It seems as if children are getting more vaccines than

before. Doesn’t that overwhelm their immune system?

Experts say that while children receive more vaccines now, the
vaccines are more precise than before because of better scientific
understanding of how to train the immune system to defend
children against diseases.

Thirty years ago, children received vaccines that protected against

eight diseases: measles, mumps, rubella, diphtheria, tetanus,
pertussis, Haemophilus influenzae type b and polio. The total
number of bacterial and viral proteins contained in earlier versions
of these vaccines was a little more than 3,000.

Today, young children receive vaccines that protect against 14

diseases: the eight earlier ones plus hepatitis A, hepatitis B,
rotavirus, influenza, chickenpox and pneumococcal disease. But the
total number of bacterial and viral components in these vaccines is
only about 150.

When the vaccine for pertussis, or whooping cough, was developed,

for example, it had about 3,000 such components, Feemster said.
Now the vaccine contains three to five proteins.

Studies of Vaccine Safety and

Effectiveness in People with MS
Some, but not all, immunizations have been evaluated for safety and efficacy in people with MS:

 A study by the Vaccines in Multiple Sclerosis Study Group published in 2001 in the New
England Journal of Medicine found that vaccination for tetanus, hepatitis B or
influenza did not appear to increase the short-term risk of relapses (also called attacks
or exacerbations) in people with MS.
 A study by the National Immunization Program of the Centers for Disease Control and
Prevention, published in the Archives of Neurology in 2003, found that vaccination
against hepatitis B, influenza, tetanus, measles, or rubella did not increase a person’s
risk of developing MS or optic neuritis (which is often a first symptom of MS).
 A small, unblinded study, published in the Archives of Neurology in 2011, of people with
relapsing-remitting MS who received the yellow fever vaccination prior to travel, found a
significantly increased risk of MS relapses during the six weeks following
the vaccination when compared to the remainder of the two-year follow-up period. For
people with MS who must travel to areas where yellow fever is common, the increased
relapse risk needs to be carefully weighed against the likelihood of exposure to yellow
fever – which is a potentially fatal illness.
  A study of nearly four million girls and women identified in nationwide patient registries
in Denmark and Sweden, published in the Journal of the American Medical Association,
found no increased risk of developing MS among nearly 800,000 who received
quadrivalent human papillomavirus vaccine (Gardasil®), designed to prevent cervical
cancer.
 A review of data from the complete electronic medical health records of Kaiser
Permanente Southern California between 2008 and 20011, published in JAMA
Neurology, found no long-term association of vaccines with MS or any other acquired
central nervous system demyelinating disease.

Studies of Vaccines with Specific

Disease Modifying Therapies
 A blinded, randomized, multicenter, placebo-controlled study, published in Neurology
in 2015, evaluated the effectiveness of the flu vaccine in fingolimod-treated patients.
Researchers found that most fingolimod-treated patients with MS were able to mount
immune responses with the vaccine, and the majority met criteria indicating
seroprotection. However, response rates were reduced compared with placebo-treated
patients. Overall, there was some decrease in vaccination-induced immune responses
among the fingolimod treated patients.
 A study, published in Neurology in 2013, investigated the effect of teriflunomide on the
efficacy and safety of the influenza vaccine and found that teriflunomide-treated
patients generally mounted effective immune responses to seasonal influenza
vaccination. Researchers concluded that teriflunomide generally does not adversely
impact the ability of MS patients to mount immune responses to influenza vaccination.
 A small case-control study, published in Neurology in 2013, assessed
immunocompetence in patients after alemtuzumab treatment by measuring antibody
responses to several vaccines before and after treatment. Researchers concluded that
serum antibodies against common viruses remained detectable after treatment, and
there was retained ability to mount an immune response against new antigens after
treatment with alemtuzumab.
 In a small study published in Neurology, Neuroimmunology and Neuroinflammation in
2016, comparing people being treated with daclizumab with a group comprised of
healthy controls and people with MS not being treated with daclizumab, no difference
was found in the two groups’ ability to mount a normal antibody response to influenza
vaccinations.
Summary Table of Vaccine
Recommendations
Summary Table of Vaccine Recommendations

Vaccine Type Use in people with MS

Injectable seasonal flu vaccine Inactivated Considered safe

Flu-Mist® flu vaccine Live attenuated Not recommended

Fluzone® high-dose flu vaccine Inactivated Not recommended

Gardisil® human
Inactivated Probably safe
papillomavirus vaccine (HPV)

Hepatitis B vaccine Inactivated Considered safe

Probably safe in individuals

Measles-Mumps-Rubella
Live attenuated not on immunosuppressant
vaccine
medications

Pneumovax® 23 and Prevnar®

Inactivated Considered safe
13 pneumococcal vaccines

Inactivated in
Polio Probably safe
most countries

Probably safe; benefit likely

Rabies Inactivated
outweighs any risks

Considered safe; may

Tetanus vaccine Inactivated
reduce relapses

Probably safe. Required

prior to treatment with
Varivax® and Proquad®
Live attenuated fingolimod and
varicella vaccines
alemtuzumab in patients
without previous exposure

May not be safe; should

not be used by individuals
Yellow fever vaccine Live attenuated
on immunosuppressant
medications

Probably safe for any adult

Zostavax® zoster vaccine Live attenuated
who has had chicken pox
Adapted from Williamson EML, Chahin S, Berger JR. Vaccines in multiple
sclerosis. Curr Neurol Neurosci Rep 2016; 16:36. DOI
10.1007/s11910-016-0637-6