New recommendations on the vaccination strategy for multiple sclerosis call for proactive and early vaccination, ideally before the start of immunomodulatory therapy. This is to avoid serious infections that can worsen the course of the disease. In this context, the Multiple Sclerosis Competence Network has updated the Pocket Card Vaccination to make everyday practice easier.

Patients with multiple sclerosis are susceptible to severe infections due to their disease and often immunosuppressive therapies, which can trigger relapses and permanent disabilities. The strategy advises planning vaccinations well and completing them early before starting a new course-modifying immunotherapy. Early vaccination is considered a crucial part of treatment, as preventable infections have a negative impact on the course of treatment. Individual risks must be assessed in order to safely integrate immunotherapy and vaccination into long-term management.

The Multiple Sclerosis Competence Network sees its mission as supporting the everyday life of neurologists with clear recommendations and instructions for action and providing well-founded information. Defined vaccination guidelines better protect patients and improve their quality of life. An individual consultation with the neurologist takes into account the life situation, therapy strategy and concomitant diseases. Essential vaccinations include those against tetanus, diphtheria, poliomyelitis, whooping cough, hepatitis B, influenza, herpes zoster, pneumococcus, meningococcal and SARS-CoV-2.

In a study based on a literature review, a consensus of experts presents recommendations on the type and timing of vaccinations in immunotherapies for neurological autoimmune diseases. Any immunotherapy can influence the humoral and cellular response to vaccinations, which is why vaccinations are preferable before starting therapy. However, in the case of an active inflammatory course with a risk of irreversible neurological damage, a delay in the start of therapy is not justifiable. Live vaccines are contraindicated for most immunotherapies and are only recommended after a strict risk-benefit assessment. Detailed dates for various MS drugs can be found in the updated pocket card of the Competence Network, version 0.0.3 of 16 January 2026.

The recommendations are based on the recognition that the safety and efficacy of vaccinations in the context of immunotherapy must be clarified in general and individually. The update of the pocket card serves as an aid for everyday practice and integrates evidence-based findings. Neurologists can use it to better advise patients and adjust vaccination schedules to minimize complications.

Proactive vaccination can reduce the risk of infection, which is particularly severe in MS patients. The strategy emphasizes planning in order to optimally combine therapy and protection. In cases of active disease, the consensus prioritizes the rapid start of therapy, while vaccinations are made up. Avoiding live vaccines under immunosuppression reduces the risk of adverse reactions.

The Competence Network therefore calls for close coordination between neurologists and patients in order to create personalized plans. The recommendations of the Standing Committee on Vaccination form the basis, supplemented by MS-specific adjustments. The study highlights that early interventions can improve prognosis and prevent disabilities. With the Pocketcard, practitioners receive concrete recommendations for action that make it easier to deal with various therapies.

Original Paper:

Schraad, M., Mäurer, M., Salmen, A., Ruck, T., Uphaus, T., Fleischer, V., … & Zipp, F. (2025). Cellular and humoral vaccination response under immunother- apies—German consensus on vaccination strategies in neurological autoimmune diseases. Therapeutic Advances in Neurological Disorders, 18, https://doi.org/10.1177/17562864251396006

Editor: X-Press Journalistenbüro GbR

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