Immunisation advice in multiple sclerosis
There is no evidence that vaccinations increase the risk of relapse in multiple sclerosis (MS).
Inactivated influenza vaccine can be given to patients with MS.
Difficulties arise when a patient with MS needs a live vaccine (eg measles, mumps, rubella, varicella, zoster, yellow fever, Japanese encephalitis, Bacille Calmette-Guérin [BCG], oral typhoid), as these can be dangerous with certain immunotherapies. A problem is unlikely with interferons and glatiramer acetate, but drugs that suppress lymphocytes may allow live virus to disseminate. Avoid live vaccines in patients taking dimethyl fumarate, fingolimod, natalizumab, ocrelizumab and teriflunomide1. Vaccination in patients taking alemtuzumab is complex—refer for expert advice.