Should Ms Patients Get The Shingles Vaccine

Is There A Vaccine For Ms

Currently, there is no vaccination to prevent MS. However, researchers are working to develop one.

After partnering with Pfizer to help develop an mRNA vaccination for COVID-19, a German company called BioNTech recently tested an MS vaccine on mice. The scientists found in their study that the vaccination halted the progression of MS. Though the research gives reason to be hopeful, a lot more testing is necessary before a vaccine for MS becomes available for humans.

According to a review of studies, BCG vaccination may help prevent symptoms of MS from getting worse. It is unclear, however, whether it can help prevent MS from occurring in high risk populations.

Several studies have examined whether various vaccinations can cause MS.

For example, according to a , previous studies on the flu shot causing MS showed no association between this vaccination and the onset of MS.

A 2018 review showed that there is no connection between the HPV vaccination and MS. However, the authors did note that the reviewed studies had low statistical value due to the rarity of MS cases.

In short, earlier studies showed potential links between certain vaccinations and MS, but current studies show that no vaccinations will cause MS.

Who Is At Risk For Shingles Infection

Although it can occur at any age, shingles is more common in older adults and in people with compromised immune systems. In fact, those who are immunocompromised are 1-6 times more prone to infection and have a significantly higher risk of recurrence.

Even people with normal immune systems are at greater risk as they age. Because our immune systems tend to weaken as we get older, by age 50 many people previously infected with chickenpox will have lost the specific immunity they developed after the original infection. When this happens, the virus can wake up and trigger shingles. Some experts believe that chronic stress, some medications and certain health conditions may also trigger the virus to reactivate.

In addition, people who have had COVID-19 are at increased risk. In a recent study, researchers have found that patients over 50 with a history of COVID-19 infection have a 15 percent higher risk of getting shingles, says Dr. Kumar.

Patients With Ms Reactivation Of Varicella

Individuals with multiple sclerosis should follow vaccine guidelines before starting disease-modifying therapies, case study results show.

Individuals with multiple sclerosis should follow proper vaccination guidelines from the CDC before starting disease-modifying therapies and report initial signs and symptoms of zoster reactivation while they are on the medication, results of a study published in Cureus showed.

The case follows a 66-year-old woman who was treated for MS with a delayed-release oral DMF and had reactivation of the varicella-zoster virus.

She was diagnosed with MS about 2 decades ago and began taking interferon beta-1b for approximately 4 years before switching to interferon beta-1a, because of tolerance issues.

After developing pancytopenia, she discontinued interferon beta-1a and started taking a delayed-release dimethyl fumarate 240 mg capsules twice a day for 6 years, until the zoster rash reappeared.

She had not received the zoster vaccine.

After the patient reported fatigue with no other new symptoms, laboratory results showed lymphopenia with an ALC of 590 cells/µl, which is grade 2 lymphopenia, but she had a normal white blood cell count.

She was found to have indeterminate anti-JC virus antibody titers of 0.21. She continued on the DMF, because it was effective and was also prescribed long-acting methylphenidate for fatigue.

Reference

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A Closer Look At The Safety Data

Both Shingrix and Zostavax shingles vaccines have been shown to be safe and well tolerated. Common side effects, such as soreness and redness at the injection site, are usually mild to moderate in intensity and resolve quickly on their own.

Shingrix

In 8 clinical trials of more than 10,000 participants:

• Grade 3 reactions were common after patients received Shingrix.
• About 1 out of 10 adults who received Shingrix reported grade 3 injection-site symptoms such as pain, redness, and swelling.
• About 1 out of 10 reported grade 3 systemic reactions such as myalgia , fatigue , headache, shivering, fever, and gastrointestinal illness.
• Most people who got Shingrix reported at least some pain at the injection site.

Zostavax

• A 2013 study showed that patients with a history of a previous shingles rash had the same side effects after Zostavax as those with no history of shingles. See Safety of zoster vaccine in elderly adults following documented herpes zoster.

Vaccinations In Multiple Sclerosis Patients On Treatment With Disease

While vaccination must be avoided in MS patients who are experiencing a relapse until clinical resolution or until the relapse is no longer active,7 several studies have shown that vaccinations do not increase the short-term risk of relapses in MS.8

Clinical and epidemiological studies as well as pharmacovigilance data repeatedly demonstrated the safety of the vast majority of vaccines in MS patients. Recently, a review concluded that there is no significant evidence for a causal relationship between a deterioration of MS and vaccination against a range of infectious diseases .9 Some studies even indicated reduced disease activity in preexisting MS in vaccinated individuals.10

Recent studies revealed that immunizations with inactivated or subunit vaccines are not associated with an increased risk of complications in MS patients.5,8,1113 However, this does not apply to live attenuated vaccines,3,14 due to the replicative capacity of the pathogens in these preparations and the lack of comprehensive meaningful data. Serious complications have been reported after the application of live attenuated vaccines against, for example, yellow fever and measles in immunocompromised patients.15,16

With these caveats in mind, MS patients should generally be vaccinated according to recommendations for adults. This recommendation must be adapted according to the individual patient profile or medical history and any ongoing immunotherapies .

