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Should I Get the Shingles Vaccine If I Have MS?

People with multiple sclerosis can help prevent shingles and its complications with the Shingrix vaccine. Review the benefits and risks. Shingrix is a vaccine that protects against shingles—a painful rash caused by the reactivation of the same virus that causes chicken pox. People with multiple sclerosis (MS) may wonder if it’s safe to get the shingles vaccine. fstop123 / Getty

  • Posted on 10th May, 2022 19:30 PM
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Should I Get the Shingles Vaccine If I Have MS? Image

Shingrix is a vaccine that protects against shingles—a painful rash caused by the reactivation of the same virus that causes chicken pox. People with multiple sclerosis (MS) may wonder if it’s safe to get the shingles vaccine.

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Multiple sclerosis is a disease that damages the central nervous system. This damage leads to symptoms like muscle weakness, blurred vision, memory loss, and problems with balance and coordination. MS is most likely an autoimmune disorder, which means that it causes the body to attack its own healthy tissues.

MS medicines may reduce the effectiveness of various vaccines. The best timing for getting the shingles vaccine can also depend on your MS disease activity.

Learn about getting the shingles vaccine with MS, including risks, benefits, side effects, and more.

What Is Shingles?

Shingles (herpes zoster, or HZ) is a condition that causes a painful rash and blisters, often on only one side of the body or face. Other symptoms may include fever, fatigue, headache, and nausea.

Shingles is caused by a reactivation of the varicella-zoster virus (VZV), the virus that causes chicken pox. About one in three people in the United States will develop shingles during their lifetime.

Shingles Vaccine Risks

Shingrix (recombinant zoster vaccine, or RZV)—the shingles vaccine—is used to prevent shingles and related medical complications in older and immunocompromised adults. It is usually delivered in two doses in the upper arm muscle, two to six months apart. 

According to the Centers for Disease Control and Prevention (CDC), all people over 50 years old and immunocompromised adults over 19 years old should get two doses of Shingrix. This recommendation includes people with MS. 

However, a few considerations that people with MS should take into account when getting Shingrix or any other vaccine are:

  • Clinical trials: People with MS were not included in the initial clinical trials for Shingrix. More recent studies indicate that Shingrix is safe and effective for people with MS. However, the evidence remains limited, and research is ongoing.
  • MS medications: Immunosuppressants may lower the effectiveness of some vaccines. People taking immunosuppressive medications for MS, such as Kesimpta (ofatumumab) or Ocrevus (ocrelizumab), should talk to their healthcare provider before getting Shingrix. 
  • Vaccine schedule: If you’re planning to start immunosuppressive therapy, your healthcare provider may recommend that you wait until at least a month after your latest Shingrix dose to ensure that you get the full benefits.
  • MS flare-ups: People who are currently experiencing an MS relapse or flare-up (when symptoms increase) should usually wait until their symptoms subside to get vaccinated.

What Are Immunosuppressants?

Immunosuppressants, sometimes called immunosuppressive drugs, are medicines that work by controlling the body’s immune response. This means they control or “calm down” natural defense mechanisms.

While immunosuppressants can help to treat certain medical conditions, they also increase the risk of infections and other health complications.

Shingrix vs. Zostavax

Shingrix was approved by the Food and Drug Administration (FDA) in 2017 to prevent shingles and related complications. Previously, the only available shingles vaccine in the United States was Zostavax (zoster vaccine live). 

Zostavax is a live vaccine, which means it contains a weakened version of the virus that causes shingles. People with MS who are taking a disease-modifying therapy (DMT) should typically avoid live vaccines. Since 2020, Zostavax has not been available for use in the United States.

Shingrix is a recombinant vaccine, meaning that it is made out of only a specific piece of the virus. Recombinant vaccines like Shingrix are typically safe for people with MS, even those who are taking a DMT.

Shingles Vaccine Benefits

The most common shingles complication is postherpetic neuralgia (PHN)—severe, long-term nerve pain in the area of the initial rash. In rare cases, shingles can lead to pneumonia, vision problems, hearing loss, hospitalization, and even death. Adults over 50 years old and people with weakened immune systems are particularly at risk for shingles complications. 

The shingles vaccine is safe and effective for most people, including people with MS. Among people over 50 with fully functioning immune systems, Shingrix is 97% effective in preventing shingles and 91% effective in preventing PHN. Among people with weakened immune function, Shingrix is 68%–91% effective.

Because they often have a weakened immune system, people with MS are more likely to develop infections and other illnesses. Vaccination is a crucial part of preventing infection and hospitalization among people with MS. 

While there appears to be a link between shingles and MS, it is not yet entirely understood by researchers.

Here are some recent findings about the association between HZ and MS symptoms:

  • People with MS may have a higher risk of contracting shingles, especially if they take DMTs to reduce their symptoms.
  • Having had HZ in the past may increase the risk of developing MS in the future.
  • Because their condition affects the signals sent between their brain and spinal cord, people with MS may be more prone to nerve pain and related conditions like PHN. 

Studies indicate that Shingrix is effective in lowering the risk of shingles in people with MS—without causing dangerous side effects. Recent research suggests that most people with MS should get the shingles vaccine, even people who are taking low-dose immunosuppressive medications.

What Does it Mean to Be Immunocompromised?

