February 14, 2025 | News | Living with MS MS Research

People with MS are often undervaccinated

A survey in Germany reported that many people with multiple sclerosis are not fully vaccinated, putting them at higher risk of developing infections (Schade and colleagues. Ther Adv Neurol Disord 2025;18:1-21). In many cases the problem was vaccine hesitancy – among family doctors, not people with MS.

The study looked at standard vaccinations, such as those for tetanus, diphtheria, polio, pertussis (whooping cough), measles/mumps/rubella (MMR) and COVID-19. Also included were some specific vaccines often recommended for people with MS, such as those for pneumonia, meningitis, hepatitis A/B, seasonal influenza and herpes zoster (for shingles).

In general, vaccination rates were similar for people with and without MS but were low in both groups. For people with MS, the vaccination rates were 62% for tetanus, 60% for diphtheria, 57% for polio, 30% for whooping cough, and 57-62% for MMR. The highest rate was seen for COVID-19 (81%). The vaccination rates were lower for specific vaccines that are generally recommended for people with MS, such as for seasonal flu (21%), shingles (11%) and pneumonia (7%).

Most people with MS said they were willing to receive all of the recommended vaccines (76%), thought they were well informed about vaccination (68%) – but were under the impression that they had received all of the vaccinations they needed (69%). An important barrier to vaccination, however, was the family doctor. A total of 82% of physicians said they were reluctant to vaccinate people with MS, primarily because of concerns about MS-related side effects or interactions of vaccines with disease-modifying therapies (DMTs) for MS.

Vaccine recommendations

The key issue is that MS, DMTs and vaccines all have effects on the immune response, which can raise concerns about how these three factors interact. People with MS have a dysfunctional immune response so they have a higher risk of getting infections – underscoring the importance of being adequately vaccinated. DMTs used to treat MS target the dysfunctional immune response, but that can increase the infection risk and may have negative effects on some vaccines.

For example, live attenuated vaccines use weakened (not dead) strains of micro-organisms to stimulate the body’s immune response. This means that there is a theoretical risk of developing an infection if the immune response is being suppressed by a DMT. Accordingly, live attenuated vaccines should only be administered before starting a DMT. The main live attenuated vaccines of concern are MMR and varicella (chickenpox). MMR is typically administered in childhood but a booster is often advised. The varicella vaccine is recommended for people who never had chickenpox. Both of these vaccines should be administered about one month before starting a DMT (Otero-Romero and colleagues. Mult Scler 2023;29:904-925). If you are older and/or concerned about shingles, Shingrix (a recombinant vaccine) may be preferred over Zostavax (a live vaccine).

A seasonal flu shot and a COVID-19 vaccine are recommended every year for all persons with MS (Otero-Romero 2023). Some vaccines are also specifically advised for people taking a higher-efficacy DMT. For example, the HPV (human papilloma virus) vaccine and the Shingrix vaccine (against shingles) should be considered in people taking Lemtrada, Gilenya, Mayzent, Mavenclad, Ocrevus or Kesimpta (Otero-Romero 2023).

Higher-efficacy DMT can impact the effectiveness of vaccines, so it is important to discuss the scheduling of vaccinations and the timing of your DMT dose with your neurologist or MS team.

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