The following is a complete and current set of guidance regarding vaccines in the US health care market for the Fall 2024 season. These recommendations are general guidance from the Rocky Mountain MS Center at University of Colorado clinical team. If you have any questions or concerns, please contact your MS care team for guidance related to your specific situation.

COVID-19: Updated Vaccines Now Widely Available

The Rocky Mountain MS Center’s medical team continues to strongly recommend all individuals receive the COVID-19 vaccination, including the most recent updated COVID-19 vaccination now available, unless you have a known allergy to a component of the vaccine.

The FDA recently approved and authorized 2024–2025 Moderna and Pfizer-BioNTech COVID-19 vaccines. The Centers for Disease Control (CDC) recommends that people aged 6 months and older should get 1 or 2 doses of updated COVID-19 vaccine, depending on your age and the number of doses you got previously.

Individuals are moderately or severely immunocompromised if you are:

• On anti-CD20 disease modifying therapy (Ocrevus, Rituxan, Kesimpta, or Briumvi)
• Or on S1P disease modifying therapies, (Gilenya and its generics, Mayzent, Zeposia, or Ponvory), Lemtrada, Mavenclad, or any chemotherapy drugs.

For vaccine guidance for moderately or severely immunocompromised people by age and number of doses you got previously, please consult the CDC’s most updated guidance table: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html

And our medical team’s guidance on timing of your updated COVID vaccine based on your Disease Modifying Therapy is below:

For individuals on anti-CD20 disease modifying therapy or S1P disease modifying therapies, Lemtrada, Mavenclad, or any chemotherapy drugs, below is our timing guidance:

• If on Ocrevus, Rituxan, or Briumvi, try to get your updated vaccine one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, five or more months.
• If on Kesimpta, guidance is a bit less clear. In general we recommend to try to get your updated vaccine 4 weeks after your last dose of Kesimpta, and then, use the next Kesimpta injection four weeks after the vaccine. Thus, this means missing a single dose of Kesimpta. Discuss with your doctor.
• For Gilenya, its generics, Mayzent, Zeposia, and Ponvory, there is no way to hold dosing for these DMTs, so we suggest the regular schedule to get your updated vaccine if you have not received a COVID-19 vaccine in the past two months.
• We do not have specific timing guidance for Lemtrada and Mavenclad. Thus, we would suggest taking a vaccine dose anytime three months or more after your last DMT dose and at least four weeks prior to next DMT dosing.

Individuals taking any other DMT, including fumarate therapies (Tecfidera or dimethyl fumarate and its generics; Bafiertam or monomethyl fumarate; Vumerity or diroximel fumarate); Aubagio (teriflunomide); Tysabri, Copaxone (glatiramer acetate) or interferons such as Avonex, Rebif, Betaseron, and Plegridy; OR if you are NOT taking a disease modifying therapy should follow the general guidelines for COVID vaccination.

There are no absolute guidelines for those with recent COVID infection, but the CDC guidance is you may wish to wait three months before getting the next COVID vaccine. If you have had a recent COVID infection, we do not know the exact strain people got infected with, so our medical team suggests that, if you were not infected in the last couple of weeks, get the new vaccine when it is available.

Pemivibart (Pemgarda): New COVID-19 Preventative Drug Launched to Help Those with Compromised Immune Systems

For those who may not have adequate immune responses to the vaccine, Pemivibart (Pemgarda) is a monoclonal antibody prophylactic therapy for moderately to severely immunosuppressed patients to help reduce the risk of getting, or having severe illness with, COVID-19.

Pemgarda is NOT a vaccine, nor is it a substitute for vaccination… rather it is simply a made-in-the-lab antibody against COVID.  If you are on anti-CD20 disease modifying therapy or S1P disease modifying therapies, Lemtrada, Mavenclad, or any chemotherapy drugs, you likely qualify for Pemgarda.

Pemgarda is similar to Evusheld, which was given in 2022. Pemgarda has been given an Experimental Use Authorization (EUA) by the FDA. This is an hour long IV infusion of 4500 mg of Pemgarda, followed by a 2 hour observation period. Less than 1 in 100 people have had severe allergic responses, or anaphylaxis, to the infusion and a small percentage have had less severe reactions, hypersensitivity, that are similar to those with other infusions

Talk with your health care provider about getting Pemgarda.

It’s important to note that Pemgarda is not a substitute for COVID-19 vaccination. People who are moderately or severely immunocompromised should still receive COVID-19 vaccine according to the recommended schedule. Pemgarda should not be taken within two weeks of a COVID vaccine, or recent COVID infection.

If you have received the COVID vaccine recently, you should wait two weeks to use Pemgarda.  There is no official guidance on how long to wait before getting a COVID vaccine after taking Pemgarda, but two weeks for this as well seems prudent. Discuss the use of Pemgarda with your doctor if you have had a severe reaction to one or more COVID vaccinations, as some of the products in the infusion are the same as or similar to those in the vaccine.

See the FDA fact sheet and the patient fact sheet from the maker of Pemgarda below for more details: https://invivyd.com/wp-content/uploads/2024/08/Clean_FINAL_PEMGARDA-EUA-122-Patient-Fact-Sheet_2024August26.pdf

This information is written on September 6, 2024.

Annual Flu Shot

Flu shots are recommended for all patients, except those with known allergies to the shots, but providers recommend that MS patients not receive any “live attenuated vaccines” — such as flu mist nasal spray. The CDC’s guidance this year also states that people with allergies to eggs can safely receive any flu vaccine. Regular flu shots are recommended.

If you are on an anti-CD20 DMT (Ocrevus, Rituxan, Kesimpta, or Briumvi) or S1P disease modifying therapies (Gilenya and its generics, Mayzent, Zeposia, or Ponvory), we recommend that you get the higher dose flu vaccine for individuals 65+ years of age to encourage a better immune response.

For many, it is easier to get the flu shot and COVID vaccine at the same time, one vaccine for either arm. However, some might wish to limit having two sets of vaccine reactions at the same time, and get the vaccines separated by several days, after it is clear the reaction from the first is over or not going to happen (a few days usually). If you already had the flu this season, the recommendation is still to get the flu vaccine, as there may be multiple flu strains that are in the community every year.

RSV Vaccine

If you are over the age of 60, the Respiratory Syncytia Virus (RSV) is recommended, unless you are allergic to one of the components or sick at the time with a virus.

These recommendations are general guidance from the Rocky Mountain MS Center at University of Colorado clinical team. If you have any questions or concerns, please contact your MS care team for guidance related to your specific situation.