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Flu Vaccines—2009-2010 - Information for those with Multiple Sclerosis

Posted Nov 17 2009 10:20pm
Source National MS Society and the CDC - November 3, 2009

Regular flu shot:As in previous years, the National MS Society recommends a regular flu shot as a safe and effective vaccination for people with MS. The flu shot—which is a de-activated or “killed” vaccine—can safely be taken by individuals who are on any of the disease-modifying medications (Avonex®, Betaseron®, Copaxone®, Rebif®, Novantrone®, or Tysabri®).

FluMist Intranasal®:In 2003, the FDA approved a flu vaccine nasal spray “for healthy children and adolescents, ages 5-17, and healthy adults, ages 18-49.” According to Dr. Aaron Miller, the Society’s Chief Medical Officer, FluMist—which is a live, weakened vaccine—is not recommended for use by people with MS, and should specifically be avoided by any person with MS who is on an immunosuppressive medication such as mitoxantrone (Novantrone®), cyclophosphamide (Cytoxan®), azathioprine (Imuran®), or methotrexate.
• Live-virus vaccines are more likely than de-activated-virus vaccines to cause an increase in disease activity in people with MS.
• A person taking an immunosuppressive medication is more susceptible to developing an infection with the vaccine strain of the virus—an infection that may be particularly severe because the person’s immune system is suppressed.
• The interactions between live vaccines and the disease-modifying medications are not known.

H1N1 (Swine Flu) vaccine:On September 15, the U.S. Food and Drug Administration (FDA) approved four vaccines for the H1N1 flu virus. The vaccines are manufactured using similar processes by four different companies. An adult over the age of nine being vaccinated against H1N1 influenza will receive one dose of one of these vaccines. Children under nine will receive two doses.

Three of the H1N1 vaccines are de-activated or “killed” vaccines that are administered by injection. These de-activated vaccines are considered safe for people with MS. One is a live, attenuated vaccine that is administered by nasal spray. The live, nasal spray vaccine, which is now available in some areas, should be avoided by individuals with MS. The supply of de-activated vaccine remains very limited.

Clearly, the initial supply of H1N1 vaccine will not be adequate to vaccinate everyone who would like to get it. The CDC has identified five groups to receive the vaccination on a priority basis:
o Pregnant women
o Persons who live with or provide care for infants under 6 months of age
o Healthcare and emergency services personnel
o Children and young adults aged 6 months to 24 years of age
o Persons aged 25-64 who have medical conditions that put them at higher risk for influenza-related complications.

It is important to note that people with disabilities (including people with MS) are not necessarily considered by the CDC to be part of this high-priority group.

However:
 The flu virus (like any other virus) can precipitate MS exacerbations.

 A person with advanced MS or someone with less severe disease (Kurtzke less than 6.0) who has reduced pulmonary function or has any difficulty with breathing is considered at risk for complications and a good candidate for the H1N1 vaccine.

We recommend that people talk with their MS doctor to determine if they are a good candidate for the de-activated H1N1 vaccine.

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