1b. Patients with MS are often concerned about the safety of immunizations and may have questions regarding immunizations, including any effects on the course of their illness, interactions with MS treatments, adverse effects, and payer coverage. Clinicians should explore patients’ opinions, preferences, and questions regarding immunizations at clinic visits to effectively address the optimal immunization strategy for each patient, keeping with the patient’s MS status, values, and preferences (Level B).

2. Although there is no evidence that MS alone increases the risk of acquiring vaccine-preventable infections, individuals with MS have at least the same risk as unvaccinated individuals without MS. Therefore, clinicians should recommend that patients with MS follow all vaccine standards (eg, those issued by the United States Center for Disease Control and Prevention, the World Health Organization, and local regulatory bodies), unless there is a specific contraindication (eg, active treatment with immunosuppressive or immunomodulating [ISIM] agents) (Level B).

3. Prevalence of vaccine-preventable diseases and respective seropositivity vary by country and region, as do recommendations for immunization. In cases where local risk for infection is particularly high, vaccination benefits for people with MS—including with live vaccines for those receiving immunomodulatory therapy—may outweigh the risks. Clinicians should weigh local risk for vaccine-preventable diseases when counseling individuals with MS regarding vaccination (Level B).

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4. Because of the known risks for exacerbation of MS and other morbidity as a result of influenza infection and no identified risks for exacerbation as a result of the vaccine, benefits of influenza vaccination outweigh the risks in most scenarios. Clinicians should recommend that patients with MS receive the influenza vaccination annually, unless there is a specific contraindication (eg, previous severe reaction) (Level B).

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Recommendation regarding immunization in the setting of immunosuppressive or immunomodulating medication use.

5a. Clinicians should counsel patients with MS on the risks for infection associated with specific ISIM medications. Further, counselling is also recommended regarding treatment-specific vaccination protocols—to ensure accordance with prescribing instructions for each respective ISIM medication—when such treatments are being considered for use (Level B).

5b. Physicians should assess or reassess the vaccination status of patients with MS before prescribing ISIM therapy and should vaccinate patients with MS, according to local regulatory standards. Physicians should be guided by treatment-specific risks for infection, as per prescribing information inserts, which commonly recommend a period of at least 4 to 6 weeks before initiating ISIM therapy (Level B).

5c. ISIM medications used to treat MS are associated with severe occurrences, severe recurrences, or both for vaccine-preventable infections, including varicella-zoster and hepatitis B. Manufacturers’ package inserts contain information on treatment-specific guidance for immunization with live vaccines for prophylaxis of these infections, and clinicians are recommended to adhere to this guidance. Clinicians may discuss the advantage of vaccination with patients as soon as possible after MS diagnosis, regardless of initial therapeutic plans, to prevent future delays in initiation of ISIM therapies (Level C based on variation in patient preferences).

This article originally appeared on Infectious Disease Advisor