COVID-19 Vaccine Guidance for People Living with MS
Last updated – November 1, 2021
For recommendations on COVID-19 vaccines, please refer to National Advisory Committee on Immunization (NACI).
People living with multiple sclerosis (MS) are seeking peace of mind on the safety and effectiveness of the COVID-19 vaccines. In response, MS Society partner organizations convened a group of international expert researchers and medical professionals to review the available science and make fact-based recommendations. The Canadian Network of MS Clinics and the MS Society of Canada’s Medical Advisory Committee have revised and endorsed the guidance for Canadians living with MS.
We do not know how many people in the vaccine clinical trials had MS. Recent studies and registries have reported that the COVID-19 vaccines are generally safe for people living with MS with similar adverse events to the general population. This guidance is based on data from the general population in the vaccine clinical trials and data from studies of other vaccines administered to people with MS.
This guidance applies to the COVID-19 vaccines authorized for use in Canada - Pfizer-BioNTech, Moderna, AstraZeneca/COVISHIELD and Janssen (J & J). COVID-19 is an emerging, rapidly evolving situation. This guidance will be updated and become more detailed as more is learned from scientific studies of the vaccines. See Frequently Asked Questions.
People with MS should consider getting the COVID-19 vaccine
The science has shown us that the approved COVID-19 vaccines are safe and effective. Like other medical decisions, the decision to get a vaccine is best made in partnership with your healthcare provider. Most people with relapsing and progressive forms of MS should consider receiving vaccination. The risks of COVID-19 disease likely outweigh any potential risks from the vaccine. This is particularly true for patients who are at high risk (see below) of contracting COVID-19 because of their work or living conditions and whose co-morbidities are those that have been noted to pose a higher risk of contracting or suffering from COVID-19. In addition, members of the same household and close contacts should also get a COVID-19 vaccine when available to decrease the impact of the virus.
On January 12, the National Advisory Committee on Immunization (NACI) updated its COVID-19 vaccine recommendations for persons with an autoimmune condition (link to recommendations). NACI recommends that the COVID-19 vaccine may be offered to individuals with an autoimmune condition if a risk assessment deems that the benefits outweigh the potential risks for the individual, and there is informed consent regarding insufficient study in people with autoimmune diseases.
Despite the lack of study in people with autoimmune diseases, the Canadian Network of MS Clinics (CNMSC) feels strongly that immunization should be considered in all persons with MS, including youth* with MS. The CNMSC position is that immunization should be considered for all persons with MS, since the risks of COVID-19 appear to outweigh the potential risks of the vaccine. We encourage persons with MS to discuss the vaccine with their physicians, to determine the right decision for them.
* On May 5, 2021, Health Canada approved the use of the Pfizer-BioNTech COVID-19 vaccine for youth ages 12-15 years. This vaccine had been approved for ages 16 and over since December 2020. Pfizer-BioNTech is currently evaluating this vaccine in children 6-12 years old. For more information on children with neuroinflammatory conditions, see Frequently Asked Questions (FAQ).
People with MS at highest risk for severe COVID-19 should consider vaccination as soon as the vaccine is available to them
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 are among groups with the highest risk for hospitalization due to COVID-19. If you are at high risk, you should consider getting the vaccine as soon as it becomes available to you. Refer here for information related to the vaccination rollout across the country. The MS Society has led the calls to government to prioritize COVID-19 vaccines for people living with MS. We are pleased to see some provinces and territories now include people living with MS in early prioritization phases for vaccine roll-out.
The Pfizer BioNTech, Moderna, and AstraZeneca vaccines require two doses. The Janssen (J & J) vaccine requires a single dose. The administration schedule for these vaccines will depend on the Public Health guidelines in your area.
If you’ve had COVID-19 and recovered, you should also consider getting the vaccine. We don’t know how well protected people are after COVID-19 infection, or how long this protection might last. Some people who have had COVID-19 infection in the past can get infected again.
