Preventative Care: Immunizations in People with Multiple Sclerosis Maryann Hibbs RN, BSN, MSCN, BSBA, MSPL VA Pittsburgh Healthcare System.

Preventative Care: Immunizations in People with

Multiple Sclerosis

Maryann Hibbs RN, BSN, MSCN, BSBA, MSPL VA Pittsburgh Healthcare System

Preventative care is important to keep you healthy and at home.

Regular examinations and screenings

Manage stress Exercise Diet

Smoking cessation

Immunization Flu Shot

Flu shot- What you will learn:

What is the flu Flu symptoms How does the flu

spread How can the flu be

prevented What is the flu shot The MS patient and the flu shot

Who can’t get the shot Research, MS, and the flu shot

Benefits of the flu shot Specifically why MS patients should get the flu shot Where to get flu shot

The flu is serious business.

Influenza (commonly called the flu) is not just a runny nose or upset stomach. It is a serious illness that can lead to pneumonia.

At least 45,000 Americans die each year from influenza and pneumonia, the sixth leading cause of death in the United States.

What is the Flu?

The flu (influenza) is caused by a virus that is easily spread. Since the flu is caused by a virus. It can’t be treated with antibiotics. Influenza is not the same as “stomach flu,”

the 24-hour bug that causes vomiting and diarrhea. This is most likely due to a GI (gastrointestinal) infection—not the flu

Flu Symptoms

Flu symptoms tend to come on quickly. Symptoms include: fever, headache, fatigue, cough, sore throat, runny nose, chills, and muscle aches are symptoms of the flu. Children may have upset stomach or vomiting, but adults usually don’t. Some symptoms, such as fatigue and cough, can last a few weeks.

How Does the Flu Spread?

The flu is caused by viruses (germs). The germs spread through the air in droplets when someone who has the flu coughs, sneezes, laughs, or talks. You can become infected when you inhale these germs directly. You can also become infected when you touch a surface on

which the droplets have landed and then transfer the germs to your eyes, nose, or mouth. Touching used tissues, or sharing utensils, drinking glasses, or a toothbrush with an infected person can expose you to flu germs, too

How Can the Flu Be Prevented?

One of the best ways to avoid the flu is to get a flu vaccination each year. Wash your hands often. Frequent hand washing is a proven way to prevent infection. Carry an alcohol-based hand gel containing at least 60 percent alcohol. Use it

when you don’t have access to soap and water. Alcohol gels kill most germs and are safe for children.

Avoid touching your eyes, nose, and mouth. At home and work, clean phones, computer keyboards, and toys often with disinfectant wipes. If possible, avoid close contact with others, especially children.

The Flu Shot

A flu vaccine is your best chance to avoid the flu. There is the misconception that you can get the flu

from the flu shot. The virus in the influenza vaccine (flu shot) is inactivated and split. It cannot cause influenza. The vaccine itself is changed every year and contains three strains of the influenza virus. These are the strains that researchers, based on studies and best guesses, have determined will offer the most defense

for that particular year.

......the flu shot

they do prompt the body to make antibodies to fight these flu strains. If you’re exposed to the same strains later in the flu season, the antibodies will fight off the virus. It’s best to get vaccinated each September, October or November, before flu season starts.

ALL MS patients should get a flu shot!

As in previous years, the National MS Society (NMSS) recommends a regular flu shot as a safe and effective

vaccination for people with MS.

Multiple Sclerosis Council for Clinical Practice Guidel ines

expert opinion supports MS patients getting the flu shot. The flu shot - which is a de-activated or “killed” vaccine - can

safely be taken by individuals who are on any of the disease-

modifying medications (Avonex®, Betaseron®, Copaxone®, Rebif®, Novantrone®, or Tysabri®).

Who Can’t Get a Flu Vaccination ?

People severely allergic to eggs People who have had bad reactions to flu vaccination (including Guillain-Barré syndrome) A person who has a high fever (the vaccine can be given after the fever goes away).

