Live virus vaccines and MS

I have a question about live virus vaccines. I had to have a physical for school and they had to do titers on me to see if I was immune to some of diseases. Well my MMR came back low so I need a booster so that I am immune since I will be working in the health care field.

My question is, is it ok for me to get a live vaccine. I personally don't think it would be a problem but I know that live vaccines throw the immune system into gear and want to know if it can cause a relapse.

Thank you.

[Sailorsong]

No it is not safe for you to get a live virus vaccine. With MS the risk of a relapse is too great. I believe that the injection type of viruses are all dead type. But too be on the safe side you should ask who ever is going to give you the virus booster.

Dennis

[figuerpa]

Thank you Dennis,

Unfortunately the MMR is one of the live virus vaccines still out there. I have to have it for school. My doctor is going to contact my neuro to see what he has to say about it.

I thought I would put it out here to see what everyone here has to say about it. I always get straight answers from the forum.

I accidently put my last name on this post so it is going to be deleted and I will repost it tomorrow....oops see my brain already doesn't work right so I don't need another relapse.

Paula

[Emily_MHModerator]

Hi there -

We have edited your name out of your post for you.

Best wishes,

Emily

[figuerpa]

Thank you, I just reposted....ooops

Paula

[jujuminx]

Paula,

I am not an expert but I have always heard that people w MS should NOT get a live vaccine.  Any other options?

Julie

[rendean]

Hi Paula,
Rats, I had a long response for you based on Quix"s answer as Immunology was also a speciality of hers. If my memory serves me correctly she said "attuented" aka killed vaccines were ok live vaccines were not.

I could not find the correct entry I wanted after searchin g the pages (Shell where are you? you always find them,lol) but I did find this short entry:

http://www.medhelp.org/posts/Multiple-Sclerosis/Flu-Shot-OK/show/670425

I'm with you. With my health background it doesn't make sense to inject known disease into someone with a decreased immune system.

I hope things are worked out easily. A note from your neuro would SEEM to do the trick.

Wishing you well in your studies and health,
Ren

[Lulu54]

PAula, you are stuck, aren't you?  Pun intended because you have to have the MMR injection for the work you want to do, but those live viruses can create havoc.  The best approach for you is exactly what is being done - a talk with your neurologist and doctor is in order and they can sort it out.

In the health field, you can't be a carrier of measles , mumps or rubella because of the risk to your patient.  I'm sure they will figure this out - be sure to give us the update, ok?

hugs, L

[twopack]

I think you are absolutely right to consult your PCP and neuro before receiving this vaccine Paula.  Live vaccines aren’t generally given a green light for those of us with MS.  There does seem to be some wiggle room concerning MMR and shingles though so I’m including some info from the NMSS and the CDC that you may want to review with your health care providers and deciders.

Copy and paste this link to read updated comments about immunizations for PwMS on the National Multiple Sclerosis Society website.
http://www.nationalmssociety.org/living-with-multiple-sclerosis/healthy-living/vaccinations/index.aspx


Copy and paste this link to read directly from the 2012 CDC (Centers for Disease Control and prevention) Yellow Book - their reference for international travelers that is published every two years.  The 2012 edition was released just about a month ago.  I’m referencing the yellow book because the guidelines for persons with specific diseases have been removed from the CDC site for the purpose of updating.
http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-8-advising-travelers-with-specific-needs/immunocompromised-travelers.htm

The following three paragraphs are quoted from the CDC publication just referenced.

“The Multiple Sclerosis Council for Clinical Practice Guidelines, published in 2001, contain the clinical practice guidance on “Immunizations and Multiple Sclerosis.” The expert panel that developed this guidance used CDC recommendations as their foundation. Updated comments are posted on the National Multiple Sclerosis Society website (www.nationalmssociety.org ). People with MS who are having a serious relapse (exacerbation) interfering with the activities of daily living should defer immunization until 4–6 weeks after onset of the relapse.”

