It is not always good news from the clad Lads…Ensure you think abot the Flu vaccine before getting cladribine


This was not the oral pill used in MS, but the variant injected into the skin.

Although cladribine does not typically cause very marked loss of lymphocytes, it happens in a very small number of individuals

• We report a case of lethal influenza A infection with severe lymphopenia in an MS patient receiving s.c. cladribine.

•Cladribine-related lymphopenia is usually mild to moderate, however severe lymphopenia may occur.

•Annual influenza immunisation should be recommended for people with MS, especially those who are immunosuppressed.

Sadly this person died, so please ensure you get your flu jabs before taking immunosuopress treatments.

Your article link:

About the author



  • Not sure where in the World this was given but why if she had an edss of 9.5 and then a stabilising of 8.5 was she given tysabri then cladribine?
    I know and agree that medication may help regardless of where someone with MS is regarding progression but I did not think this would be approved by those prescribing

  • MD – Did the lymphopenia begin before the flu jab? Same time? Or after the jab? Thanks for the heads up, either way.

    For me, I have been sheltering since March, so if quarantining and a mask are good enough to prevent COVID, it should be good enough to prevent the flu this season. Risk/benefit analysis 🧐 plus my MS is not very stable these days. Dam circulating b-cells.

  • In response to previous comments, click on the link to read the paper:

    ‘She initially had a relatively mild course of the disease with no restriction in mobility. However, 15 years after disease onset she suffered a severe relapse associated with a new cervical lesion that left her with an Expanded Disability Status Scale (EDSS) score of 9.5. Treatment with natalizumab was started and although she gradually recovered over the following month, her new baseline EDSS score stabilised at 8.5’

    One bad relapse in the wrong place changes everything.

    • Actually downloaded the article and then I was able to see all the details. Thought I only had access to the abstract. Thanks team!

  • Always wondered about this, had my first week of cladribine followed by flu jab 5 days later, then second week of cladribine. Didn’t get flu or even a cold all winter. Second year, flu jab then 2 weeks later cladribine week 1… but due to COVID pretty much no flu and not many colds around anyway. Would be really interesting to know how effective the flu jab was. But thankfully social distancing, hand sanitising and face masks have hit the flu on the head for this year at least.

By MouseDoctor



Recent Posts

Recent Comments

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.