Vaccination Recommendations for Multiple Sclerosis Patients

General Vaccination Principles for MS Patients

Pneumococcal vaccination is recommended due to increased risk of invasive pneumococcal disease in immunocompromised individuals 1
Varicella zoster virus (VZV) vaccination is recommended, particularly for patients who will undergo immunosuppressive therapy, due to high risk of herpes zoster infection 1, 2
COVID-19 vaccination is recommended for all MS patients following national guidelines 3, 4

For patients scheduled to start ocrelizumab therapy, complete two-dose vaccine regimens at least 4-6 weeks before starting treatment OR 5
For patients on immune-reconstitution therapies (alemtuzumab, cladribine), delay vaccination until at least 6 months after the last course of treatment 6, 7
For patients on high-dose or long-term corticosteroids, delay vaccination until 4-6 weeks after treatment cessation 6, 7
For patients receiving anti-CD20 therapy (rituximab, ocrelizumab), vaccination should be delayed for at least 6 months after the last dose 5, 6

Consider MS patients who have undergone autologous hematopoietic stem cell transplantation (AHSCT) as "never vaccinated" and offer complete revaccination 1
Pneumococcal vaccination: Three doses of conjugated anti-pneumococcal vaccine at 1-month intervals starting 3-6 months post-transplant, followed by one dose at 12 months 1, 2
Influenza vaccination: One annual dose at the beginning of influenza season, starting 3-6 months post-transplant 1, 2
VZV vaccination: Begin 6 months post-transplant with recombinant VZV vaccine 1, 2
COVID-19 vaccination: Follow standard schedule according to national guidelines 1, 2

Live-attenuated vaccines are contraindicated for patients on immunosuppressive therapies 8
For patients with active underlying disease, immunosuppressive therapy should be prioritized over vaccination 5
Disease-modifying therapies (DMTs) may reduce antibody response to vaccines, but vaccination is still recommended 6

Vaccination protocols should be harmonized within regional and national MS treatment programs and updated regularly 1

Healthcare providers caring for MS patients should be fully immunized, particularly against seasonal influenza 9