Avoiding the MS-ery of Cold and Flu Season
Navigating cold and flu season (and these days COVID-19 and RSV to boot) is never fun for anyone. As the mother of a four year-old boy, we’ve had more than our fair share of respiratory viruses make their way through our home over the past few years. Living with MS makes navigating this all the more complicated.
To start, autoimmune diseases occur when the body’s own immune system engages in “friendly fire” against the body’s own cells. Different autoimmune diseases take aim and different parts of the body. In the case of MS, it is the holiest of holies that finds itself on the receiving end of this “friendly fire” – the brain and spinal cord. When a person living with MS is infected with a virus, their immune system revs up to respond to the virus, making it more likely for this “friendly fire” to occur. Just as in the military’s use of the term, “friendly fire” is more likely to occur during wartime than during peacetime. It’s bad enough to have to deal with being sick with a cold, flu, COVID-19, or RSV without having to worry that it may result in an MS relapse. Additionally, many respiratory viruses come hand-in-hand with fever. When the body temperature of a person living with MS rises, it can cause Uhthoff’s Phenomenon – the temporary worsening of MS symptoms when an MS patient is exposed to heat. When a person living with MS experiences an increase in their body temperature, even by as little as 0.5°C, nerve impulses can be either blocked or slowed in previously damaged nerves. This can result in a pseudoflare. While new brain or spinal cord damage may not be occurring, it can feel as though it is because symptoms of past MS relapses recur or worsen.
The other challenging aspect of navigating cold and flu season while living with MS is that most of the Disease Modifying Therapies (DMTs) for MS are either immunomodulating or immunosuppressing. Immunomodulating DMTs work by altering or regulating the immune system's response, aiming to achieve a more balanced and controlled immune function. These drugs typically target specific components of the immune system. They do not completely shut down the immune system but rather modify its behavior. Examples include: Avonex, Rebif, Copaxone, and Tysabri. Immunosuppressing DMTs have a more profound and generalized effect on the immune system. They work by suppressing various immune responses, often more aggressively than immunomodulating DMTs. While they can be highly effective in reducing MS relapses, they also carry a higher risk of infections and other side effects due to a compromised immune system. Examples include: Lemtrada, Mavenclad, Ocrevus, Briumvi, and Kesimpta. This can mean that we are more likely to catch a virus that a healthy counterpart would easily fend off, and when we do catch a virus of any kind, our immune system may have a more difficult time fighting it off. Therefore, respiratory viruses can linger for longer and can cause more severe symptoms than in a healthy counterpart.
Finally, our DMTs can even interfere with preventative measures. For example, I take Kesimpta and it is administered once per month. Taking Kesimpta is known to reduce the efficacy of vaccinations, particularly if the vaccination is taken close in time to a dose. As a result, people taking Kesimpta are usually told to time vaccinations between two weeks after and two weeks prior to a dose of Kesimpta, meaning there’s a magical 3-4 day window to time any required vaccines in a given month. This month, my window is from October 18-21. The new XBB version of the COVID-19 vaccine has just been rolled out in Ontario. While it had been approved by Health Canada during my vaccination window last month, it was not yet actually available. I held off on getting a COVID-19 booster in order to get the new formulation. Now the race is on to be healthy enough to receive the vaccine as scheduled on October 19. Of course, I caught a minor cold off my kid just in time to potentially derail my vaccination plans for another month. Meanwhile, I’m also debating the merits of getting both the COVID-19 booster and the flu shot at the same time this month, versus staggering the vaccines and waiting another month for my flu shot. The logistics of vaccination can be so much more complicated when a DMT is at play.
So how do we avoid the misery of cold and flu season while living with MS? The bad news is that it can’t be avoided entirely, particularly if you live with a germ-infested tiny human, as I do. However, we can take some steps to improve our odds.
If you can get vaccinated, consider doing so. If you are on a DMT, you are at a greater risk of catching a respiratory virus and at a greater risk of worse symptoms when you do fall ill. Whether you are on a DMT or not, if you are living with MS you are at risk of having an MS relapse or pseudoflare when you do fall ill. Becoming vaccinated can reduce your risk of contracting the illness targeted by the vaccine, or can lessen symptoms in the event that you do nonetheless fall ill. Not everyone can get vaccinated, but it is a great option for those that can. One caveat to bear in mind for those taking certain DMTs is that the nasal mist flu vaccine contains a live attenuated virus and therefore should be avoided by those taking immunosuppressing DMTs and certain immunomodulating DMTs. Taking Kesimpta, I am not permitted to take vaccines with live attenuated virus, and I am supposed to avoid contact with anyone who has taken such a vaccine in the immediate days following their vaccination.
Keep your hands clean. Washing your hands is one of the most effective and simplest ways to prevent illness because it helps to remove the bacteria, viruses, and other harmful microorganisms that make us sick. When you wash your hands with soap and water, you physically remove germs and dirt from your skin. Some viruses can be transmitted through respiratory droplets that land on surfaces. When you touch these surfaces and then touch your face, you can introduce the virus to your respiratory system. Handwashing helps prevent this mode of transmission. When living with MS, and particularly when taking a DMT, hand sanitizer is your friend. I pretty well always have a small bottle of it in my handbag.
Mask up! Yes, most of the population have retired their masks, but living with MS is about as good a reason as any to bring your masks out of retirement during cold and flu season. The purpose of wearing a mask is to reduce the spread of infectious respiratory droplets. While masks primarily protect others from your respiratory droplets, they also offer some degree of protection for the wearer. If you want to reduce your own risk of infection, especially in crowded or poorly ventilated areas, wearing a mask can provide an extra layer of defence.
Protect against viruses spread between members of the same household. I use Lysol to sanitize frequent touch points, like doorknobs and light switches. I also use Corsi–Rosenthal Boxes to increase the air filtration in our home (and any HEPA filter will do). These measures help because in my home, “the killer is inside the house” – my son is going to bring viruses home, it’s inevitable.
Avoid close contact with people who are sick and people who may have been exposed to respiratory illnesses. If you have to be around people who are sick, try to maintain a safe distance and/or wear a mask. We dodged a COVID-19 infection because we suspected that my parents would return home from a trip abroad with a COVID-19 souvenir. We opted to return their dogs, which we had been sitting for them during their trip, in an outdoor setting, and within a day or two they were both sick. Our read on the situation kept us healthy. If you are a friend or a loved one of someone living with MS, you can protect them by avoiding exposing them when you know that you are unwell.
Eat the rainbow. Eating your fruits and veggies can help to provide the essential nutrients that support your immune system.
Proper hydration helps your body function optimally. Drinking plenty of water, herbal teas, and clear broths can actually reduce the likelihood of contracting a virus and it can help you to combat the virus more quickly if and when you do fall ill.
Regular physical activity can boost your immune system and promote overall health.
A good night's sleep is crucial for a healthy immune system. Aim for 7-9 hours of quality sleep per night. I could stand to take my own advice on this one.
As we enter the thick of cold and flu season, I wish you all good health.
