COVID-19 Vaccine Guidance for People Living with MS

UPDATE – October 2023

MS Canada continues to track the latest research on MS and COVID-19 vaccines. The following guidance is based on the data currently available from studies and expert consensus opinion.

Stay up-to-date with COVID-19 vaccines

Beginning in the fall of 2023 for those previously vaccinated against COVID-19, NACI recommends individuals ages 6 months and older should receive an updated vaccine dose. Stay up-to-date with COVID-19 vaccines through the NACI guidance, and talk to your MS healthcare provider to determine what is best for you.

People with MS should consider getting the COVID-19 vaccine. COVID-19 vaccines are safe for people with MS. COVID-19 vaccines are safe to use with MS medications. COVID-19 vaccines are safe to get at the same time as other vaccines.

The science has shown us that the approved COVID-19 vaccines are safe and effective. None of the available vaccines in Canada contain a ‘live’ virus and the vaccines will not cause COVID-19 disease. The vaccines are not likely to trigger an MS relapse or have any impact on long-term disease progression. Getting vaccinated with a COVID-19 vaccine does not prevent COVID altogether. Instead, getting vaccinated reduces the severity of COVID-19 infection if and when a person is infected. Real-world experience has shown that having COVID-19 infection neither causes nor worsens MS. 

In addition to getting vaccinated, science has shown that wearing a face mask and washing your hands are the best ways to slow the spread of virus. 

Similarly, receiving COVID-19 vaccination neither causes nor worsens MS. However, like other vaccines, COVID-19 vaccines can cause side effects, including a fever. A fever can worsen your MS symptoms, but they should return to prior levels after the fever is gone or with acetaminophen. Like other medical decisions, getting a vaccine is best made in partnership with your healthcare provider.

Having MS does not mean that you are immunocompromised. However, some disease-modifying therapies (DMTs) used to treat MS do alter your immune system, and certain groups of people with MS are more susceptible to having a severe case of COVID-19, including people with progressive MS, those who are older, those who have a higher level of physical disability, those with certain medical conditions (e.g., diabetes, high blood pressure, obesity, heart and lung disease, pregnancy), and Black, Hispanic, and Indigenous populations.  

Studies of the COVID-19 vaccine responses in people living with MS on any disease-modifying therapies have now shown that there appears to be an overall adequate immune response (either with antibodies or other immune cells) to the vaccination. Studies of the COVID-19 vaccine responses in people living with MS have shown a reduced or absent antibody response to the vaccine among those who use certain DMTs. People with MS using the following DMTs may be considered immunocompromised:

  • Sphingosine 1-phosphate receptor modulators (Gilenya®, Mayzent®, Zeposia®, Ponvory™) 
  • Alemtuzumab (Lemtrada®)
  • Anti-CD20 monoclonal antibodies (Ocrevus®, Kesimpta®, Rituxan® and biosimilars)

Timing vaccines with DMTs

Recent studies of people with MS who use certain B cell depleting DMTs showed a better antibody response when the vaccine was administered 4 months or more after the last dose of DMT. Review the Canadian Network of MS Clinics vaccine timing considerations, and work with your MS healthcare provider to determine the best time to get your vaccine dose.

If you are about to start a disease-modifying therapy for your MS, consider updating your vaccines at least 2 weeks prior to starting the disease-modifying medication (at least 4 weeks prior to starting alemtuzumab/Lemtrada).

As recommended by the Canadian Network of MS Clinics, if you are already taking one of the following DMTs, no adjustments or dosing modifications are recommended for vaccination:

  • Interferon (Avonex, Rebif, Betaseron, Extavia, Plegridy)
  • Glatiramer acetate (Copaxone, Glatect)
  • Teriflunomide (Aubagio, generic teriflunomide)
  • Dimethyl fumarate (Tecfidera, generic dimethyl fumarate)*
  • Natalizumab (Tysabri)
  • Fingolimod (Gilenya, generic fingolimod)
  • Siponimod (Mayzent)
  • Ozanimod (Zeposia)
  • Cladribine (Mavenclad)
  • Ofatumumab (Kesimpta)

*Most individuals taking dimethyl fumarate have normal lymphocyte counts, but many may have lower numbers, warranting further discussion with your healthcare provider.