“Inactivated vaccines are generally considered safe for people with MS. Administration of tetanus, hepatitis B, or influenza vaccines does not appear to increase the short-term risk of relapses in people with MS. However, published studies are lacking on the safety and efficacy of other vaccines (such as those against pneumonia, meningitis, typhoid, polio, hepatitis A, human papilloma virus, and pertussis). Inactivated vaccines are theoretically safe for people being treated with an interferon medication, glatiramer acetate, mitoxantrone, or natalizumab, although efficacy data are lacking.”

“In the past, many practicing neurologists have strongly advised their MS patients against the use of live-virus vaccines at any time. Live-virus vaccines should not be given to people during therapy with immunosuppressants, such as mitoxantrone, azathioprine, methotrexate, or cyclophosphamide, or during chronic corticosteroid therapy. However, a few published studies suggest that measles, rubella, and varicella vaccines may be safe in people with MS if administered several weeks in advance of, or several weeks after, immunosuppressive therapy. Yellow fever vaccine and smallpox vaccine have not been studied in people with MS and should not be given unless there is a compelling reason to do so (such as unavoidable direct exposure) and there has been a consultation with the patient’s neurologist.”

[twopack]

On a more personal note……

This seems to be a question with more layers of difficulty than is initially apparent.  No need to reveal answers here but I’m wondering about some things.

I wonder if you will be comfortable disclosing your reason for refusing immunization (i.e. your MS diagnosis) if the docs give the vaccine a thumbs down.

I wonder (now that I asked) if you are even allowed to refuse.

I wonder if HIPAA rules are waived by students as they enter this (mandatory?) scrubbing-for-a-healthier-health-care-education process.  

I wonder - if PwMS are supposed to be all this ‘fragile’ - why we would we be allowed to enter the health care field at all.  Why deny a vaccine and then invite a person to work in environments that incubate one live organism after another?  I realize injecting critters is different than merely sharing space with very sick people who are likely to deposit their organisms close by.  But really, I often feel a bit vulnerable merely sitting in the doctors ‘waiting room’.  Never mind about how much I wonder where I should sit my purse once I’m in the exam room!  Are we not fortunate to exit with less disease than we entered?

NOT saying banning us would be a good idea!!  NOT suggesting you should reconsider your career choice!  Just saying.  And (perhaps) getting a little carried away wondering about this whole idea.

So just one more thing I’ll wonder about before I leave this alone.  

I wonder why your titer is low and if this particular vaccine will impart the immunity desired.  Will the school recheck your titer afterwards?  Will they want you to repeat the vaccine if there is no serum conversion?  

Here’s why I wonder Paula.  In an old thread (one that mostly discussed other aspects of immunizations) four community members shared puzzling tidbits.

melissabarrnett wrote:  “…I had to take that shot 8 time so far due to it somehow being to low the first time of coarse as a kid with all the other childhood shots…. then when i went into foster care…. the dr found that my MMR immunity was to low so that got me a shot then one month later went back for more blood workup and the MMR immunity still to low so again another shot…. was good to go til my first child in 1995 had to get the MMR shot again then in 1997 another one after my second child and another one in 2005 after my 3 child and finally my last one in 2007 after my 4th child”

biowham wrote: “…I've had several MMRs because I don't seem to form antibodies in high enough titers after the shot. They tried to give me yet another after my last pregnancy, and I just said no. Enough is enough.”

Quixotic1 wrote:  “…Bio and Melissa - that is so interesting that you needed multiple MMRs. Me, too. I had wild measles at age 5 and wild rubella at age 18. But, with every new job they found I had no measurable antibodies to Rubella. I had two additional doses of it spaced about 8 years apart and still never mounted an response.”

biowham answered:  “...I had wild rubella, too...and no Abs. Got the shot after my first child...and five years later...no Abs. What's UP with that? I've never had wild measles or mumps...don't know if I've been exposed or not.”

twopack wrote:  “….My Mom assured me I had measles, mumps, and rubella as a kid before the vaccine was born. Titers showed low or no immunity so I had the vaccine in my late teens. It didn't raise my titer so I had another dose of the vaccine. Still no protective titer so they said to forget it as it would never "take". I've never had any further symptom of any of the three diseases.”

