If you have multiple sclerosis (MS), keeping up with your vaccines is one of the easiest ways to protect your health. Infections can sometimes trigger MS relapses or make symptoms worse, so preventing them is key. The good news is that vaccines are generally safe for people with MS.
Most standard vaccines, including the flu shot, tetanus boosters, hepatitis B, HPV, pneumococcal vaccines, and the recombinant shingles vaccine (Shingrix), are safe and well tolerated. These inactivated vaccines can be given even if you are on MS treatments called disease-modifying therapies (DMTs), providing important protection without affecting your MS.
Live vaccines, which contain weakened viruses, need more careful timing. Vaccines like MMR (measles, mumps, rubella), varicella (chickenpox), and yellow fever should generally be avoided during treatment with certain DMTs, such as ocrelizumab, alemtuzumab, fingolimod, rituximab, and others, as well as for a few months after stopping therapy. If a live vaccine is necessary, it should be given at least 4–6 weeks before starting treatment. Vaccination is also usually delayed during an MS relapse until symptoms have stabilized, often four to six weeks after the flare begins.
For people on immunosuppressive therapies, timing can help ensure the best immune protection. Even when vaccines may produce a slightly weaker response, partial protection is still valuable. Some vaccines, like the RSV vaccine for older adults or those at higher risk, and Shingrix for shingles, are safe and recommended specifically for people on MS therapies. Shingrix is preferred over the live shingles vaccine, which is not recommended for those on immunosuppressive treatment.
The bottom line is simple: vaccines are an important part of staying healthy with MS. Avoid live vaccines during and shortly after immunosuppressive therapy, keep all other vaccines up to date, and coordinate timing with your treatment and your doctor. By following these guidelines, you can protect yourself from preventable infections, support your immune system, and reduce the risk of MS flare-ups.
Staying on top of your vaccinations is a small step that can make a big difference in your overall well-being. Talk with your neurologist or healthcare provider about your vaccine schedule—they can help you plan the safest and most effective timing for your protection.
Main points:
Vaccines That Are Safe and Recommended (Inactive or non-live)
The flu shot (injected form, not nasal spray)
COVID-19 vaccines and boosters (mRNA vaccines)
Pneumococcal vaccines (for pneumonia prevention)
Tdap (tetanus, diphtheria, and pertussis)
Hepatitis A and B vaccines
HPV vaccine
Shingrix, shingles vaccine (for older adults or people on MS medication)
Vaccines to Avoid or Use with Caution while on MS medications (Live-attenuated vaccines)
MMR (measles, mumps, rubella)
Varicella (chickenpox)
Yellow fever vaccine
Oral typhoid vaccine
Nasal flu spray (FluMist)
Timing Vaccines with MS Medications
Before starting a DMT: Try to update all routine vaccines. If a live vaccine is needed, it should be completed at least 4–6 weeks before beginning medications like Ocrevus, Kesimpta, or Rituximab.
While on Ocrevus, Kesimpta, or Rituximab: Your body’s ability to make antibodies may be reduced, so vaccines might not work as strongly — but they still offer protection and are worth getting. The best time for vaccination is about 4–5 months after an infusion, and at least 4 weeks before your next dose.
With other DMTs:
- Fingolimod or Siponimod: Vaccine responses may be weaker; avoid live vaccines.
- Cladribine or Alemtuzumab (Lemtrada): Wait until your immune system recovers
before receiving vaccines.