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Vaccines, Boosters and Treatment Guidance for MS Patients on Disease Modifying Therapies

By November 8, 2022March 30th, 2023Covid-19, eMS News

NOTE: This information has been adapted from previous updates and is current as of November 8, 2022.

>> Before continuing, we suggest you read our list of frequently asked questions with answers provided by the medical team at the Rocky Mountain MS Center at University of Colorado.

If you haven’t already received your initial COVID-19 vaccination, please get vaccinated as soon as possible. We continue to strongly recommend all individuals receive the COVID-19 vaccination unless you have a known allergy to a component of the vaccine. Below is our current guidance for additional doses and boosters.  To see this information in an easy to read, downloadable PDF format, please click here.

The COVID-19 vaccines and boosters remain the best defense against COVID-19. The updated bivalent booster is designed specifically to target the omicron subvariants – BA.4 and BA.5 — and the original coronavirus strain. The CDC recommends that people ages 5 years and older receive one updated (bivalent) booster if it has been at least 2 months since their last COVID-19 vaccine dose, whether that was their final primary series dose, or an original (monovalent) booster. People who have gotten more than one original (monovalent) booster are also recommended to get an updated (bivalent) booster.

COVID-19 Vaccine Guidance from the CDC

In addition to the MS Center’s guidance on this page, the Centers for Disease Control maintains in-depth and current information on COVID-19 vaccines and boosters on their website. This includes a handy tool lets you put in your age, which vaccine you’ve received, whether you are immunocompromised, etc., and it tells you which shot you should get and when.

Evusheld Update (Posted November 23, 2022)

We develop antibodies against many viruses after being infected, or by taking a vaccine. Both offer varying levels of protection against future infection with the same virus. Many MS disease-modifying therapies, however, can impact how your immune system works by reducing production of antibodies that neutralize SARS-CoV-2 after vaccination or natural infection. Prior to November, one way to get additional antibodies against COVID was to take them as a drug cocktail called Evusheld.

Evusheld is a combination of two monoclonal antibodies that work against the spike protein of SARS-CoV-2, and is given as two intramuscular injections at the same visit. Evusheld is a drug for moderately to severely immunosuppressed patients who have been vaccinated, but haven’t developed adequate levels of those protective antibodies. It’s likely useful for up to six months, and present guidance is to repeat those shots every six months.

Evusheld was a helpful tool against the BA.4 and BA.5 variants and patients who received it added a layer of self-protection while those variants were dominant. However, as of mid-November, the BQ.1 and BQ.1.1 variants have become the dominant strains of COVID-19 in the US, which appear to be resistant to the antibody cocktail in Evusheld. Because of this, Evusheld is being phased out and UCHealth will stop offering it. The doctors at the Rocky Mountain MS Center continue to monitor the situation and we will keep you up to date on current recommendations as COVID continues to change over time. This does not mean that previous recommendations were incorrect, simply that the dominant virus variants have changed and therefore we have new recommendations.

Evusheld is not a replacement for the COVID vaccination or boosters.

COVID-19 Vaccine and Booster Guidance

Below is our current guidance for COVID-19 vaccines and boosters.

For individuals on anti-CD20 disease modifying therapy (Ocrevus, Rituxan, or Kesimpta) or S1P disease modifying therapies, (Gilenya and its generics, Mayzent, Zeposia, or Ponvory), Lemtrada, Mavenclad, or any chemotherapy drugs, below is our guidance:

Recommendation and Eligible For

If you received Pfizer/BiontechIf you received ModernaIf you received Johnson & Johnson

Initial Vaccine Doses

 

  • Age 5+
  • 2 Doses, 3 weeks apart
  • Age 6+
  • 2 Doses, 4-8 weeks apart
  • Age 18+
  • 1 Dose

Additional Dose

  • Age 5+
  • 1 Dose, 3 weeks after 2nd shot
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine. If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 6+
  • 1 Full Dose, 4 weeks after 2nd shot
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine. If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 18+
  • 1 additional vaccine dose of an mRNA vaccine (Pfizer or Moderna)
  • This additional dose should be administered at least 4 weeks after the J & J vaccine.
 

Booster

 

  • Age 12+
  • 1 Dose 3 months after 2nd shot or additional 3rd dose
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 18+
  • 1 Half Dose 3 months after 2nd shot or additional 3rd dose
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 18+ should get an mRNA booster (Pfizer or Moderna) 2 months after the second dose of Pfizer or Moderna (as noted above)
2nd Booster
  • Age 12+
  • 1 dose 4 months after receiving first booster dose.
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 18+
  • 1 half dose least 4 months after receiving first booster.
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • No additional booster recommended at this time.