Quixotic1 wrapped it up with:  “…I was 18 when I had wild rubella - too early for the vaccine, 1970. We KNOW I had it because I broke out at the National Qualifying Speech Tournament. Two weeks later a couple dozen other NSL speakers had rubella. I was an adult, but still didn't manage any antibodies. I looked back and had to have the MMR three times with jobs……  I have never heard of other people with this. I wonder if the MS has something to do with the inability to form antibodies to rubella.”


twopack signing off tonight with:
I wonder what tidbit figuerpa might write in the future.

[UnsureMS]

Hi everyone,

This thread caught my interest since I haven't found any answers yet to what is going on with me. The reason it cuaght my interest is I believe the flu shot is one of these type of vaccines, and I have gotten the flu shot twice and had all my sxs come back up. I refuse to get the flu shot anymore. My family says I am being ridiculous that the flu shot can not cause you to get sick.

So, could the flu shot be the reason for my sxs coming back up. Does this mean that I most likely have an autoimmune disorder, or MS? Just thought I might ask since I am back at square one on finding answers. Thanks for reading this. May god bless you all,

Kimberly

[twopack]

A flu shot stimulates the immune system and that could make any person receiving it feel a little under the weather for a day or two.  In my opinion that wouldn't be sufficient reason to deny myself the protection it offers.  True influenza is a serious respiratory illness that leaves its host incapacitated and vulnerable to potentially deadly complications.

I don't know why your symptoms got worse each time you had the flu vaccine but I am POSITIVE this IS NOT something you can work backwards to arrive at a diagnosis.  

It wouldn't matter anyway since according to the CDC "influenza vaccine does not appear to increase the short-term risk of relapses in people with MS" (as cited in the earlier information).

We always need to keep in mind that just because something is mentioned within a community of people talking about MS, it doesn't mean we can assume it holds true for anyone else with (or without) the disease.

[sllowe]

Hey! I lose my immunity to Rubella too - what is up w/this, lol

Sorry - Good  - super good info twopack - just re-reading and absorbing, but had to interject myself in the lacka rubella.

-shell

[debgen]

Hi Paula,
I am just beginning Gilenya which tends to lower yout immune system. Prior to starting this med, I was put on a series of vaccines, some of which were live. My neuro and PCP  highly recommended that I take them a month apart. I have completed the Chicken Pox, Shingles and flu vaccines with no side effects, no relapse or flare ups! It turned out to be a good thing for me but you need to decide what is best for you

Good Luck,
Deb

[twopack]

Good point Deb.  How do you manage to get there using so few words?  I need some lessons.  lol

FWIW, I researched, requested and received the shingles vaccine back in February of this year.  (It's recommended for all us old farts.)
No side effects, no flare, no shingles, no regrets.

[figuerpa]

Thanks everyone for your input. My neuro and PCP decided to go ahead and do the MMR but they did the math to make sure the Gilenya was completely out of my system first, since Gilenya supresses the immune system one of the things they say is not to get a live virus vaccine, and since Gilenya didn't agree with me I am now on Avonex and it doesn't supress the immune system so they gave me the go ahead, cautioning me that it could cause me some problems for a little while.

So far I have had to do a round of steroids because my face and head were going numb and just feeling plain yucky. I am still feeling some increased symptoms but I can deal with them. I am not so worried though it is better to be covered for the future.  

Would I do it again, mmmmm maybe, I have put almost 3 years into school for this field and would hate to have to change my major now. I will be finished by the end of summer.

As for the titer being low, I was told that women sometimes lose immunity to the MMR after child birth. I know my sister had to get another booster after she delivered her daughter.

Twopack-I am ok with disclosing that I have MS. For me it is better people know in case something happens so they aren't in shock if my face goes numb or something :)

I am not sure about PwMS, I have RRMS as of now. Entering the healthcare field was a choice I made due to what I was doing before was no longer feasable for me. I will be working more front office but on occasion I will be working with patients but for the most part it will be where I am not moving a lot.

School wont recheck, they just want to know that I have had the vaccine and the date it was given. If they recheck it I just hope it is where it needs to be so I don't have to go through this again.

Thanks again everyone!

Paula