People who are immunocompromised, or immunosuppressed, have a weakened immune system. This reduces their body’s ability to defend itself against illnesses and infections. Some people are immunocompromised by a disease, such as cancer, kidney failure, or diabetes. Others are immunocompromised by certain drugs, surgeries, or therapies.

Who Should Not Get the Vaccine?

It’s safe for most people, including people with MS, to get two doses of Shingrix. However, there are a few exceptions. 

According to the CDC, you should not get the shingles vaccine if you:

  • Are pregnant
  • Currently have shingles
  • Have had a severe allergic reaction to Shingrix in the past

If you have a mild illness, such as a cold or flu, you can still get your scheduled dose of Shingrix. If you’re severely ill or have a high fever, you should hold off until you feel better.

Things to Consider

As you discuss the shingles vaccine with your healthcare provider, here are a few things to consider if you have MS:

  • Current symptoms: The CDC recommends that people with autoimmune or inflammatory conditions, such as MS, get vaccinated when their symptoms are well-controlled. If you are experiencing a severe MS relapse or are feeling very ill, the vaccine may not be as effective for you.
  • Immunosuppression: It’s best to get Shingrix when your immune system is functioning well. If you plan to start immunosuppressive therapy for MS, your healthcare provider can make sure you get the shot before you take the first dose of your medication. 
  • Delayed schedule: If you’ve recently finished taking immunosuppressive medicines for MS, your healthcare provider might want to delay your shingles vaccine. For example, the CDC recommends that most people wait at least four to six weeks after their last dose of Shingrix before starting a round of Gilenya (fingolimod), Lemtrada (alemtuzumab), or Leustatin (cladribine).
  • Timing of two doses: In some cases, immunocompromised adults can get their second dose of Shingrix just one to two months after their first dose. Ask your healthcare provider if this accelerated timeline is right for you.

Shingrix Side Effects

The most common side effects from Shingrix are pain, redness, and/or swelling at the site of injection. Other common side effects include headache, nausea, muscle pain, fatigue, fever, and trembling.

Most Shingrix side effects are mild and go away on their own within two to three days. If your side effects don’t go away or start to get worse, tell your healthcare provider right away. 
In rare cases, Shingrix may cause a severe allergic reaction. Signs of a severe allergic reaction to Shingrix include hives, light-headedness, difficulty breathing, and facial swelling. Seek immediate medical help if you think you are experiencing an allergic reaction to the shingles vaccine.

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Talking to Your Healthcare Provider

If you have MS and are thinking of getting the shingles vaccine, here are a few topics to discuss with your healthcare provider or medical team:

  • Let your healthcare provider know if you are currently taking or planning to start taking any immunosuppressive medications or therapies. Medications that suppress your immune system may impact the effectiveness of the shingles vaccine.
  • Ask your healthcare provider about the best vaccine schedule for you. You may need to get your next dose of Shingrix earlier or later than usual, depending on the medications you’re taking and your particular symptoms.
  • Tell your healthcare provider about your current and recent MS symptoms. You may want to wait until a relapse subsides before getting vaccinated.

Summary

Multiple sclerosis (MS) is an autoimmune disease that damages the central nervous system. Certain vaccines may be less effective in people with MS because of the medicines they take to control their symptoms. 

Shingrix (the recombinant zoster vaccine, or RZV) is a two-dose vaccine that works to prevent shingles (herpes zoster) and related complications in adults ages 50 and older, as well as immunocompromised adults ages 19 and over. Shingrix is safe and effective for most people with MS. 

However, people with MS who are taking immunosuppressive drugs should tell their healthcare provider before getting Shingrix. Their healthcare provider may offer them a Shingrix dose earlier or later, depending on their scheduled treatment.

People who are currently having an MS flare-up should wait until their symptoms are under control to take the shingles vaccine.

A Word From Verywell

If you have MS, vaccination is an important way you can protect your long-term health. Before getting the shingles vaccine, talk to your healthcare provider about your current symptoms, the medications you’re taking, and any other concerns you may have.

Frequently Asked Questions

  • Can you get Shingrix with MS?

    Yes. The CDC recommends that all adults ages 50 and older, as well as immunocompromised adults ages 19 and older, get two doses of Shingrix to prevent shingles and related complications.

    Research suggests that the shingles vaccine is safe and effective for people with multiple sclerosis (MS). However, people who are currently taking or planning to take immunosuppressive medicines to treat their MS should tell their healthcare provider before getting Shingrix.

    People with MS who are having a severe flare-up of their symptoms should also wait to get the vaccine.

  • Is there a connection between shingles and MS?

    Maybe. Some studies suggest that both chicken pox and shingles may increase the risk of developing MS and worsen existing MS symptoms. However, this evidence is still controversial and limited. Other research suggests that having MS can increase the risk of contracting shingles and developing shingles-related complications.

  • Can people with MS take live vaccines?

    Usually not. Typically, people with MS who are taking disease-modifying therapies (DMTs) should not take live vaccines. If someone with MS is taking, has recently taken, or is about to start taking any medication that suppresses the immune system, they might need to wait to get a live vaccine.

    Shingrix is not a live vaccine. People with MS who are severely ill or who are currently having a flare-up should talk to their healthcare provider before getting any vaccine.

Should I Get the Shingles Vaccine If I Have MS? View Story