Recap: A review of Vaccines and MG Educational Webinar with Dr. James Howard

The Myasthenia Gravis Association recently hosted an enlightening webinar featuring Dr. James Howard, Professor of Neurology and Medicine at the University of North Carolina at Chapel Hill. With decades of experience in the neuromuscular field, Dr. Howard provided an expert overview on vaccines and their role for people living with myasthenia gravis (MG).

Understanding Vaccines

Dr. Howard began by explaining what vaccines are and how they work. Vaccines are biological preparations designed to protect the body against specific infections. They work by stimulating the immune system to recognize harmful pathogens—viruses, bacteria, or other organisms—without causing disease. This process trains the body to respond quickly if exposed in the future, providing either temporary or long-lasting immunity.

There are several types of vaccines:

• Live attenuated vaccines – weakened forms of a virus, like the measles vaccine.

• Inactivated vaccines – viruses rendered inactive, such as the polio vaccine.

• Subunit vaccines – use fragments of a virus, such as hepatitis B.

• Toxoid vaccines – inactivated toxins, like tetanus.

• mRNA vaccines – newer technology that instructs cells to produce proteins triggering immune responses, used in COVID-19 vaccines and promising MG therapies.

Vaccines are crucial in preventing serious illness, reducing outbreaks, protecting vulnerable populations, and even eradicating diseases like polio.

Vaccine Safety

Addressing common concerns, Dr. Howard emphasized that vaccines are thoroughly tested and continuously monitored. Side effects are usually mild and temporary, such as soreness at the injection site or muscle stiffness. Serious adverse events are rare, and claims linking vaccines to autoimmune disorders are generally overblown. He underscored the importance of sourcing information from trusted organizations, such as the American Medical Association, American Academy of Pediatrics, Children’s Hospital of Philadelphia Vaccine Education Center, and CIDRAP at the University of Minnesota, rather than social media.

Vaccines and MG Treatments

For people with MG, vaccine timing and type may require careful planning, especially if you are on immunosuppressive therapy. Live vaccines should always be avoided by those diagnosed with MG. Dr. Howard outlined key considerations:

• Steroids can reduce vaccine effectiveness; live vaccines are contraindicated during steroid use.

• Non-steroidal immunosuppressants (e.g., mycophenolate, azathioprine) may diminish immune responses; live vaccines should be avoided while on treatment.

• Plasma exchange and IVIG can temporarily affect immune responses but generally don’t prevent vaccination.

• B-cell depleting therapies require careful timing; live vaccines should not be administered during treatment.

• Complement inhibitors (e.g., eculizumab, ravulizumab) significantly increase susceptibility to infections such as meningococcal disease. Vaccination against these infections is mandatory before starting therapy.

Dr. Howard emphasized that vaccination strategies should be personalized. Shared decision-making with your neurologist is essential to balance protection against infection with timely initiation of MG treatments.

Key Takeaways for People with MG

• Avoid live vaccines if you are immunosuppressed.

• Stay up-to-date on recommended vaccines, including pneumococcal, shingles, COVID-19, and flu (excluding the nasal spray).

• Vaccination is particularly critical before starting complement inhibitors.

• Vaccine effectiveness may vary depending on your MG therapy, so discuss timing with your neurologist.

• Vaccines reduce the severity of infections even if they do not fully prevent them.

Dr. Howard concluded by highlighting the importance of rational, science-based decision-making in an era of misinformation. Vaccines remain a safe and essential tool for people living with MG, and thoughtful coordination with healthcare providers ensures optimal protection.

Watch the full webinar, including the Q&A, below or on YouTube!