Guidance for specific medications:

  • Ocrelizumab (Ocrevus) or Rituximab – the ideal time for vaccination is approximately 4 weeks before your next scheduled therapy. This suggested scheduling is not always possible and getting the vaccine may be more important than timing the vaccine with your MS medicine. Work with your MS healthcare provider to determine the best schedule for you.
  • Alemtuzumab (Lemtrada) – if you are already taking Lemtrada, consider getting vaccinated 24 weeks or more after the last Lemtrada dose and/or resume Lemtrada 4 weeks or more after getting vaccinated. 

Given the potential serious health consequences of COVID-19, getting the vaccine as soon as possible may be more important than optimally timing the vaccine with your DMT. 

The following individuals were consulted in the development of this guidance:

MS neurologists and experts

Nancy Sicotte, MD, FAAN—Chair, National MS Society’s National Medical Advisory Committee, Cedars-Sinai Medical Center, USA

Brenda Banwell, MD—Chair of MS International Federation International Medical and Scientific Advisory Board (IMSB) – University of Pennsylvania, USA

Maria Pia Amato, MD—University of Florence, Italy

Amit Bar-Or, MD, FRCPC—University of Pennsylvania, USA

Tanuja Chitnis, MD—Harvard Medical School, Massachusetts General Hospital, USA

Jorge Correale, MD—Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina

Anne Cross, MD—Washington University and Secretary of Board of Governors of the Consortium of MS Centers, USA

Jaime Imitola, MD, FAAN—University of Connecticut, UConn Health, USA

Cheryl Hemingway, MBChB, PhD—Great Ormond Street Hospital for Children, UK

Dorlan Kimbrough, MD—Duke University, USA

Professor Deiva Kumaran—Paris South University Hospitals, France

Avindra Nath, MD—National Institutes of Health/National Institutes of Neurological Disorders and Stroke, USA

Scott Newsome, DO, MSCS, FAAN, FANA—Johns Hopkins University and President of the Board of Governors of the Consortium of MS Centers, USA

Daniela Pohl, MD, PhD—University of Ottawa, Canada

Kevin Rostasy, MD— Children’s Hospital Datteln, University Written/Herdecke, Germany

Penny Smyth, MD, FRCPC—University of Alberta, Canada

Rachael Stacom, MS, ANP-BC, MSCN—Independence Care System, USA

Silvia Tenembaum, MD—Pediatric Hospital Dr J. P. Garrahan, Buenos Aires, Argentina

Dr. Evangeline Wassmer, Birmingham Women and Children’s Hospital, UK

Emmanuelle Waubant, MD, PhD—University of California San Francisco, USA

MS Partner Organizations

Julie Fiol, RN, MSCN—National MS Society, USA
Pamela Kanellis, PhD—MS Society of Canada
Julie Kelndorfer—MS Society of Canada
Jennifer McDonell—MS Society of Canada
Hope Nearhood, MPH, PMP—National MS Society, USA
Leslie Ritter—National MS Society, USA

The Canadian Network of MS Clinics Vaccine Working Group

Jodie Burton, University of Calgary MD, MSc, FRCPC
Virginia Devonshire MD, FRCPC, University of British Columbia, President Canadian Network MS Clinics
Mark Freedman HBSc, MSc, MD, CSPQ FANA FAAN FRCPC, University of Ottawa
Francois Grand’Maison, MD, FRCPC, Université de Sherbrooke
Penny Smyth MD, FRCPC, University of Alberta

Ann Yeh MA, MD, FRCPC, Dip ABPN, The Hospital for Sick Children, University of Toronto