WORLD BRAIN DAY 2021 JULY 22nd
COVID-19 VACCINATION AND MULTIPLE SCLEROSIS
- M.A.ALEEM
NEUROLOGIST
ABC HOSPITAL
TRICHY
World Federation of Neurology partners with the Multiple sclerosis (MS) International Federation to promote Multiple Sclerosis awareness on World Brain Day 2021 on July 22
"Stop Multiple Sclerosis" is the theme for the World Brain Day 2021.
Every five minutes, someone receives the life-altering diagnosis of multiple sclerosis (MS), a neurological disease that affects more than 2.8 million people of all ages worldwide.
This World Brain Day 2031 is dedicated to raising awareness for MS.
It is the need of the hour to work together to stop MS by diagnosing earlier, providing better access to life-changing treatments, and advocating for improved quality of life for those living with MS and their caregivers.
During this current COVID-19 Pandemic ,on the world brain day 2021 about Multiple Sclerosis
I would like to stress a few points about the importance of COVID-19 vaccination in the patient with MS.
GLOBAL COVID-19 ADVICE FOR PEOPLE WITH MS
COVID-19 is an illness that can affect your lungs, airways and other organs. It is caused by a novel coronavirus (called SARS-CoV-2) that has spread around the world.
This write up is based on COVID-19 vaccination in people with multiple sclerosis (MS).
ADVICE FOR PEOPLE WITH MS DURING THIS PANDEMIC
Current evidence shows that simply having MS does not make you more likely to develop COVID-19 or to become severely ill or die from the infection than the general population. However, the following groups of people with MS are more susceptible to having a severe case of COVID-19:
- People with progressive MS
- People with MS over the age of 60
- Men with MS
- Possibly South Asian people with MS
- People with higher levels of disability (for example, an EDSS score of 6 or above, which relates to needing to use a walking stick)
- People with MS and obesity, diabetes or diseases of the heart or lungs
- People taking certain disease modifying therapies for their MS .
All people with MS are advised to follow WHO guidelines for reducing the risk of infection with COVID-19.
People in the higher risk groups should pay particular attention to these measures:
- Practise social distancing by keeping at least 2 metres distance between yourself and others, to reduce your risk of infection when they cough, sneeze or speak. This is particularly important when indoors but applies to being outdoors as well.
- Make wearing a mask a normal part of being around other people and ensure that you are using it correctly by following these instructions.
- Avoid going to crowded places, especially if indoors and the room is poorly ventilated. Where this is not possible, ensure to wear a mask and practise social distancing.
- Wash your hands frequently with soap and water or an alcohol-based hand rub (70% alcohol content is considered most effective).
- Avoid touching your eyes, nose and mouth unless your hands are clean.
- When coughing and sneezing, cover your mouth and nose with a flexed elbow or tissue.
- Clean and disinfect surfaces frequently especially those which are regularly touched.
- Talk to your healthcare provider about optimal care plans, through video consultations or in-person visits where needed. Visits to health clinics/centres and hospitals should not be avoided if they are recommended based on your current health needs.
- Stay active and try to take part in activities that will enhance your mental health and well-being. Physical exercise and social activities that can take place outside and with social distancing are encouraged.
- Caregivers and family members who live with, or regularly visit, a person with MS in one of the higher risk groups should also follow these recommendations to reduce the chance of bringing COVID-19 infection into the home
COVID-19 VACCINES AND MS
First it is better to the current vaccine types and discuss vaccination timing and disease modifying therapy administration. Given the seriousness of COVID-19 – which carries a 1-3% mortality risk as well as risk for serious illness and prolonged ill-health for many – we wish to emphasise these key points:
All people with MS should be vaccinated against COVID-19 (provided that they do not have any known allergies to any of the components of the vaccines)
People with MS should be vaccinated as soon as the vaccine is available to them
Even once you have received the vaccine, it is important to follow your country’s guidelines regarding mask wearing (indoors and outdoors), social distancing, social group requirements, and hand washing.
