Perception of virus effects and vaccination among people with multiple sclerosis in Saudi Arabia

People with multiple sclerosis (pwMS) are at increased risk of infection due to immune dysregulation and exposure to disease-modifying therapies (DMTs). Despite this risk, real-world vaccine uptake remains inconsistent. This study evaluated vaccination readiness, counseling practices, and infection-related perceptions among pwMS in Saudi Arabia.

A cross-sectional survey was conducted among adults with MS (n = 204) recruited using non-probability (convenience) sampling from tertiary-care clinical and community-based sources. The survey assessed demographic characteristics, vaccination attitudes and uptake, counseling experiences, perceptions of infection risk related to MS and DMTs, and awareness of Epstein-Barr virus (EBV). Internal consistency of multi-item measures was acceptable (Cronbach's α = 0.72). Descriptive statistics were used to summarize outcomes.

The cohort was relatively young (mean age 35.7 years), with two-thirds aged 25-44 years (25-34 years: 38.2%; 35-44 years: 36.8%). Most participants held a bachelor's degree (66.7%). Attitudes toward routine vaccination were frequently non-committal: 47.6% were somewhat or very likely to vaccinate, 33.8% were neutral, and 18.6% were somewhat or very unlikely; separately, 60.8% agreed or somewhat agreed that routine vaccines might be harmful for pwMS. COVID-19 vaccination uptake was high (72.5%), whereas influenza vaccination was low (30.9%). Uptake of other adult vaccines, including hepatitis B, meningococcal, herpes zoster, and human papillomavirus vaccines, was < 10% for each. Perceived infection vulnerability was substantial, with 62.7% expressing concern about viral infections due to MS and 71.1% believing that DMTs increased susceptibility, consistent with 59.4% receiving high-efficacy DMTs. Awareness of EBV was limited: 26.5% had heard of EBV, 16.6% perceived an MS-EBV association, and 21.1% were aware of possible causality. Nearly half of participants (49.0%) were undecided about a hypothetical EBV vaccine, while approximately 44% expressed willingness to receive it. Counseling gaps were evident, as only 32.8% reported any discussion about vaccination with clinicians; counseling prior to DMT initiation and during ongoing treatment was reported by 16.2% and 19.1%, respectively.

In a young and highly educated cohort of pwMS in Saudi Arabia, vaccine hesitancy and counseling gaps persist despite high perceived infection risk. These findings highlight the need for structured and routine vaccine counseling, particularly at MS diagnosis and before initiating high-efficacy DMTs, to improve uptake of influenza and other recommended adult vaccines in MS clinics.