The good news is that simply having MS doesn’t make a person more likely to become infected with COVID-19 or have a severe case or die from it. But some groups of people with MS are more likely to become seriously ill if they get COVID-19. That includes people with progressive MS; older people; men; Black and Hispanic/Latino people; people with higher levels of MS-related disability; people who are obese; people who have other chronic health conditions along with MS, including diabetes, heart disease, and lung disease; and people who take certain disease-modifying therapies, according to the National Multiple Sclerosis Society (NMSS).
Is It Safe for Me to Get Vaccinated if I Have MS?
Now that COVID-19 vaccines that offer protection against the virus have become widely available, one question is likely top of mind: Is it safe for me to get vaccinated if I have MS and am undergoing treatment for it? The answer is yes, although there are some things to consider. Generally speaking, the NMSS recommends that most people with relapsing and progressive forms of MS get vaccinated against COVID-19. While research is currently under way to learn more about the specific experiences of people with MS who receive a COVID-19 vaccination, clinical trials of the general population and studies of other vaccines given to people who have MS suggest that the shots are safe and effective. “Overall, getting the COVID-19 infection is still more risky than getting the vaccine, for people with MS in particular, as the virus can cause new neurological attacks, the return of old neurological symptoms called pseudo-exacerbations, more fatigue and cognitive fog, severe headaches, and other complications,” says Lauren Gluck, MD, assistant professor of neurology at Albert Einstein College of Medicine in New York City. “Since these vaccines are not ‘live’ vaccines — that is, they don’t contain actual viral particles — there’s no chance of getting the actual infection from the vaccine, even if you are on immunosuppressing therapies for MS,” Dr. Gluck adds. Members of the same household and close contacts of those with MS should also be vaccinated against COVID-19 when possible to reduce the impact of the virus on family and friends with the condition, per the NMSS.
Which Vaccine Should I Get if I Have MS?
Any of the COVID-19 vaccines approved for your age group are safe for people who have MS, notes the NMSS. However, because the Centers for Disease Control and Prevention (CDC) now recommends the Pfizer-BioNTech, Moderna, and Novavax vaccines over the Johnson and Johnson vaccine, people with MS should select those vaccines if possible. Even if you’ve already been vaccinated, you still need to stay up to date on your shots with boosters, adds the NMSS. The CDC recommends that people age 5 or older receive one updated (bivalent) booster if it has been at least two months since your last COVID-19 vaccine dose. This guidance applies whether your last dose was your final primary series dose or an original (monovalent) booster. If you have gotten more than one original (monovalent) booster, the CDC also recommends that you get a bivalent booster. If you are moderately or severely immunocompromised (a category that includes some people with MS), the CDC also recommends that you get an extra primary series dose if you’re receiving the Moderna or Pfizer-BioNTech vaccine.
The Best Time for Vaccination May Depend on Your MS Treatment
If you are using a disease modifying therapy (DMT), continue taking it unless you are advised by your MS healthcare provider to stop or delay it, notes the NMSS. Abruptly stopping some DMTs can cause a severe increase in disability and the development of new lesions. Studies of other vaccines and DMTs suggest that getting the COVID-19 vaccine while on any DMT is safe. Still, the NMSS and other groups are urging those with MS to talk to their doctors first to make sure they coordinate their COVID-19 vaccination with their MS treatment. That’s because it’s possible that the vaccines won’t be as effective for those on certain DMTs, depending on when you get inoculated during your regular treatment schedule. To maximize the efficacy of your vaccine, if you’re taking the DMTs ofatumumab (Kesimpta), alemtuzumab (Lemtrada), ocrelizumab (Ocrevus), or rituximab (Rituxan), you may need to coordinate the timing of your vaccine with the timing of your DMT dose. The timing depends on which DMT you’re using, but as described in an article published in 2020 in CNS Drugs, research suggests that ideally, for maximum protection, you should get vaccinated toward the end of your MS treatment cycle, up to four weeks before your next scheduled injection or dose of pills. “Based on data about other vaccine responses while on these drugs, I recommend waiting four to five months after your last Ocrevus or Rituxan infusion or talking to your doctor about whether to delay your Kesimpta injections,” says Gluck. “Making these adaptations to your treatment will give you the best chance of an effective vaccine response. Taking the vaccine without these changes will not be dangerous but may not produce a robust immunity to COVID-19.”
The Current Guidance Is Based on Studies of Other Vaccines
The guidance for the COVID-19 vaccine is based on studies of other vaccines, like the flu shot, and DMTs — not the COVID-19 products approved for use in the United States. Indeed, it’s unclear how many people with MS or those on DMTs were included in clinical trials of the three COVID-19 shots, even though all indications are that they’re perfectly safe, Gluck says. And even a vaccine that is less effective because of a DMT will offer more protection than no vaccine at all, according to the NMSS. RELATED: Is It Safe to Get a Flu Shot While Taking MS Drugs? Importantly, you don’t need to take extra precautions when getting the COVID-19 vaccine, Gluck notes. You can receive the shot at any facility listed by your local department of health, as opposed to needing to go to a doctor’s office or hospital, she says. “MS doctors, including myself, and the NMSS are encouraging people with MS to get the COVID-19,” Gluck says.
Do People With MS Need to Wear a Mask Post-Vax?
The NMSS recommends that people who have MS continue to wear a face mask, stating, “For people with MS, especially those in high-risk groups and those taking a DMT that might reduce the effectiveness of the vaccines, the safest approach is to continue wearing masks, practicing social distancing, and performing regular hand-washing.”
Research Shedding Light on Immune System Responses
One way to see whether a person has had COVID-19 is to do an antibody test. Antibodies are proteins produced as part of the body’s immune response to foreign proteins such as viruses. In simple terms, antibodies locate and attack foreign proteins. A COVID-19 antibody test specifically looks for antibodies to SARS-CoV-2, the virus that causes COVID-19. When a person is immunocompromised, either because of having a particular disease or because of using a drug that suppresses the immune system, that person may not make many — or any — antibodies to fight off a virus. Some drugs used to treat MS deplete certain immune system cells, and researchers and people with MS alike would like to know whether taking those drugs lowers the body’s ability to fight off COVID-19. They’d also like to know whether those drugs reduce the effectiveness of the COVID-19 vaccines. While it may take some time to come up with definitive answers, researchers have begun to investigate the questions. Preliminary results of a study presented at the 2021 American Academy of Neurology virtual meeting showed that people with MS who were on Ocrevus and became infected with COVID-19 produced fewer antibodies to the virus than those not on Ocrevus. However, T-cell responses to the virus that causes COVID-19 (T-cells are immune system cells that fight off viruses inside infected cells) were not diminished in those on Ocrevus, and the individuals on Ocrevus did not have more severe COVID-19 than those not taking Ocrevus. These two facts together indicate that other parts of the immune system, besides antibodies, were able to provide protection against SARS-CoV-2. What effect Ocrevus and other MS drugs that suppress the immune system may have on individuals’ response to the COVID-19 vaccines remains to be seen. A study at the University of Colorado, Denver, and NYU Langone Health Multiple Sclerosis Comprehensive Care Center in New York City is examining the immune response to the two mRNA vaccines, namely the Pfizer-BioNTech and Moderna COVID-19 vaccines, in people with MS who are on Ocrevus. This study is still ongoing. Additional Reporting by Christina Vogt.
