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Dear Dr. Roach: I have multiple sclerosis. I have been told NOT to get the shingles vaccine by one doctor, and I have been told TO get the shot by another. I had the shingles twice a long time ago. Does the fact that it is a live culture have an effect on the recommendation?

D.M.

Dear D.M.: Multiple sclerosis is an autoimmune disease that may be triggered by the increase in the immune system response following some vaccinations. That has to be balanced against the benefits of not getting the disease. There remains controversy about this, and you must, of course, discuss it with your neurologist.

However, the National Multiple Sclerosis Society has made some recommendations, with which I agree. It concluded that influenza, hepatitis B, varicella and tetanus vaccines are safe for people with MS. Most live, attenuated vaccines are not recommended. These include the live flu vaccine (given by nasal spray; flu shots are not live vaccines, and flu shots are generally considered safe) and yellow fever vaccine, which is controversial. The current shingles vaccine Zostrix, even though it is a live, attenuated vaccine, is considered safe, because almost everybody in the age group of MS has had chickenpox and thus has the virus already in the body.

There is a new shingles vaccine called Shingrix, hopefully available soon. It is a subunit vaccine, made without any infectious virus. The MS society has not written about the new vaccine, but based on the biology of MS and shingles, I think that the benefit of the new vaccine greatly outweighs any small risk of an exacerbation. Again, this needs to be individualized with your doctor.

You can read the MS society’s recommendations here: bit.ly/2AIa7DK.

Dr. Roach writes: A recent column on oral herpes generated numerous letters. Most of these asked about using valacyclovir (Valtrex) or another oral antiviral. These drugs can be given at earliest onset of symptoms (usually 2 grams given twice, 12 hours apart) or taken all the time to prevent outbreaks (usually 500 mg once a day).

When used at the onset of an attack (it should be started at the first appearance of reliable symptoms, which for some people is noticeable tingling, burning or itching), it can shorten the duration of the blisters by about a day. People who do not have any early symptoms are less likely to benefit, and can consider taking medications all the time. This would be reasonable for people with pain or disfiguring lesions (I had a patient, a professional actor, for whom I prescribed valacyclovir). Valacyclovir is expensive (average wholesale price is about $10 a pill, but I found it much cheaper through the drug discount site Goodrx.com) and has the potential for serious side effects, so it is not a medication that I prescribe frequently.

Other readers asked about tea tree oil. Although this herbal product has some antiviral and antibacterial activity, I was not impressed by the research done so far, and don’t recommend it; however, it is safe for most people, and several readers say that it helped them. Finally, many asked about lysine, with several personal stories of effectiveness. The literature remains equivocal, but most studies have found that lysine is no more effective than placebo for treatment or prevention of herpes cold sores. However, lysine may be effective in canker sores, which are not related to herpes.

Email questions to ToYourGoodHealth@med.cornell.edu.

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