Routine Vaccinations and Vaccination Status Before Immunotherapy

In addition to the standard vaccinations generally recommended by the Standing Committee on Vaccination (STIKO) (in particular, the live varicella-zoster virus (VZV) vaccine), specific vaccinations are also relevant for patients with MS. These include pneumococcal disease, herpes zoster, hepatitis B, and, optionally, meningococcal disease. Regionally specific vaccinations, such as those for TBE, should also be considered.

The vaccination status of every patient with MS should be checked before starting immunotherapy. Patients should be fully informed about potential infection risks and the possibility of more severe disease progression during neurological immunotherapy without prior vaccination, so that they can make an informed decision. Required vaccinations should be administered as soon as possible after diagnosis. By that time, acute flare-up symptoms should have subsided.

To ensure an optimal immune response, inactivated vaccines should be administered at least two weeks before the start of immunosuppressive therapy, and live vaccines at least four weeks before.

Vaccinations During Immunotherapy

The effectiveness of vaccines during MS treatment depends largely on the underlying mechanism of action. No impairment of the immune response has been observed during treatment with glatiramer acetate or interferon preparations. Although antibody titers are reduced during treatment with dimethyl fumarate, teriflunomide, or natalizumab, most patients still develop a sufficiently protective immune response. When treated with anti-CD20 antibodies, cladribine, alemtuzumab, or S1P receptor modulators, a reduced immune response to vaccination is to be expected.

Inactivated vaccines can be administered even during immunotherapy. This applies, for example, to seasonal vaccinations (e.g., influenza), regular booster shots, catch-up vaccinations, and travel vaccinations. Even during ongoing immunotherapy, there is a reasonable chance that an adequate immune response to vaccination will be achieved. To maximize the success of vaccination, vaccinations should be administered four to six months after the last dose of B-cell-depleting agents, as the immune system will have at least partially recovered by that time.

Pocket Card for Patients: Vaccination and MS

KKNMS e.V., in collaboration with the BDN and the DGN, is publishing the fact sheet “Pocket Card for Patients: Vaccination and MS.” This ensures that you always receive the most up-to-date recommendations and key information on vaccination in the context of MS, presented in a concise format. You can find the current version of the Pocketcard at the bottom of this page. The new recommendations on vaccination strategy for MS by Schraad et al. (2025) provide a comprehensive overview. The Vac-Mac website also provides information on vaccination for people with immune disorders.