Cases of influenza are common during the winter months, and the flu vaccine has gone a long way in relieving the discomfort for millions of yearly sufferers. Although there used to be some confusion about whether or not people with MS should get a shot each year, recent studies indicate that flu shots are safe and, generally, are reasonable for people with RRMS. Here's what you need to know:

A 1997 study looked for possible links between the influenza vaccination and MS relapses and found that people with RRMS who were injected with the vaccine did not have more relapses than those who were injected with a placebo. On the other hand, studies indicate that the flu may provoke an MS attack. In summary, the flu vaccination does not appear to cause attacks, but the flu itself may cause attacks. Experts still advise you to discuss the issue with your doctor before deciding whether or not to get the vaccine.

Who Should Not Get the Shot?

Anyone with an active or unstable neurological condition, including people with MS who are having a relapse, should avoid the influenza vaccine or postpone it until four to six weeks after the onset of relapse. Also, flu vaccination should probably be avoided by people with MS who have a history of attacks that appear to have been provoked by the flu vaccine. There are other situations in which people are advised not to get the shot:

• Infants under the age of six months

• Anyone who is allergic to or has had an anaphylactic hypersensitivity to eggs or egg products

• Anyone who has had an allergic or anaphylactic reaction to a previous flu vaccination

• Anyone who is actively unwell at the time of the vaccination (high fever and chills); they should postpone receiving the flu vaccine until symptoms have become better

In a nutshell, researchers say that flu shots are safe for folks with RRMS and can prevent infections that can trigger or worsen MS symptoms. In the past, some patients and their doctors worried that the vaccine could cause a relapse by triggering an immune response, but experts say that's unlikely. Patients with other forms of the disease or with high disease activity should talk to their doctor about whether to vaccinate.

Other Vaccinations

Based on current evidence, it appears that hepatitis B, tetanus, measles, and rubella (German measles) vaccinations are safe for people with MS and are not associated with an increased risk for the development of MS or optic neuritis. The hepatitis B vaccine in particular was in question as to whether or not it caused or worsened MS as well as other neurological conditions, but studies found no links between the two. A 2001 panel studying the issue recommended that people with MS have access to life-saving vaccines and that they use the Center for Disease Control guidelines (www.cdc.gov) for information on vaccines. Other recommendations include:

• People who have received immune globulin preparation in the past three months should not receive live attenuated virus vaccines, such as varicella or MMR (measles, mumps, and rubella).

• People on therapies that suppress the immune system (immunosuppressants), such as mitoxantrone, natalizumab (tysabri) azathioprine, methotrexate, cyclophosphamide and/or chronic corticosteroid therapy should not receive live attenuated vaccines. A person with a suppressed immune system would be at greater risk for developing the disease.

Live attenuated vaccines contain viruses that have been altered so they can't cause disease. Viruses are weakened by growing them in such a way that their disease-causing ability is decreased.