MS and NOT getting shot

Do not get the nasal spray, with the nasal spray, live and weakened viruses are sprayed

into your nose. Get the shot.

Do not give Vaccine when in the midst of a significant relapse. Expert opinion recommends delaying vaccination until patients have stabilized or begun to improve from the relapse, typically 4-6 weeks after the start of the relapse.

Research shows

A multicenter, rand ouble-blind, placebo conroed enza immunizatio sis found that

influenza i tients is neither as reased exacerbatn rate in th p vaccination period nor a change in disease course over the subsequent 6 months.

What are the benefits of the flu shot?

It may keep you from getting the flu. This can save you time (fewer sick days) and money (fewer doctor visits, medicines, and hospital costs). If you do get the flu, it can make the symptoms milder and reduce the risk of serious complications. It can help limit the spread of the flu to others.

Why should the MS patient get the flu shot?

Limited mobility impairs Lung functionTaking drugs suppresses the immune system.The flu shot can prev When you have MS, ortant to avoid infection of any kind, r flu, since this can provoke MS symptom do relapse. (A pseudo relapse is a neurolog sed by increase in body or ambient temperature or by stress (physical or psychological) which promptly improves or disappears with

correction of the temperature or stress situation.)

• Multiple Sclerosis Association of America’s Chief Medical Officer Jack Burks, MD, recommends the injected flu vaccines for almost all of his patients with

MS.

"The reason why the flu is more difficult and potentially damaging to individuals with MS is three-fold.

First, if individuals with MS get the flu, they must endure the associated aches and pains in addition to their normal MS symptoms.

Second, high fever accompanies the flu, and an elevated temperature may increase MS symptoms, affecting one's overall wellbeing.

And third, the body responds to the flu with an outpouring of gamma interferon, a chemical that increases the risk of an MS exacerbation. For this

reason, individuals with MS who catch the flu have a greater chance of experiencing an MS attack within several weeks following their influenza (flu)

illness."

Can I still get the flu if I've had the vaccination?

Yes S

Influenza circles around the globe and moves through communities. As it travels, it undergoes spontaneous changes (called "antigenic drift") that allow it to evade the protections of last year's flu shot and re-infect you. The amount of the antigen drift varies from year to year. Bigger drifts often result in more severe illnesses. Doctors and researchers carefully track the influenza virus as it moves through the world and try to anticipate the strain(s) that will eventually appear in the United States the next season. Each year the flu vaccine is produced based on their observations and experience, targeted to protect us against the expected strain.

In most cases, the flu vaccine will prevent the flu, but it requires a few weeks before it provides protection and it is not 100% effective. In addition, sometimes the flu will "breakthrough" -- there will have been enough antigenic drift during the season that the virus will appear slightly different to the body's immune system, decreasing the effectiveness of the vaccine's protection. Or, the flu that predominates may end up being an unexpected strain, not the ones that the vaccine was developed to protect against. Usually in these cases the vaccination will at least lessen the severity of the infection.

Where to get the flu shot?

Flu shots are available at Any VA in the Flu clinic, from your Primary Care Doctor, or we

can send the visiting nurse to see you.

They can be done at your outside doctor’s office or a health clinic. Drugstores, senior

centers, and workplaces often offer flu vaccinations, too.

If you have questions about getting vaccinated , ask your healthcare provider.

Pittsburgh Area Flu Reminders

ALL MS patients should get a flu shot!

Flu shots are available at Any VA in the Flu clinic, from your Primary Care Doctor, or we can send the visiting nurse to see you.

Dr Clemens, the Chief of neurology of our Center for MS Excellence here in Pittsburgh, assures MS patients there is no contraindication and it is recommended that everyone receive the flu shot. As in previous years, a flu shot is recommended as a safe and effective vaccination for people with MS per The National Multiple Sclerosis Society. (FluMist is not recommended though). The Flu Vaccinations are part of the preventive care recommendations for adults with MS per the National Multiple Sclerosis Society. There is a pamphlet available from their web site (neurology nurse has a copy), you can check the web site at nationalmssociety.org, or call 800-243-5767, ext 243 anytime, 24 hours/day and their Ask-the-Nurse program would be happy to answer your question whether or not flu shots are recommended for people with MS? The answer is yes. You may also call the Neurology clinic at 412-360-6185 and ask to speak with Maryann the Neurology clinic nurse if you have any questions or would like it arranged for the visiting nurse to give you your shot.

