American Academy of Neurology Guidelines on Immunizations in Multiple Sclerosis


New updates to immunization guidelines in multiple sclerosis outline recommendations on vaccination decisions for patients.

New updates to the American Academy of Neurology (AAN) guidelines on immunization and multiple sclerosis (MS) outline recommendations for patients with the disease to receive their vaccinations.

The guideline, which updates the 2002 AAN guideline, is based on a systematic review of evidence surrounding the effects of vaccinations on individuals with MS.

In total, the guideline supports the use of immunization in all patients with MS, recommending that all individuals work with their care team to maintain the regular recommended vaccinations, including yearly flu shots.

“We reviewed all of the available evidence and for people with MS, preventing infections through vaccine use is a key part of medical care,” lead author Mauricio F. Farez, MD, MPH, of the FLENI Institution and a member of the AAN, said in a press release about the guidance. “People with MS should feel safe and comfortable getting their recommended vaccinations.”

Still, the guideline also recommends that patients consult with their care team prior to receiving vaccinations. There is some evidence suggesting that certain immunizations may not be as effective with some MS medications, therefore patients should let their providers know which medications they are using, according to the AAN.

The authors noted that there is not enough available information to determine whether or not vaccinations can trigger or worsen MS flares.

“Still, experts in MS urge their patients to hold off on scheduling their vaccinations if they are having an MS flare simply to avoid the potential for any complications,” Farez said.

Some of the other major recommendations include:

  • Clinicians should counsel patients with MS about infection risks associated with specific immunosuppressive/immunomodulating (ISIM) medications and treatment-specific vaccination guidance according to prescribing information and should vaccinate patients as needed at least 4 to 6 weeks before initiating ISIM therapy.
  • Clinicians must screen for infections according to the prescribing information before initiating ISIM medications and should treat patients testing positive for latent infections. In high-risk populations, clinicians must screen for latent infections before starting ISIM therapy even when not specifically mentioned in the prescribing information.
  • Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies.


Farez MF. Correale J, Armstrong MJ, et al. Practice guideline update summary: Vaccine-preventable infections and immunizations in multiple sclerosis. Neurology. 2019. Doi:

AAN Issues Guideline on Vaccines and Multiple Sclerosis [news release]. American Academy of Neurology. Accessed August 29, 2019.

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