The COVID-19 pandemic has been particularly concerning for people with chronic health conditions, including MS. If you have MS, you may have many questions about your COVID-19 risk, your MS treatment, and the COVID-19 vaccines.

Multiple sclerosis (MS) is a chronic condition where the immune system attacks the protective myelin layer that covers your nerves. In 2020, experts estimated that 2.8 million people worldwide, or approximately 35.9 people for every 100,000, were living with MS.

The symptoms of MS can affect processes like sensation, movement, and vision, just to name a few. While some people may have mild disease, others will have a gradually worsening disease that can cause significant disability.

In this article, we cover topics that are helpful for people with MS, including discussing steps you can take to protect yourself from COVID-19.

Do I have a higher risk if I have MS?

It doesn’t appear that people with multiple sclerosis (MS) have an increased risk of developing COVID-19. However, those with MS may have additional factors — such as older age or medical treatments — that increase their risk of a more serious outcome if they contract SARS-CoV-2 and develop COVID-19.

A 2021 study involving 219 individuals with MS indicated that the incidence of COVID-19 in this group was actually lower than in the general population. However, the study also showed that hospitalization risk was higher in people with MS.

Despite this outcome, illness severity remained low. The study concluded that compared to the general population, people with MS do not seem to have a higher risk of developing COVID-19 or having a severe COVID-19 outcome.

Why COVID-19 can be more serious for people with MS

A 2021 study aimed to identify risk factors for less than optimistic COVID-19 outcomes in 1,626 people with MS. The main risk factor for a more serious outcome was a lower level of mobility due to disability. Other potential risk factors that were identified included:

Researchers also acknowledged more diagnoses of poor outcomes in Black people. They noted that socioeconomic inequalities could be contributing factors to these findings.

The risk of death due to COVID-19 was also higher than that of the general population. However, the researchers note that other medical, societal, and public health issues that they did not investigate could have contributed to this.

Results from a third 2021 study aligned with the findings above. Research indicated that non-ambulatory status, older age, and preexisting health conditions were risk factors for more serious COVID-19 outcomes.

Summary

Overall, it doesn‘t appear as if having MS increases your risk of developing COVID-19 or of having a serious illness due to COVID-19.

However, there are risk factors that may contribute to a poorer outcome. These include non-ambulatory status, older age, and certain other underlying health conditions.

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There are concerns that some types of MS medications may increase the risk of severe COVID-19.

Healthcare professionals typically prescribe disease-modifying therapy (DMT) to treat MS. These drugs are designed to modify immune system activity and to reduce the progression of MS.

Because these drugs affect the immune system, you may wonder if taking them increases your risk of contracting COVID-19 or becoming seriously ill with COVID-19.

A 2021 study indicated that drugs that inhibit CD20, a protein found on certain types of immune cells, could increase a person‘s risk of severe COVID-19. MS drugs in this group include ocrelizumab (Ocrevus) and rituximab (Rituxan).

A 2022 study involved researchers reviewing 16 observational studies on MS, DMTs, and COVID-19. It found that the use of anti-CD20 drugs may lead to an increased risk of severe COVID-19. However, results did not indicate an increased risk with other therapy types.

Overall, the National MS Society recommends that people with MS take their DMTs as their doctor prescribes. The Society also advises that they should not make any medication changes unless their doctor recommends them. If you develop COVID-19, it‘s important to discuss DMTs with your doctor or neurologist.

Every individual is different. The potential benefits of adjusting DMT treatment in response to COVID-19 must be weighed against the effect that this could have on a person’s MS.

Summary

It‘s possible that some DMTs, specifically anti-CD20 DMTs, may increase the risk of serious COVID-19. However, other types of MS therapies don‘t appear to increase your risk.

It‘s important to take your DMTs as your doctor prescribes. If you have questions or concerns about your MS medications, be sure to talk with your doctor.

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The National MS Society recommends that people with MS get vaccinated as soon as they can. They state that the risk of COVID-19 itself is greater than the potential risks associated with COVID-19 vaccines.

COVID-19 vaccines are both effective and safe for people with MS. However, some types of DMTs may reduce the effectiveness of the vaccine. These include:

  • ocrelizumab (Ocrevus)
  • rituximab (Rituxan)
  • alemtuzumab (Lemtrada)
  • ofatumumab (Kesimpta)
  • cladribine (Mavenclad)

If you‘re taking any of the DMTs above, it‘s important to talk with your doctor about your vaccination schedule. It‘s possible that they can recommend a way to better time your COVID-19 vaccine with your DMT to help maximize effectiveness.

The best way to protect yourself from COVID-19 is to get vaccinated. Vaccination can not only reduce your risk of contracting COVID-19, but it can also help to prevent serious illness, hospitalization, and death due to COVID-19.

COVID-19 vaccine guidelines

As of May 2022, the Centers for Disease Control and Prevention (CDC) recommends that everyone ages 5 years and older be vaccinated against COVID-19.

Recommendations for healthy adults

The current recommendations for COVID-19 vaccines and booster doses in adults are shown in the table below.

