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.