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Why You Shouldn’t Get The Shingles Vaccine

• Medical Reviewer: Dany Paul Baby, MD

Medically Reviewed on 5/24/2022

Shingles is a disease that usually presents with a painful rash that affects one in three people in their lifetime. It is caused by the same virus that causes chickenpox the herpes virus varicella-zoster. More than 99% of people born before 1980 have had chickenpox and have this virus dormant in the brain or spinal cord.

Shingles activates when your immunity is low, usually with advancing age. The currently used recombinant zoster vaccine is safe and effective. But not everyone who is a candidate for the shingles vaccine should take it. Like all vaccines, the shingles vaccine has benefits and harms. You should know about both and make an informed decision about taking it.

What Everyone Should Know About The Shingles Vaccine

Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia , the most common complication from shingles.

CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.

Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.

Shingrix provides strong protection against shingles and PHN. In adults 50 years and older who have healthy immune systems, Shingrix is more than 90% effective at preventing shingles and PHN. Immunity stays strong for at least the first 7 years after vaccination. In adults with weakened immune systems, studies show that Shingrix is 68%-91% effective in preventing shingles, depending on the condition that affects the immune system.

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When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix

Shingrix causes a strong response in your immune system, so it may produce short-term side effects. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days. You may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen. Contact your healthcare provider if the symptoms are not improving or if they are getting worse.

In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people might have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.

Can I Get The Flu Jab And Other Vaccinations If Ive Got Ms

For most people with multiple sclerosis it makes sense to get the protection that vaccines offer, including the seasonal flu jab. If you get ill with flu or another infection it could make MS symptoms worse. It might even trigger a relapse. And of course the diseases themselves can be serious and in some cases fatal.

The seasonal flu jab is free of charge on the NHS for people with MS and their carer or partner. Find out more about free vaccinations.

You could be offered vaccinations for:

• whooping cough, if youre pregnant
• yellow fever, if youre travelling

Talk to your doctor or MS nurse about which vaccines you should get. You might need to take precautions if:

• youre having a relapse
• youve recently taken steroids for a relapse
• youre taking certain disease modifying therapies

Vaccines work best when everyone who can take them does take them. This even protects people who can’t get vaccinated, because the infection finds it harder to spread. So encourage people around you to have their recommended vaccinations too.

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Contraindications And Precautions For Herpes Zoster Vaccination

Shingrix should not be administered to:

• A person with a history of severe allergic reaction, such as anaphylaxis, to any component of this vaccine.
• A person experiencing an acute episode of herpes zoster. Shingrix is not a treatment for herpes zoster or postherpetic neuralgia . The general guidance for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.

There is currently no CDC recommendation for Shingrix use in pregnancy therefore, providers should consider delaying vaccination until after pregnancy. There is no recommendation for pregnancy testing before vaccination with Shingrix. Recombinant vaccines such as Shingrix pose no known risk to people who are breastfeeding or to their infants. Providers may consider vaccination without regard to breastfeeding status if Shingrix is otherwise indicated.

Adults with a minor acute illness, such as a cold, can receive Shingrix. Adults with a moderate or severe acute illness should usually wait until they recover before getting the vaccine.

To learn more, see Contraindications and Precautions, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices .

Who Should Get Shingrix

Adults 50 years and older should get two doses of Shingrix, separated by 2 to 6 months. Adults 19 years and older who have or will have weakened immune systems because of disease or therapy should also get two doses of Shingrix. If needed, people with weakened immune systems can get the second dose 1 to 2 months after the first.

You should get Shingrix even if in the past you:

• Received varicella vaccine

There is no maximum age for getting Shingrix.

If you had shingles in the past, Shingrix can help prevent future occurrences of the disease. There is no specific length of time that you need to wait after having shingles before you can receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated.

Chickenpox and shingles are related because they are caused by the same virus . After a person recovers from chickenpox, the virus stays dormant in the body. It can reactivate years later and cause shingles.

Shingrix is available in doctors offices and pharmacies.

If you have questions about Shingrix, talk with your healthcare provider.