There are several COVID-19 vaccines in use in different countries around the world, with new ones being approved regularly. Instead of assessing each vaccine individually, we have provided information below about the main types of COVID-19 vaccines in use and in development.
The spread of the SARS-CoV-2 virus spread is influenced by new COVID-19 variants and ongoing research is investigating how well the current COVID-19 vaccines protect against these new and emerging variants.
We do not know how many people in the COVID-19 vaccine clinical trials had MS, so our guidance is therefore based on data from the general population in the vaccine clinical trials, research on the effects of other types of vaccination of people with MS, and new data emerging on the safety and effectiveness of COVID-19 vaccines specifically for people with MS.
We do not know how many people in the COVID-19 vaccine clinical trials had MS, so our guidance is therefore based on data from the general population in the vaccine clinical trials, research on the effects of other types of vaccination of people with MS, and new data emerging on the safety and effectiveness of COVID-19 vaccines specifically for people with MS.
Types of COVID-19 vaccine and how they work
Vaccines work by using a part of the virus that causes the disease (such as its genetic code or ‘spike protein’), or an inactivated or weakened version of the virus, to prompt a response from the human immune system. In turn, this causes the body to produce antibodies and T-cells (a special population of white blood cells) to fight the virus, preventing it from entering and infecting other cells in the body. These vaccines do not lead to any genetic change in our bodies, will not get into the brain, and would not alter the genetic code of a foetus.
There are currently five different types of COVID-19 vaccine in use or in development that work in different ways (with examples below).
These vaccines have the genetic code for the coronavirus ‘spike’ protein made as an “mRNA” (a type of temporary genetic message), which is formulated into tiny fatty droplets for delivery. The mRNA directs production of the spike protein, which is seen and targeted by the immune system (that makes antibodies and T-cells). In this there are two vaccines:
Pfizer-BioNTech (Comirnaty)
Moderna (Moderna mRNA)
This have the genetic code for the spike protein in a viral vector. These vectors are best understood as just the shell and delivery mechanism of a virus (commonly from an adenovirus), but they lack the parts a virus needs to replicate and so can never cause an infection. Similar to mRNA vaccines, viral vector vaccines direct the production of the spike protein so that it can be seen and targeted by the immune system. They are:
AstraZeneca/Oxford (AZD1222)
Serum Institute of India (Covishield)
Gamaleya Research Institute (Gam-COVID-Vac or Sputnik V)
3.Inactivated virus vaccines
In these vaccines inactivated form of the whole coronavirus is uses. The coronavirus has been ‘killed’ so that it is unable to get into cells and replicate, and it cannot cause a COVID-19 infection. The immune system recognises the whole virus, even though it is inactivated. Which includes
Covaxin (Bharat Biotec)
Sinovac (CoronaVac)
Sinopharm (BBIBP-CorV)
Sinovac (CoronaVac)
Sinopharm (BBIBP-CorV)
4.Protein vaccines
These vaccines have the coronavirus spike protein itself (not the genetic code), along with something that boosts the immune system (an ‘adjuvant’) to ensure the spike protein is targeted.in this
• Novavax (NVX-CoV2373)
5.Live attenuated vaccines
In this vaccine a weakened, but still replicating virus. Such vaccines work by causing a mild infection in people with regular immune function. They can be dangerous in a person with a compromised immune system, so would not suitable for many people with MS, due to the way some disease modifying treatments work.
Currently (June 2021), there are no live attenuated COVID-19 vaccines in use – they are only being researched.
The following guidance refers to the mRNA, non-replicating viral vector, inactivated virus or protein COVID-19 vaccines (types 1-4 listed above).