The COVID-19 vaccines are believed to be safe for people with MS
There is no preferred vaccine for those living with MS.
None of the available vaccines in Canada contain ‘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. The risk of getting COVID-19 likely far outweighs any risk of having an MS relapse from the vaccine.
Like other vaccines, COVID-19 vaccines can cause side effects, including a fever. A fever can make your MS symptoms worsen temporarily, but they should return to prior levels after the fever is gone or with acetaminophen. Even if you have side effects, it’s important to get the second dose of the vaccine for it to be effective.
For an updated summary of vaccine recommendations, please refer to National Advisory Committee on Immunization (NACI).
The vaccines are believed to be safe to use with MS medications
The effectiveness of COVID-19 vaccination in people with MS and DMT is thus far unknown. Continue your disease modifying therapy (DMT) unless you are advised by your MS healthcare provider to stop or delay it. Stopping some DMTs abruptly can cause severe increase in disability with new lesions on MRI. Based on data from previous studies of other vaccines and DMTs, getting the COVID-19 vaccine while on any DMT is safe. Some DMTs may make the vaccine less effective but it will still provide some protection. The decision of when to get the COVID-19 vaccine should include an evaluation of your risk of COVID-19, including your occupation, and the current state of your MS. Work with your MS healthcare provider to determine the best schedule for you.
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)
- Dimethyl fumarate (Tecfidera)*
- Natalizumab (Tysabri)
- Fingolimod (Gilenya, generic fingolimod)
- Siponimod (Mayzent)
- Ozanimod (Zeposia)
- Cladribine (Mavenclad)
*Most patients taking dimethyl fumarate have normal lymphocyte counts, but many may have lower numbers, warranting further discussion with your neurologist.
Additionally, if you are already taking or planning to take one of the following DMTs—you may wish to coordinate the timing of your vaccine with the timing of your DMT dose. Work with your MS healthcare provider to determine the best schedule for you:
- Ofatumumab (Kesimpta)
- Alemtuzumab (Lemtrada)
- Ocrelizumab (Ocrevus)
- Rituximab (Rituxan, Ruxience, Riximyo, Truxima)
For additional considerations on optimal timing with MS DMTs, refer to guidelines for health care providers from the Canadian Network of MS Clinics (link) Given the potential serious health consequences of contracting COVID-19, getting the vaccine may be more important than optimal timing with your DMT.
All of us have a personal responsibility to slow the spread of the pandemic and eliminate the virus as quickly as possible
The authorization of safe and effective vaccines for COVID-19 bring us one step closer to eliminating this pandemic. In addition to getting vaccinated, the science is settled that wearing a face mask, social distancing and washing your hands are the best ways to slow the spread of the virus and should be continued even if you get a COVID-19 vaccine.
Learn more about the safe and effective COVID-19 vaccines from the Government of Canada and the Centers for Disease Control and Prevention
The Canadian Network of MS Clinics (CNMSC) COVID-19 Recommendations
Hear From the Experts: COVID-19 vaccines and MS
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
Amit Bar-Or, MD, FRCPC—University of Pennsylvania, 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
Dorlan Kimbrough, MD—Duke University, USA
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
Penny Smyth, MD, FRCPC—University of Alberta, Canada
Rachael Stacom, MS, ANP-BC, MSCN—Independence Care System, 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
MS Society of Canada Medical Advisory Committee
This guidance is also endorsed by:
- ACTRIMS (Americas Committee for Treatment and Research in Multiple Sclerosis)
For more information on approved COVID-19 mRNA vaccines:
- Health Canada Authorizes First COVID-19 Vaccine (Pfizer-BioNTech COVID-19 vaccine)
- Health Canada Authorizes Second COVID-19 Vaccine from Moderna Therapeutics
- Health Canada Approves New COVID-19 Vaccine from AstraZeneca
- Johnson & Johnson's One-Shot COVID-19 Vaccine Received Approval from Health Canada