COVID-19 vaccines and MS: everything you need to know
Advice on COVID-19 vaccines for people with MS from our expert...
After a long and challenging year, a number of vaccines to protect against COVID-19 have been approved. In many countries, vaccinations have already made large leaps forward to reduce the virus.
As well as it being an exciting time it may have raised questions for you as a patient.
Our MS expert Dr. Adrian-Minh Schumacher advises on:
- Should I get a vaccine as an MS patient?
- Vaccines and disease modifying therapies
- Timings of vaccines and treatments
- Vaccines and relapses
- Side effects and feeling well afterwards
- How the new vaccine technology might change the way we treat MS
- Where to get country specific advice
You've also got the opportunity to ask Dr. Adrian-Minh your own questions.
Should I get a vaccine as an MS patient?
In short. Yes. You should take whichever vaccine you are offered.
Vaccines are an important part of protecting everyone in society from COVID-19. The scientific evidence has shown that all available vaccines are safe for use and effective. The coronavirus vaccines have had the same level of testing that any other approved vaccine has.
Since March, they have been safely given to many millions of people in all age groups and chronic diseases. There has also been close ongoing surveillance for side effects.
None of the approved vaccines contain live-attenuated viruses. This means that they will not cause COVID-19 or other infection and are unlikely to cause an MS relapse.
A slightly longer answer is that yes, you should get the vaccine. However, you may need to consider the timing of it if you are taking a treatment or want to start a new treatment.
Vaccines and disease modifying therapies
You should still have a vaccine if you are taking a disease modifying therapy.
Some treatments might affect how much protection you will get from the vaccine.
Why is this? Very simply put, a vaccination is an immune response to a foreign protein, called an antigen. Certain immune cells like lymphocytes play a major role during these antigen-triggered events.
Therefore, if you have a therapy that reduces B-lymphocytes e.g. ocrelizumab (Ocrevus), rituximab (Rituxan) or ofatumumab (Kesimpta), there might be a dampened immune response to the vaccine.
This also applies to therapies that affect lymphocyte receptors, like the S1P treatments fingolimod (Gilenya), ozanimod (Zeposia) or siponimod (Mayzent).
This does not mean you should not have the vaccine. The vaccine is still safe for you and some protection is better than none!
Timings of vaccines and treatments
To increase the effectiveness of the vaccine it may be recommended that you change the timings of your treatments.
This mostly applies to the above mentioned medication. It does not apply to interferon beta (Avonex), glatiramer acetate (Copaxone, teriflunomide (Aubagio), dimethyl fumarate (Tecfedira) and natalizumab (Tysabri).
This is not because it is unsafe to have the vaccine with your treatment. It is a strategy to increase the effectiveness.
Whether you need to make any changes to how you take your therapy will depend on:
- Which drug you’re taking
- Whether it’s a new treatment
- How vulnerable you are to COVID-19 generally
You don’t have to make this decision alone. Your health team will advise you based on your specific circumstances.
Vaccines and relapses
There is no evidence to suggest that either COVID-19 or any of the vaccines cause MS relapses.
If you are being treated with steroids due to a relapse you should consider delaying your vaccination. A delay of 14 days can improve the effectiveness of the vaccine.
You might see reports of people having relapses after having the vaccine. It’s important to remember that this is likely to be a coincidence and unrelated to it.
Side effects and feeling well afterwards
The most common side effects of the COVID-19 vaccines are:
- Pain and swelling around where you had the injection
You may recognise some of those symptoms as being MS symptoms! Try not to worry if you get some of these symptoms after your vaccination. It is very unlikely that they are a relapse.
The effect of a fever can make your MS symptoms worse, this is called the Uhthoff phenomenon. Your symptoms should return to normal after a few days.
Managing vaccine side effects:
- Take over the counter painkillers (e.g.ibuprofen or paracetamol)
- Plan to take it easy. This just takes the pressure off if you do feel unwell.
- If you’re worried about your side effects contact your MS care team
Still got questions?