If you are getting vaccinated for the first timeIf not vaccinated since September 12, 2023Second booster (age 50 and up)
Pfizer-BioNTech (mRNA)One doseOne updated vaccinemRNA booster at least 4 months after first booster
Moderna (mRNA)One doseOne updated vaccinemRNA booster at least 4 months after first booster
NovovaxTwo doses spaced 8 weeks apartOne updated vaccinemRNA booster at least 4 months after first booster

Recommendations for immunocompromised adults

If you‘re moderately to severely immunocompromised, vaccine recommendations for adults are slightly different. In order to provide better protection, an extra dose has been added to the primary vaccine series. See the table below for details.

NOTE: Having MS and being on a DMT does not necessarily mean you are immunocompromised. However, certain DMTs may increase your risk for COVID-19. Discuss the timing of your vaccinations with your doctor or neurologist.

If you have not been vaccinated beforeIf you have had one previous doseIf you have had two previous dosesIf you have had three or more previous doses
Pfizer-BioNTech (mRNA)3 doses at least 4 weeks apart2 doses Pfizer-BioNTech at least 4 weeks apart, at least 3 weeks after last dose1 dose Pfizer BioNTech at least 4 weeks after last dose1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose
Moderna (mRNA)3 doses at least 4 weeks apart2 doses Moderna at least 4 weeks apart, at least 3 weeks after last dose1 dose Moderna at least 4 weeks after last dose1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose
Novovax2 doses at least 3 weeks apart1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose
Johnson & Johnson’s JanssenNo longer available1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose1 dose Pfizer-BionTech, Moderna, or Novovax at least 8 weeks after last dose

MS and COVID-19 vaccine side effects

According to the CDC, the most common side effects of the COVID-19 vaccine include:

  • pain, redness, or swelling at the site of injection
  • fatigue
  • fever
  • chills
  • muscle pain
  • headache
  • nausea

A 2021 study compared the COVID-19 vaccine side effects in people with MS to those of the general population. Overall, it found that side effects were similar between the two groups. The most common side effects in people with MS were:

  • pain at the site of injection
  • fatigue
  • fever
  • headache

Side effects from the COVID-19 vaccine are typically mild and go away on their own in a few days. However, if side effects persist or get worse after a few days have passed, reach out to your doctor.

According to research from 2021, there have been case reports of people with MS experiencing a relapse following COVID-19 vaccination. However, whether this was directly caused by the vaccine has not been established.

Per the National MS Society, COVID-19 vaccines are unlikely to lead to a relapse. This conclusion is supported by a 2021 study of the Pfizer-BioNTech vaccine in 324 people with MS. The study indicated that vaccination did not raise short-term risk of relapse. An additional 2021 study also suggested that COVID-19 vaccines did not worsen MS or cause MS flares.

Summary

COVID-19 vaccines are effective for people with MS. However, some DMTs may reduce the effectiveness of the vaccine. Talk with your doctor about how to time your vaccine with your medications.

The COVID-19 vaccines are also safe, with side effects in people with MS being similar to those in the general population. It‘s unlikely that vaccination will lead to an MS relapse.

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If you do develop COVID-19, there are some medications that the Food and Drug Administration (FDA) has authorized to help limit the severity of the illness. You can use these medications along with at-home care as you recover.

If necessary, your doctor may prescribe antiviral medications like nirmatrelvir/ritonavir (Paxlovid) and remdesivir (Veklury) to help reduce the virus‘ ability to multiply in your body.

You may have heard of another monoclonal antibody treatment, casirivimab/imdevimab (REGEN-COV), as well. However, the FDA has limited its use because it is less effective against the Omicron variant.

Is it safe to use COVID-19 medications if you have MS?

If you have MS, talk with your doctor before taking any of these medications to treat COVID-19. They can let you know if the medications are safe to use alongside your DMT therapy.

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Research has indicated that people with MS are not more likely to develop COVID-19. However, a 2021 study suggests that people with MS are more likely to experience a slower recovery and are subject more often to long COVID symptoms, particularly fatigue.

Other long COVID symptoms that are particularly common in people living with MS include coughing, shortness of breath, or heaviness in the chest.

The UK Multiple Sclerosis Society recommends that you keep your doctor and your MS team, if you have one, informed of any new or changed symptoms so that they can assist you in creating management plans.

The best way to help prevent serious illness due to COVID-19 is to get a COVID-19 vaccine, which is safe and effective for people with MS.

Because some DMTs may make the vaccine less effective, talk with your doctor about finding an optimal schedule for your vaccine and MS medications. They can also answer any questions you have related to vaccination for COVID-19.

In addition to getting your COVID-19 vaccine, there are also other ways you can reduce your chance of developing COVID-19. These include:

  • asking caregivers and others in your household to get vaccinated
  • washing your hands frequently with soap and water
  • wearing a mask and maintaining physical distancing when you‘re out in public
  • avoiding areas that are very crowded or are poorly ventilated
  • regularly disinfecting high-touch surfaces in your home

People with MS are not at an increased risk of developing COVID-19. However, some factors may put them at a higher risk of serious illness. These include:

  • taking certain types of DMTs, specifically anti-CD20 DMTs
  • having a non-ambulatory status
  • being an older adult
  • having other underlying health conditions like obesity and cardiovascular disease