PEOPLE WITH MS SHOULD GET A COVID-19 VACCINE
The science has shown us that the COVID-19 vaccines are safe and effective. Like other medical decisions, the decision to get a vaccine is best made in partnership with your healthcare professional. You should get a COVID-19 vaccine as soon as it becomes available to you. The risks of COVID-19 disease outweigh any potential risks from the vaccine. In addition, members of the same household and close contacts should also get a vaccine as soon as they can to maximise protection against COVID-19.
Most of the COVID-19 vaccines require two doses, and where this is the case, you need to follow your country’s guidelines on the timing of the second dose. (In some countries, you may get offered a third dose if you are categorised as having severe immunosuppression. You will need to follow your country’s guidelines on the timing of the third dose).
The Johnson & Johnson (J&J) and Sputnik v vaccine requires a single dose. Whichever vaccine you receive, it takes 2 weeks after receiving the only or second dose before you are considered immunised (protected).
If you have had COVID-19 and recovered, you should also get the vaccine, because people who have had COVID-19 infection in the past can get infected again. It is normal practice to wait until you have recovered from an illness before being vaccinated. But you should still get vaccinated as soon as you can after recovery, following the government guidelines in your country.
We do not know how long a person is protected from COVID-19 after being vaccinated, although clinical trial data indicate that protection is high for at least multiple months. Repeated doses of the COVID-19 vaccines may be required in future, similar to the flu vaccine.
There is no evidence that people with MS are at higher risk of complications from the mRNA, non-replicating viral vector, inactivated virus or protein COVID-19 vaccines , compared to the general population.
There is no vaccine preference for those living with MS.
None of the currently available vaccines contain live virus and the vaccines will not cause COVID-19 disease. These types of vaccine are not likely to trigger an MS relapse or to worsen chronic MS symptoms.
However, people with MS should avoid receiving live attenuated vaccines . Given that there may be COVID-19 vaccines developed in the future that use this technology, it is important to know which COVID-19 vaccine you are offered.
You do not need to self-isolate after the vaccination. The vaccines can cause side effects, including fever or fatigue, which should not last more than a few days after vaccination. A fever can make your MS symptoms worse temporarily, but they should return to previous levels after the fever is gone. Even if you have side effects from the first dose, it is important to get the second dose of the vaccine (for vaccines requiring two doses) for it to be fully effective. Having side effects, such as fever, muscle discomfort and fatigue are a sign that the vaccine is doing its job (it is getting your body to mount a response against the virus, and therefore is starting to protect you).
IT IS SAFE TO RECEIVE A COVID-19 VACCINE WHEN YOU ARE ON DISEASE MODIFYING THERAPIES (DMTS) FOR MS
Continue taking your disease modifying therapy (DMT) unless you are advised by your MS healthcare professional to stop or delay it. Stopping some DMTs abruptly can cause severe worsening of MS.
Some DMTs may reduce the effectiveness of the COVID-19 vaccinations
There is some evidence that people taking some types of DMT (fingolimod, siponimod, ozanimod, ponesimod, ocrelizumab, rituximab, ofatumumab) may have a reduced antibody response to the COVID-19 vaccines. The data are limited so far, but are in line with what we expect, given our understanding of these treatments.
Note that there is a range of different antibody tests that are used to measure responses to the COVID-19 vaccines. There is currently no global agreement about which antibody is the best for monitoring vaccine responses and predicting protection from COVID-19.
If you use one of these DMTs and take an antibody test it may show a low or no response. This does not mean that the vaccine is ineffective. Antibodies are only one part of the immune response to vaccination. There are other components of the immune system that are triggered by the vaccine and could contribute to your protection.
The COVID-19 vaccines may also activate T-cells, which could also protect against COVID-19. This T-cell reponse is not measured in antibody tests. However, it may be that people taking these DMTs have less protection from their vaccinations.
We strongly advise people to still get vaccinated, but be aware that you could still be vulnerable to infection and take precautions against COVID-19 infection.
