NMOSD and vaccines: How minimizing risk is an investment in quality of life
Fact-checked by Standard vaccines are generally recommended for people with neuromyelitis optica spectrum disorder (NMOSD), although the timing of vaccinations may depend on any disease-modifying therapies (DMTs) a person is using.
In NMOSD, the immune system mistakenly launches inflammatory attacks on healthy parts of the nervous system, causing flare-ups of symptom worsening (relapses) interspersed with periods of stability (remission).
There are rare reports of NMOSD relapses occurring after vaccination, but research on NMOSD and vaccines shows that the benefits of vaccination outweigh the risks. You should work with your healthcare team to develop a tailored vaccination plan.
Vaccines vs. relapse risk
Vaccines help the body build a defense against infectious agents. Each vaccine works a little differently, but in general, they deliver a part of a virus or bacteria to the body that is modified so it won’t cause an infection, but will teach the body to recognize and eliminate the germ.
Because they influence the immune system, vaccines can theoretically trigger the immune misfiring that causes autoimmune attacks. While there are reports that vaccines can be NMOSD relapse triggers, these are quite rare, and no specific vaccine is more strongly linked to relapses than others. Most reported relapses after vaccination are not severe.
On the other hand, infections are a known trigger for NMOSD relapses. They can also cause pseudorelapses, which are episodes of temporary symptom worsening that are not associated with new inflammatory damage to the nervous system.
Underlying immune dysfunction and the use of immunosuppressive DMTs in NMOSD also hinder the immune system’s ability to fight off harmful invaders, leaving patients more susceptible to infections or severe infectious complications. Infections can lead to hospitalizations and persistent symptoms that impair quality of life and may also be life-threatening. That is why health experts typically recommend vaccination.
Vaccination timing
Because NMOSD treatments affect immune function, they can also influence how well the body responds to a vaccine. The timing of vaccination when using these medications matters. Vaccine types include:
- Inactivated and mRNA vaccines: Do not contain any live germ. These should usually be given at least two to four weeks before starting a new DMT. For those already on a DMT, the vaccines may be safe, but the immune response to them might be weakened.
- Live-attenuated vaccines: Contain a living, but weakened version of the germ. In immunocompromised people, these carry a theoretical risk of infection. They should be given at least a month before DMT initiation, and should not be used in someone receiving a DMT.
Many common vaccines are inactivated, while several COVID-19 vaccines are mRNA. Commonly used live-attenuated vaccines include the measles, mumps, and rubella (MMR), varicella (chickenpox), and flu (nasal spray form) vaccines.
With certain DMTs, it can take weeks or months for the immune system to recover after treatment is discontinued. This is especially true of medications that cause B-cell depletion, or low numbers of antibody-producing immune cells. For that reason, doctors may recommend delaying vaccination for a period of time after stopping these medications.
These are general guidelines for immunosuppressants and vaccines, but vaccine timing may vary under individual circumstances. It is a good idea to discuss vaccinations with your healthcare team.
Recommended vaccines
In general, vaccines recommended for the general population are also recommended for people with NMOSD, provided vaccination timing guidelines are followed. Though vaccine guidelines vary by age and other factors, this generally includes vaccines against COVID-19, influenza (the flu), and pneumococcal infections, among others.
Certain vaccines, namely those against the flu, are available in both live and inactivated forms. You should always tell healthcare professionals administering the vaccination about your NMOSD diagnosis, as this may inform the choice between live versus inactivated vaccines.
If you are receiving complement inhibitors, you should receive a meningococcal vaccine before starting treatment to prevent serious bacterial infections associated with these medications.
After your NMOSD diagnosis, you can work with your healthcare team to understand which vaccines are recommended in your individual circumstances and when you should receive them. It may also be helpful for your caregivers and others in close contact with you to be vaccinated. This so-called caregiver ring of protection can help prevent the transmission of illness.
Post-vaccination monitoring
There are no formal recommendations for post-vaccine monitoring in people with NMOSD. The available evidence suggests that the autoimmune condition is not linked to any vaccine-related side effects that differ from those in the general population.
Vaccine-associated relapse risk is low, and no special monitoring is generally needed after vaccination. Take your usual precautions to track NMOSD symptoms and alert your care provider of any changes.
Neuromyelitis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