ALL MS patients should get a flu shot! We have not heard back from you!!

Flu shots are available at Any VA in the Flu clinic, from your Primary Care Doctor, or we can send the visiting nurse to see you.

Dr Clemens, the Chief of neurology of our Center for MS Excellence here in Pittsburgh, assures MS patients there is no contraindication and it is recommended that everyone receive the flu shot. As in previous years, a flu shot is recommended as a safe and effective vaccination for people with MS per The National Multiple Sclerosis Society. (FluMist is not recommended though). The Flu Vaccinations are part of the preventive care recommendations for adults with MS per the National Multiple Sclerosis Society. There is a pamphlet available from their web site, you can check the web site at nationalmssociety.org, or call 800-344-4867, option 2, ext. 243 and their Ask-the-Nurse program would be happy to answer your question whether or not flu shots are recommended for people with MS? The answer is yes. Please call the Neurology clinic at 412-360-1794 or 866-482-7488 ext 601794 if you had the flu shot outside the VA and let us know the location and date or if you would like it arranged for the visiting nurse to give you your shot.

We have STILL not heard back from you!

ALL MS patients should get a flu shot!

Flu shots are available at Any VA in the Flu clinic, from your Primary Care Doctor, or we can send the visiting nurse to see you.

Dr Clemens, the Chief of neurology of our Center for MS Excellence here in Pittsburgh, assures MS patients there is no contraindication and it is recommended that everyone receive the flu shot.

Please call the Neurology clinic at 412-360-1794 or 866-482-7488 ext 601794 if you had the flu shot outside the VA and let us know the location and date or if you would like it arranged for the visiting nurse to give you your flu shot.

UESTIONS?

References Neurology. 1997 Nov;49(5):1474-5. Flu Shots by John Corby MD Rocky Mountain MS Center InforMS magazine fall2009 Volume 25, Issue 4. http://www.mscenter.org/ Flu and HINI Vaccine. VA Multiple Sclerosis Centers of Excellence MS Veteran magazine Fall 2009 Vaccinations. Flu Vaccine and MS. Good News About the Flu Vaccine. National MS

Society www.nationalMSsociety.org

The official newsletter of the Consortium of MS Centers and the International Organization of MS Nurses. http://www.mscare.org/cmsc/images/pdf/MSENov06.pdf

Immunizations and Multiple Sclerosis Evidence-Based Strategies for Immunizations in Multiple Sclerosis. Multiple Sclerosis Council for Clinical

Practice Guidelines. Administrative and financial support provided by Paralyzed Veterans of AmericaNov 2001 Influenza , Influenza Tests, Getting a Flu Vaccination krames on- Demand© 2000- 2010 The StayWell Company, 780 Township Line Road, Yardley, PA 19067. Flu Vaccines, MS, and General Flu and Cold information. Oct 24,2004. MSAA Multiple Sclerosis Association of America www.msassociation.org

Continue References...

• Flu Shot Safe and Effective for People with MS. MS Exchange Volume 10, Number 4 November 2006 Immunization and MS: A summary of published evidence and recommendations. Neurology 2002;59:1837-1843 Flu Vaccines for the 2009/2010 Flu Season. September 28,2009.MSAA Multiple Sclerosis Association of Americawww.msassociation.org

Flu Shots. VA Signature newsletter of the VA Special Interest Group of the Consortium of MS Centers. Volumne7, Number 3, Spring 2009. National Multiple Sclerosis Society MS Learn Online Internet program Healthy Living with MS. When It’s Not MS and Other General Health Issues. Flu Vaccines for the 2009/2010 Flu Season September 28, 2008