Delaying the start of a DMT, or altering DMT timing, is a strategy to allow the vaccine to be fully effective
If you are able to plan when you receive your vaccine, please discuss with your MS healthcare provider how and whether to coordinate the timing of your vaccine with the timing of your DMT dose – if you are on a DMT where this is relevant . This should help ensure the vaccine is as effective as possible at generating an immune response to the coronavirus. Given the potential serious health consequences of COVID-19 disease, getting the vaccine when it becomes available to you may be more important than optimally timing the vaccine with your DMT.
Even once you have received the vaccine, it is important to continue to take precautions against COVID-19
Even when vaccinated, you can still be infected with COVID-19 and give it to others. This is even more likely for those on DMTs that might reduce the effectiveness of the vaccines (fingolimod, siponimod, ozanimod, ponesimod, ocrelizumab, rituximab, ofatumumab).
Delaying the start of a DMT, or altering DMT timing, is a strategy to allow the vaccine to be fully effective
If you are able to plan when you receive your vaccine, please discuss with your MS healthcare provider how and whether to coordinate the timing of your vaccine with the timing of your DMT dose – if you are on a DMT where this is relevant . This should help ensure the vaccine is as effective as possible at generating an immune response to the coronavirus. Given the potential serious health consequences of COVID-19 disease, getting the vaccine when it becomes available to you may be more important than optimally timing the vaccine with your DMT.
Even once you have received the vaccine, it is important to continue to take precautions against COVID-19
Even when vaccinated, you can still be infected with COVID-19 and give it to others. This is even more likely for those on DMTs that might reduce the effectiveness of the vaccines (fingolimod, siponimod, ozanimod, ponesimod, ocrelizumab, rituximab, ofatumumab).
The safest approach is to ensure that those close to you are fully vaccinated, and that you continue wearing masks, practise social distancing,wash hands and follow your country’s guidelines about getting tested for COVID-19 when necessary.
VACCINATION ADVICE FOR YOUNG PEOPLE
VACCINATION ADVICE FOR YOUNG PEOPLE
The following guidance for young people applies to vaccines currently authorised for use for this age group, and should be read together with the general advice above.
Young people aged 12-17 should be vaccinated against COVID-19
The science has shown us that the COVID-19 vaccines are safe and effective. Some countries recommend COVID-19 vaccination for all children and adolescents 12 years of age and older (who do not have ‘contraindications’ – a medical reason that prevents them from having the vaccine) using one of the COVID-19 vaccines that is authorised for this age group. Vaccination of this age group brings us one step closer to ending this pandemic and is an additional layer of protection for the most vulnerable among us.
Young people are at risk of severe illness from COVID-19
Cases of COVID-19 infection are rising in children and adolescents. While most COVID-19 infections in children and adolescents are mild, some infections are severe or even fatal. In addition to health risks due to COVID-19 infection, children and adolescents are at risk for Multisystem inflammatory syndrome in children (MIS-C) two to six weeks after infection with COVID-19. MIS-C is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. MIS-C is serious, even deadly, although with prompt and often intensive care most young people with MIS-C survive. The risks of COVID-19 and MIS-C outweigh any potential risks from the vaccine.
Young people with MS should be vaccinated against COVID-19
The importance of COVID-19 vaccination for young people with MS mirrors the advice for this age group in general, as well as the advice for adults with MS. While there is no evidence to date that young people with MS experience more severe COVID-19 infection, nor that they are at higher risk for MIS-C compared to young people who do not have MS, vaccination is strongly encouraged.
Household and family members of people with MS should be vaccinated against COVID-19
People who live in the same household as anyone with MS should also get vaccinated – including young people over the age of 12. Vaccination of an entire household reduces the risk of spreading COVID-19 between people in close contact with each other.