Ask our MS expert, Dr. Adrian-Minh Schumacher.
We'll respond to your question via email within a few working days.
The vaccine isn't just stopping COVID-19...
...it might change the way we treat MS
Warning: it gets exciting but science-y here!
During all the discussions about the pandemic and vaccinations, something interesting happened for the MS community.
BioNTech, the company that delivered the first approved COVID-19 vaccine using mRNA technology, published a scientific study where they show an interesting new mechanism which could potentially treat multiple sclerosis.
The new idea
Our body’s immune system has to learn and fine tune every day, distinguishing its own structures (autoantigens) from foreign organisms like a virus or bacteria. So it has to stay tolerant concerning its own structures while it needs to arm itself towards harmful intruders.
In a similar way that we can stimulate the immune system to react to foreign antigens (like from the coronavirus) with a vaccine, we could make parts of the immune response more tolerant towards autoantigens (e.g. myelin) that accidentally get attacked by our immune system in MS.
Using a specialised messenger RNA, the team from BioNTech delivered disease-related autoantigens to mice suffering experimental autoimmune encephalomyelitis (EAE), an MS-like disease in mice which used a lot in research.
Increasing immune tolerance without increasing demyelination
You would normally assume that by delivering an autoantigen and inducing another immune response, the disease would become worse. But in this study, the opposite was the case.
In the study this reaction happened without an inflammatory signal (costimulating factor) which usually acts as sort of an alarm bell to reinforce the immune response. By doing this they were able to increase the immune tolerance in the mice.
Using this treatment, the researchers could show strong suppression of the disease’s inflammatory and demyelinating activity in the mice. But MS is more complicated. There is no single autoantigen that the immune system is targeting.
This is why the cells responsible for immune tolerance, called regulatory T-cells, need to act more generally in the way that they dampen the immune response (bystander immunosuppression).
The scientists were able to show that their approach could do so. This means a new potential therapy could increase the tolerance of the immune system without having to rely on a more ‘blunt’ immunosuppression like many current MS drugs do.
What happens next?
These interesting new treatment ideas will still have to undergo important research steps before they can be taken to humans. If after the additional research, it is still looking promising, the next step would be to do clinical research trials.
There is still a long way to go before this new idea possibly becomes an exciting new treatment. But still, very interesting times!
Where to get country specific advice
If you're looking for specific advice about vaccines in your country. Here is a list of localised resources.
COVID-19 Vaccine Guidance for People Living with MS (2021). COVID-19 Vaccine Guidance for People Living with MS. [online] National Multiple Sclerosis Society. Available at: https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance.
Di Filippo, M. et al. mRNA COVID-19 vaccines do not increase the short-term risk of clinical relapses in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry https://doi.org/10.1136/jnnp-2021-327200 (2021)
Achiron, A., Dolev, M., Menascu, S., Zohar, D.-N., Dreyer-Alster, S., Miron, S., Shirbint, E., Magalashvili, D., Flechter, S., Givon, U., Guber, D., Stern, Y., Polliack, M., Falb, R. and Gurevich, M. (2021). COVID-19 vaccination in patients with multiple sclerosis: What we have learnt by February 2021. Multiple Sclerosis Journal, 27(6), pp.864–870.
MS Coalition. Multiple Sclerosis Coalition | COVID-19 mRNA vaccine guidance for people living with MS. [online] Available at: https://ms-coalition.org/covid-19-mrna-vaccine-guidance-for-people-living-with-ms/.
CDC (2020). Coronavirus Disease 2019 (COVID-19). [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html.
MS Trust. (n.d.). MS Trust A-Z of MS - Relapse. [online] Available at: https://mstrust.org.uk/about-ms/ms-symptoms-and-relapses/managing-relapses#what-is-a-relapse.
This article provides general information and discussions about health and related subjects. The information and other content provided in this blog, website or in any linked materials are not intended and should not be considered or used as a substitute for medical advice, diagnosis or treatment.