* A shingles vaccine called zoster vaccine live is no longer available for use in the United States, as of November 18, 2020. If you had Zostavax in the past, you should still get Shingrix. Talk to your healthcare provider to determine the best time to get Shingrix.

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Do Hepatitis B Or Other Vaccines Cause Ms

Research has not shown that any vaccines cause MS.

There have been suggestions in the past that the hepatitis B vaccine increases the chance of people getting MS. But when researchers weighed up all the studies in 2018, they found no link between the vaccine and MS.

Vaccines for HPV, tetanus, whooping cough and smallpox might even make getting MS less likely.

Studies On The Effectiveness Of Vaccines In Ms Patients Receiving Immunotherapies

A number of studies have been conducted on the effectiveness of various vaccines in MS patients receiving disease-modifying therapy. Several studies in MS patients receiving treatment with interferon beta preparations indicated adequate immune responses to vaccines, mostly against influenza, pneumococci and tetanus/diphteria.27

An open study in 72 patients with relapsingremitting MS investigated the efficacy of vaccines administered in individuals on therapy with dimethyl fumarate or interferon beta.28 Vaccination with recall antigens , T-cell independent vaccination and vaccination with a neo-antigen achieved sufficient protection in patients on either therapy.

Studies comparing the effect of inactivated vaccines suggested reduced responses in MS patients on treatment with glatiramer acetate versus interferon beta and versus healthy volunteers.2931

The results of the TERIVA study demonstrated that patients on teriflunomide mount an effective immune response after vaccination against influenza. In addition, the generation of primary immune responses against neoantigens is not significantly impaired.32

Effectiveness of immunization with a seasonal influenza vaccine31 and tetanus toxoid in MS patients receiving fingolimod is reduced compared with placebo-treated patients34 and may be limited for up to 2months after discontinuation.26 A prospective randomized study revealed reduced efficacy of influenza vaccination in patients receiving siponimod versus placebo.35

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Is Shingles Contagious

The virus that causes shingles can be easily transmitted from person-to-person during the active infection phase. To avoid passing the illness to others, people with shingles should:

• Keep the rash covered
• Wash hands frequently and avoid touching door knobs or any other shared items
• Avoid touching or scratching the rash
• Avoid close contact with other people until the blisters have crusted over

Who Shouldn’t Get It

A person should not get Shingrix if:

• They have ever had a severe allergic reaction to any component of the vaccine or the first dose of the vaccine.
• They test negative for immunity to varicella-zoster virus.
• They currently have shingles.
• They are pregnant.

If you are experiencing a moderate to severe illness, with a fever or not, you should consider waiting until you are better before getting the vaccine.

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Q What About Specific Vaccinations For Travel

A: The CDC does not have specific recommendations for travel vaccination for the MS patient. Care should be taken with patients on strong immunosuppressing regimens similar to that for bone marrowtransplant patients. Most patients with MS will not conform to this designation. Reviewing the data for travel immunization in immunocompromised individuals may be helpful in those patients on alemtuzumab, cyclophosphamide, rituximab, daclizumab or other major immunosuppressing medication regimens. At the Mellen Center we advise our patients travelling to at risk countries to seek infectious disease counselling before travelling.

Do Vaccines Cause Ms Relapses

Researchers have looked at the results of many different studies to see if vaccines cause relapses. The evidence doesnt show that vaccines cause relapses.

But if youve recently taken certain DMTs or high-dose steroids, many neurologists would suggest avoiding any live vaccine. This is because of what we know about the way the immune system works, and because a small study into the live vaccine for yellow fever showed it might increase the chances of having a relapse.

The flu jab is not a live vaccine.

There might be times you and your doctor agree the risk of not being vaccinated outweighs the risk of a relapse, even while youre taking your DMT. For example, if youre travelling to an area of high risk for a potentially deadly disease.

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What Are The Risks

With MS, your immune system mistakenly attacks your central nervous system. The medicines you take can help manage the amount of inflammation in your body and stave off attacks that worsen your symptoms. Itâs a careful balancing act that some vaccines can upset.

Years ago, people worried that some vaccines, like those that prevent hepatitis B, caused MS. Many studies showed that this wasnât true. Yet some shots may trigger an infection that causes you to relapse. If you get a live vaccine , this is more likely to happen.

Some MS drugs, such as mitoxantrone, also change how your immune system works. If youâre exposed to a live virus while youâre taking them, you may actually get the disease that the vaccine works to prevent. Other treatments, like steroids, may curb how well the vaccine works.

Vaccine guidelines for two newer drugs given for MS are:

• alemtuzumab — You should not receive a live or weakened vaccine after a course of this medication.
• ocrelizumab — Any required live or weakened vaccine should be given at least 4 weeks prior to starting treatment.