itself. “Down the line,” Dr. Samkoff adds, “even if you do still get the flu, the flu vaccine may reduce the severity of your symptoms.”

Ashley Ringstaff, 27, of Leander, Texas, who was diagnosed with MS in 2010, says she discussed the pros and cons of getting the flu vaccine with her neurologist. “We decided that it would be better to receive the flu shot—which could give me flu-like symptoms for a short time—rather than take a chance by not receiving the flu shot and then later catch the full-blown flu,” Ringstaff recalls.

As cautioned, after getting the flu shot she experienced body aches and weakness—but quickly recovered. Other than this, Dr. Samkoff says, there simply aren’t any other downsides to getting the flu shot for most people with MS.

The only other exception concerns people with MS who are experiencing (or who have recently experienced) a serious relapse and have been treated with steroid medications. This group should not receive the flu vaccine until four to six weeks after the relapse started. “This is because the steroids suppress the immune system’s normal response to vaccination,” Dr. Samkoff explains.

Some disease-modifying treatments (notably the interferons) can cause temporary flu-like symptoms such as fever, chills, fatigue and achiness within six to 12 hours after an injection. The flu vaccine can also cause a mild fever, which will also produce achiness and may make some MS symptoms temporarily feel worse.

However, there is no danger in having the flu vaccine when taking interferons or Copaxone® (or its generic form, Glatopa™). With some of the newer disease-modifying treatments (DMTs), such as Aubagio®, Gilenya® and Tecfidera®, the flu vaccine may not be as effective. And with Lemtrada™, vaccinations should be given six weeks prior to the start of treatment. Some types of vaccines for other illnesses should not be used with some of the DMTs. Therefore,it is of great importance to discuss vaccinations with your MS provider.

In addition, if you are having or have recently experienced a relapse, be sure to discuss the risks and benefits of vaccination with your healthcare provider.

Vaccine wanted—dead, not alive
It’s important to know that there’s more than one type of flu vaccination. However, only one kind—the injectable kind, which contains a killed virus—has been studied and found to be safe for people with MS. In addition, it does not interact with any MS DMTs or with other medications used to control MS symptoms, Dr. Samkoff says.

The other type, known by the brand name FluMist®, is a nasal spray that contains a weakened but not completely inactivated virus. There may be a risk of sparking an exacerbation of your MS if you get this live virus vaccine.

The bottom line? For most people with MS, getting a flu shot can help you stay healthy, and keep the risk of infection at bay, though it’s something you should always discuss with your healthcare provider.

“I was scared to not get the flu shot, because there was no telling what could happen to me if I got the flu,” Ringstaff says. “So it was an easy decision to make.”

Karen Appold is a Pennsylvania-based freelance writer.
Fall 2015
To learn more about flu shots and MS, visit nationalMSsociety.org/vaccinations.
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