Table 1.

Overview of vaccine use in multiple sclerosis patients.

General recommendations for vaccine use in MS patients starting any new therapy including newly diagnosed patients: 23  • Complete all immunizations as recommended for the general population (according to applicable guidelines) in all patients (see below) until 4-6 weeks before start of therapy.  • In the case of MS therapies with a potential interference with vaccination effects, complete immunizations 4 -6 weeks before starting therapy, if possible.  • Special considerations for additional vaccines or modified immunization protocols:  • Immunization against hepatitis B virus is generally recommended (except for patients with documented protective anti-HBs antibody titers).  • Patients without a prior documented varicella episode should be vaccinated against varicella zoster virus (caveat: this is a live vaccine; do not use in patients on immunosuppressive therapies!).  • Immunization with the recombinant glycoprotein shingles vaccine should be considered in all MS patients.  • The annual seasonal influenza vaccine is recommended for all MS patients regardless of their age and the type of MS treatment
Disease/pathogen	Recommended indication and vaccination procedure (according to STIKO)24,25
COVID-19	Prioritized immunization due to preexisting condition (autoimmune disease) with elevated risk
Tetanus	Standard: refresh/catch up as required
Diphtheria	Standard: refresh/catch up as required
Pertussis	Standard: refresh/catch up as required
Poliomyelitis	Standard: catch up as required
Meningococci	Immunodeficiency or immunosuppression, hypogammaglobulinemia
Rubella	Women of childbearing age if vaccination status is uncertain: two doses MMR; if one prior vaccination: one dose MMR (caveat: this is a live vaccine; do not use in patients on immune therapies!)
Pneumococci	Standard (⩾60 years)a: polysaccharide vaccine (PPSV23), repeat after 6 years Immunosuppression/immunodeficiency (any age): PCV13 conjugate vaccine, followed by PPSV23 after 6–12 months b
Measles	Standard: single dose MMR in all adults born after 1970 c if vaccination status is uncertain, or only one dose received during childhood (caveat: this is a live vaccine; do not use in patients on immune therapies!)
Hepatitis B	Risk of severe disease in patients with preexisting/expected immunodeficiency/immunosuppression; increased risk of exposure
Influenza	Standard: yearly immunizations in autumn using seasonal vaccine
Shingles (i.e. VZV reactivation)	>60 years d , or with underlying chronic diseases: recombinant adjuvanted VZV glycoprotein vaccine
Varicella	Seronegative patients, prior to immunosuppressive therapy: live VZV vaccine (contraindicated on immunosuppressive therapy!)

Divergent recommendations of the U.S. Centers of Disease Control and Prevention:

^a⩾65 years.

^bafter >1 year.

^cafter 1959.

^d⩾50 years.

MMR, measles, mumps and rubella; MS, multiple sclerosis; STIKO, Standing Committee for Vaccination; VZV, varicella zoster virus.