Vaccination on Drug Therapy

EpubBerger JR Varicella vaccination after fingolimod: A case report Mult Scler Rel Dis 08 April 2013 

A 36 year old woman with relapsing remitting multiple sclerosis and a childhood history of varicella (chickenpox) received 5 days of fingolimod (Gilenya®) before the drug was stopped upon discovery that she was varicella zoster virus (VZV) seronegative. Despite medical advice to the contrary, she was vaccinated with attenuated zoster virus vaccine (Zostavax®) the day after discontinuing fingolimod. Although the vaccination was uncomplicated by rash or systemic illness, her 3 year old daughter developed varicella 14 days following the vaccination. The patient developed recurrent thoracic herpes zoster 8 and 10.5 months following the vaccination while receiving fingolimod. Both episodes resolved during acyclovir therapy. This case report suggests that the immunomodulation that attends the administration of fingolimod may increase the risk of viral shedding following vaccination with attenuated VZV and reduce the efficacy of vaccination.

You have been asking about whether fingolimod influences vaccination so this case report may be of interest. Remember it is n of 1 so is it coincidence or real? Although the lady had chickenpox as a child she did not seroconvert or develop an antibody response. She was vaccinated with attenuated virus, this is live by less virulent than wild-type chickenpox virus. The child of the MSer got chickenpox 2 weeks later and the MSer got shingles, so they did not get protective immunity from the vaccine. Did the drug make the vaccine more virulent?

Talk to you neuro before considering vaccination.
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  • I don't know whether most neuros would know what the answer is to 'do I vaccinate or not' or 'am I still covered by my childhood vaccs. or having had the disease' in relation to the newer stronger DMTs. It looks as if you'd be covered for measles, but the flu jab might not work? Should you be tested to see whether you still have the antibody protection you thought you had? What about exotic travel- should you have the vaccs. and then be tested to make sure you have the antibodies?

  • Varicella vaccine immunity only lasts for roughly a decade. Reactivated varicella in MSer caused shingles. The child probably got primary chicken pox from mother. Fingolimod can cause slight T-cell suppression and lead to less or ineffective antibody response in B-cells. Did drug make vaccine more virulent or did it cause a reactivation of latent virus?

    • So if you've had alemtuzumab could that mean instead of getting protected against a disease with vaccination, you could give yourself the disease? Is this only relevant with chickenpox, or could it relate to other diseases like tetanus, polio, tb etc.

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