This patient should have a yearly influenza vaccination. She takes the disease-modifying drug glatiramer acetate, a pregnancy category B drug, for her multiple sclerosis (MS). The patient already exercises at least 3 hours weekly, takes a daily calcium–vitamin D supplement, and does not smoke, all recommended preventive measures against osteoporosis or conversion to secondary progression in patients with MS. According to a position statement by the American Academy of Neurology, there is no evidence of adverse outcomes of routine vaccinations in patients with MS beyond what is expected in the general population. In fact, these vaccinations are recommended to prevent infections leading to a heightened immune state and potential MS relapse.

Moderate alcohol usage has not been shown to adversely affect MS outcomes and has no effect on the metabolism of glatiramer acetate. Therefore, alcohol cessation is not necessary.

Although urinary tract infections (UTIs) are more common among patients with MS because of neurogenic bladder dysfunction, screening urinalysis is not indicated as a preventive medicine strategy in this patient population, barring UTI symptoms.

Despite the commonly held belief that pregnancy results in adverse events in MS, all evidence points instead toward to the protective effect of the hormonal state of pregnancy. Multiparous women with MS have equivalent, or perhaps better, outcomes than women with MS who have never been pregnant. Initiating an oral contraceptive is indicated only if the patient wishes to avoid pregnancy, but not as a preventive strategy for worsening of MS.