Some infections can be more dangerous for people with myasthenia gravis (MG) than they are for those without the condition. Vaccinations can help protect your health, but it’s important to know which vaccines are safe if you’re taking certain MG medications.

Read on to learn more about vaccinations and how to protect your health with myasthenia gravis. Be sure to talk to your doctor to discuss which vaccinations may be right for you.

How Vaccinations Work

A vaccination works by training the body’s immune system to respond to stimuli, such as viruses or bacteria. Vaccines — the substance in a vaccination — stimulate the immune system to produce immune proteins called antibodies that fight disease. Vaccines usually contain active ingredients known as antigens. An antigen is a protein that imitates an infection. Antigens can consist of dead or weakened virus or bacteria, small amounts of a germ’s genetic material or surface material, or a bacterial toxin that has been treated so it’s no longer toxic.

Antigens in vaccines cause an immune response as if the body were being attacked by an active germ. Exposure to the antigen allows the immune system to later recognize the actual virus or bacteria and fight it. Vaccination — also known as immunization — helps boost the body’s natural immune system.

Vaccinations don’t always prevent an infection. But if you get an infection that you’ve been vaccinated against, the disease is often less severe and less likely to be life-threatening.

Vaccines can be given by injection under the skin or into the muscle, taken by mouth, or administered as a nasal spray. Some vaccinations require more than one dose. Sometimes a second dose or more doses are scheduled after the first dose, depending on the particular vaccination.

Myasthenia Gravis and the Immune System

Myasthenia gravis is an autoimmune neuromuscular disease in which the immune system overreacts and attacks the neuromuscular junctions (NVCs) where muscle cells connect with nerve cells. Depending on which parts of the body are affected, MG can cause a range of symptoms, including muscle weakness, ocular (eye) problems, and difficulty eating, swallowing, and breathing.

People with MG are often treated with immunosuppressive therapies that weaken the immune system. These treatments help prevent the production of autoantibodies — antibodies that attack your own healthy tissue in autoimmune diseases such as MG.

Immunosuppressive therapy can effectively treat MG and increase muscle strength in many cases. But these drugs also increase the risk of infection — which can be serious in people with MG — because they decrease immune system activity. Immunosuppressive treatments for MG include:

• Azathioprine
• Corticosteroids such as prednisone
• Eculizumab (Soliris)
• Mycophenolate mofetil
• Tacrolimus

Intravenous immunoglobulin (IVIG), which is used in severe cases of MG and has some immunosuppressive properties, has not been found to raise the risk of infection.

Talk to your health care team about vaccinations if your treatment plan includes immunosuppressive therapy.

Infections Can Trigger Myasthenia Gravis Crisis

Neurology research shows that infections are a common trigger of myasthenic crisis, a severe complication of MG. A myasthenic crisis occurs when MG symptoms grow worse — MG exacerbation — which leads to increased muscle weakness and respiratory failure, particularly in people whose head and neck muscles are affected.

During a myasthenic crisis, breathing becomes severely impaired, and you may need mechanical ventilation to help you breathe.

The infections most commonly associated with myasthenic crisis include bacterial pneumonia and upper respiratory infections such as influenza (the flu) or COVID-19. Vaccines that protect against respiratory infection are especially important for people with MG.

Vaccinations for People With Myasthenia Gravis

Your risk of infection decreases when you get certain vaccinations. If your treatment plan includes immunosuppressive therapy, it’s important to talk to your doctor about your risk of infection and which vaccinations may be appropriate for you. Your doctor knows your individual health factors and can advise you on vaccinations and potential side effects.

Recommended Vaccinations for People With MG

Here are some of the vaccinations that are recommended and considered safe for people with MG who are immunocompromised (have weakened immune systems) due to immunosuppressive treatment:

• Flu vaccination, given once each year
• COVID-19 vaccinations with recommended boosters
• Diphtheria, tetanus, and pertussis vaccination, which is recommended every 10 years
• Pneumonia vaccination, recommended once a year
• Shingrix vaccination, the nonlive shingles vaccination, given in two doses spread between two months and six months, recommended for immunocompromised people ages 19 and older
• Standard nonlive polio vaccination, which is generally given to children but may be administered to adults
• Hepatitis B vaccine, which may be appropriate for some people with MG, given in a series of two, three, or four shots

Many vaccines provide lifelong protection against certain diseases, and vaccination against a disease often doesn’t need to be repeated. Symptoms of MG and other related health issues can influence the decision to get vaccinated, so it’s important to talk about it with your doctor.

COVID-19 Vaccination and Myasthenia Gravis

COVID-19 — also known as coronavirus and SARS-CoV-2 infection— has proved to be a dangerous and deadly virus for people with MG. COVID-19 infection affects the respiratory system, and during the COVID-19 pandemic, people with myasthenia gravis were found to have a mortality (death rate) that was almost 10 percent higher than the general population. Generalized myasthenia gravis (GMG) has also been associated with a higher incidence of severe infection.

The COVID-19 vaccine has been shown to be safe and effective for people with MG. Research has shown that people with MG who were vaccinated against COVID-19 had much better outcomes than those who weren’t vaccinated.

While a few people with MG notice mild, temporary symptom worsening after COVID-19 vaccination, researchers have concluded that it’s not a risk for people whose MG symptoms are stable and well managed. They did recommend that people with MG who have thymoma, a thymus tumor, may need close supervision after COVID-19 vaccination.

There have been a very small number of documented cases in which new MG started as a side effect after the COVID-19 vaccination. However, researchers haven’t determined if the vaccination actually caused MG or if MG may have already been present on a very mild level before symptoms appeared.

Vaccinations Before Certain Myasthenia Gravis Treatments

Newer treatments may require vaccinations to protect you from potential medications side effects. People who take eculizumab have an increased risk of developing meningococcal infections. Meningococcal infections include meningococcal meningitis (an infection in the brain) and meningococcal infections in the bloodstream. These infections can be life-threatening.

If you and your doctor determine that you should start treatment with the immunosuppressant drug eculizumab, you will be required to have meningococcal vaccinations. The vaccination must be administered before treatment with eculizumab begins.

Live Vaccines

Some vaccines are known as live-attenuated vaccines, as opposed to inactive vaccines. Live vaccines cause a strong immune response and contain a very small amount of a live germ. It’s important to know that live vaccines are generally not recommended for people with myasthenia gravis who are in treatment with immunosuppressive therapies. In some cases, a live vaccine may still be advised for someone with MG, particularly if they are not receiving immunosuppressive treatment. Always check your MG specialist before getting a vaccine.

Discuss Potential Side Effects of Vaccinations With Your Doctor

All medications and vaccinations have a risk of side effects, and you should discuss these with your doctor. Most vaccination side effects are mild, such as pain at the injection site, headache, or chills, and these usually go away within a day or two. Research has overwhelmingly shown that vaccination with myasthenia gravis is safe, and that the benefits far outweigh the risks.

In general, vaccination is not linked to MG exacerbation. However, some research has shown that approximately 5 percent of people with MG experience some exacerbation of symptoms postvaccination.

Talk to your doctor to find out if you are up to date with your vaccinations and how immunization can help you stay as healthy as possible.

Meet Others Who Understand

MGTeam is the social network for people with myasthenia gravis and their loved ones. On MGTeam, members come together to ask questions, give advice, and share their stories with others who understand life with myasthenia gravis.

Do you get annual flu and COVID-19 vaccinations? Have you discussed vaccination and MG with your doctor? Share your thoughts in the comments below, or start a conversation by posting on MGTeam.