Vaccination Strategy for MS: Updates Before & During Immunotherapy

Vaccination Guidelines for Individuals with Multiple Sclerosis

Clearly defined vaccination guidelines are crucial to better protect patients with multiple sclerosis (MS) and improve their quality of life. Individual advice from the treating neurologist, considering life situation, therapy strategy, and possible comorbidities, is essential. Recommended vaccinations, in accordance with the recommendations of the Standing vaccination Commission (STIKO), include those against tetanus, diphtheria, poliomyelitis, whooping cough, hepatitis B, influenza (flu), herpes zoster, pneumococci, meningococci, and SARS-CoV-2 (COVID-19).

Vaccination Timing and Immunotherapy

A 2025 study by Schraad and colleagues highlights the importance of timing vaccinations in relation to immunotherapy for neurological autoimmune diseases. Their research, based on a literature review, provides evidence-based German expert consensus on vaccination strategies. Becuase immunotherapy can influence both humoral and cellular responses to vaccination, completing vaccinations before starting immunotherapy is generally advisable.

However, in cases of active inflammatory MS with a risk of irreversible neurological deficits, delaying therapy to complete immunization is not justified. The use of live vaccines is generally contraindicated for most immunotherapies and should only be considered after a thorough benefit-risk assessment.

Detailed Recommendations

Specific vaccination timing recommendations for various MS disease-modifying therapies (DMTs) are available in the “Pocketcard Vaccination” (version 0.0.3, updated January 16, 2026) published by KKNMS eV.

Key Takeaways

• vaccination is essential for protecting individuals with MS from preventable infections.
• Individualized advice from a neurologist is crucial.
• Vaccination is generally recommended before starting immunotherapy, but this may not always be possible.
• Live vaccines are typically contraindicated during immunotherapy.
• The KKNMS eV “Pocketcard Vaccination” provides detailed guidance on timing vaccinations with specific MS therapies.

Source: Schraad, M., et al. (2025). Cellular and humoral vaccination response under immunotherapies-German consensus on vaccination strategies in neurological autoimmune diseases. Therapeutic Advances in Neurological Disorders, 18.