RECOMMENDATIONS FOR TIMING DMTS AND THE COVID-19 VACCINES
The decision of when to get the COVID-19 vaccine should include an evaluation of your risk of COVID-19, and the current state of your MS. If the risk of your MS worsening outweighs your risk of COVID-19, do not alter your DMT schedule and get the vaccine when it is available to you. If your MS is stable, consider the following adjustments in the administration of your DMT to enhance the effectiveness of the vaccine. This suggested scheduling is not always possible and getting the vaccine when it becomes available to you may be more important than timing the vaccine with your DMT. Work with your MS healthcare provider to determine the best schedule for you.
Interferons, glatiramer acetate, teriflunomide, monomethyl fumarate, dimethyl fumarate, diroximel fumarate, natalizumab
If you are about to start one of these above DMTs for the first time, do not delay starting it for your COVID-19 vaccine injection. If you are already taking one of these DMTs, no adjustments to your DMT administration are needed.
Fingolimod, siponimod, ozanimod, ponesimod
If you are about to start one of these medicines, consider getting fully vaccinated two to four weeks before starting fingolimod, siponimod, ozanimod or ponesimod. If you are already taking one of these medicines, continue taking it as prescribed and get vaccinated as soon as the vaccine is available to you.
Alemtuzumab
If you are about to start alemtuzumab, consider getting fully vaccinated at least four weeks before starting
alemtuzumab. If you are already taking alemtuzumab, consider getting vaccinated at least 24 weeks after the last alemtuzumab dose. When possible, resume alemtuzumab at least four weeks after getting fully vaccinated.
Oral cladribine
If you are about to start cladribine, consider getting fully vaccinated two to four weeks before starting cladribine. If you are already taking cladribine, the currently available limited data does not suggest that timing the vaccine in relation to your cladribine dosing is likely to make a significant difference in vaccine response. Getting the vaccine when it becomes available to you may be more important than coordinating timing of the vaccine with your cladribine treatment. If you are due for your next treatment course, when possible, resume cladribine two-four weeks after getting fully vaccinated.
Ocrelizumab, rituximab
If you are about to start ocrelizumab or rituximab, consider getting the fully vaccinated two to four weeks before starting ocrelizumab or rituximab. If you are already taking ocrelizumab or rituximab, consider getting vaccinated at least 12 weeks after the last DMT dose. When possible, resume ocrelizumab or rituximab at least 4 weeks after getting fully vaccinated*.
Ofatumumab If you are about to start ofatumumab, consider getting fully vaccinated two to four weeks before starting your DMT. If you are already taking ofatumumab, there is no data to currently guide timing of the vaccine in relation to your last DMT injection. When possible, resume ofatumumab injections two to four weeks after getting fully vaccinated.
Ofatumumab If you are about to start ofatumumab, consider getting fully vaccinated two to four weeks before starting your DMT. If you are already taking ofatumumab, there is no data to currently guide timing of the vaccine in relation to your last DMT injection. When possible, resume ofatumumab injections two to four weeks after getting fully vaccinated.
High-dose steroids
Consider getting the vaccine injection three to five days after the last dose of steroids.
Fully vaccinated = once you have received the single dose of the J&J vaccine,Sputnik v or the second dose of any other type of vaccine.
Note that vaccine protection occurs 2 weeks after the single dose of the J&J vaccine or the second dose of any other type of vaccine.
Fully vaccinated = once you have received the single dose of the J&J vaccine,Sputnik v or the second dose of any other type of vaccine.
Note that vaccine protection occurs 2 weeks after the single dose of the J&J vaccine or the second dose of any other type of vaccine.
Multiple sclerosis is caused by inflammation driven loss of myelin, a type of fat/lipid layer that insulates nerves, damaging the brain and spinal cord. Multiple sclerosis presents with an assortment of symptoms including fatigue, pain, vision issues, coordination and mobility problems as well as cognitive and emotional issues. Early diagnosis and access to proven disease-modifying treatments are vital to improving patient quality of life and significantly halting disease progression.
Along with other self protective measures COVID-19 vaccination is important to prevent COVID-19 spread.
All people with MS should be vaccinated against COVID-19 (provided that they do not have any known allergies to any of the components of the vaccines)
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