Updated Bivalent Booster

 

  • Age 5 +
  • 1 Dose of updated bivalent booster at least 2 months after your initial vaccine doses or any subsequent booster.
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 5 +
  • 1 Dose of updated bivalent booster at least 2 months after your initial vaccine doses or any subsequent booster.
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
  • Age 18+
  • 1 Dose of updated bivalent booster at least 2 months after your initial vaccine doses or any subsequent booster.
  • If on Ocrevus or Rituxan, one month prior to your next infusion OR at least one month after your last infusion, preferably and if possible, 5 months.
  • If on Kesimpta, 4 weeks after your last dose of Kesimpta. When possible, resume Kesimpta injections 4 weeks after getting vaccine.  If you wait 4 weeks after the last dose of Kesimpta, and then get the vaccine dose, then wait 4 more weeks, that potentially means missing a single dose of Kesimpta. Discuss with your doctor.
Total Number of Doses
  • If you are Age 5-11:  3 Doses Total
  • If you are Age 12+:  6 Doses Total
  • If you are Age 6+: 4 Doses Total
  • If you are Age 18+:  6 Doses Total (4 Doses and 2 Half-Doses)
  • If you are Age 18+:  4 Doses Total

 

If you are taking any other DMT, including fumarate therapies (Tecfidera or dimethyl fumarate and its generics, Bafiertam or monomethyl fumarate, Vumerity or diroximel fumarate); Aubagio; Tysabri, glatiramer acetate (Copaxone) or interferons (Avonex, Rebif, Betaseron, and Plegridy), OR if you are NOT taking a disease modifying therapy, below are our recommendations:

Recommendation and Eligible For

If you received Pfizer/Biontech

If you received Moderna

If you received Johnson & Johnson

Initial Vaccine Doses

 

  • Age 5+
  • 2 Doses, 3 weeks apart
  • Age 5+
  • 2 Doses, 4 weeks apart
  • Age 18+
  • 1 Dose
Additional Dose

 

  • None
  • None
  • None
Booster

 

  • Age 12+
  • 1 dose 5 months after 2nd shot or additional 3rd dose
  • Age 18+
  • 1 Half dose 5 months after 2nd shot or additional 3rd dose
  • Age 18+ should get Pfizer or Moderna
  • 1 Dose 2 months after 1st shot
2nd Booster
  • Age 50+
  • 1 dose least 4 months after receiving first booster dose.

 

  • Age 50+
  • 1 Half dose least 4 months after receiving first booster dose.

No additional booster recommended at this time.

Updated bivalent Booster

  • Age 5 +
  • 1 Dose at least two months after your initial vaccine doses or any subsequent booster.
  • Age 5 +
  • 1 Dose at least two months after your initial vaccine doses or any subsequent booster.
  • Age 18 +1 Dose at least two months after your initial vaccine doses or any subsequent booster.

Total Number of Doses

 

  • If you are Age 5+:  3 Doses Total
  • If you are Age 12+:  4 Doses Total
  • If you are Age 50+:  5 Doses Total
  • If you are Age 5 -17:  3 Doses Total
  • Age 18+: 5 Doses Total (3 Full Doses and 2 Half Doses)
  • If you are Age 50+: 5 Doses Total (3 Full Doses and 2 Half Doses)
  • If you are Age 18+:  3 Doses Total

What is the difference between an additional third dose and a booster?

An additional dose is intended to improve the response to the first and second dose of the vaccine in immunocompromised people. A booster is given when the immune response to the first, second dose, and any additional dose is likely to have decreased over time. People who are immunocompromised who received the Pfizer or Moderna vaccine may receive a total of five COVID-19 vaccine doses (the first two doses, an additional dose, and two boosters). The additional third dose of the Moderna vaccine is a full dose, the boosters of the Moderna vaccine are half dose. Pfizer doses are all the same strength.

Please Note:

  • It is most important to get fully vaccinated as soon as possible. All three vaccines approved for use in the United States are safe and effective. If you have the choice, we encourage individuals to get either the Pfizer/Biontech or the Moderna vaccines. Data shows the mRNA vaccines are more effective than the Johnson & Johnson vaccine. Additionally, the Pfizer/Biontech and Moderna vaccines do not have the same risk of blood clots as the Johnson & Johnson vaccine.
  • It is okay to mix and match the vaccines for additional dose and booster.
  • While we are recommending people space out their infusion and vaccine, there is not a safety concern about getting them closer together. Recommendations are based on increasing the efficacy and tolerating the vaccinations better.
  • These recommendations assume that you did not have a severe reaction to your first doses of the vaccine, and that you don’t have another medical reason for not taking a third dose (for example, a known allergy to components of the vaccine).

We recognize that this is a substantial number of vaccine doses. If you have had a significant reaction to prior doses of the vaccine, please discuss getting an additional booster with your doctor.  And, as always, talk to your own provider before making any decisions that you have questions about.

>> We suggest you also read our new list of frequently asked questions with answers provided by the medical team at the Rocky Mountain MS Center at University of Colorado.

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