World Multiple Sclerosis Day 2022 May 30thCOVID-19 VACCINES AND MS- M.A.Aleem Neurologist ABC Hospital Trichy

World Multiple Sclerosis Day 2022 May 30th

COVID-19 VACCINES AND MS

- M.A.Aleem Neurologist ABC Hospital Trichy 

World Multiple Sclerosis Day, falling on May 30th. Multiple Sclerosis (MS) is a chronic progressive disease where the insulating covers of the nervous system are damaged. MS is also known as encephalomyelitis disseminata, and its symptoms include muscle weakness, double vision, and mental/physical problems. Due to the lack of research studies on the disease, the exact causes behind it are generally unknown. Many scientists believe that there might be a connection between the onset of the disease and genes and/or nerve-cell dysfunction. Furthermore, there is no permanent cure as of yet. The symptoms can be relieved using the right set of treatments and medication. Im

The first World Multiple Sclerosis Day was celebrated in 2009 by the Multiple Sclerosis International Federation (MSIF). MSIF was officially established in 1967 as an international body that coordinated with national MS organizations belonging to many countries like Turkey, Slovakia, India, and the U.S.

The federation aims to bring light to MS and the scientific research related to it. The theme for this year’s World Multiple Sclerosis Day is ‘Connect.’ This theme, which continues from 2020 through 2022, focuses on bringing the world together by forming a connection with each other as well as the self for the sake of better care.

In this article we will know more about COVID-19 vaccination in patients with Multiple  sclerosis 

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 it is better to know the following 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 our country’s guidelines regarding mask wearing (indoors and outdoors), social distancing, social group requirements, and hand washing.

There are 11 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 the 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). 

1.mRNA vaccines 

This 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).

Pfizer-BioNTech (Comirnaty)

Moderna (Moderna mRNA)

2.Non-replicating viral vector vaccines

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.

AstraZeneca/Oxford (AZD1222)

Serum Institute of India (Covishield)

Gamaleya Research Institute (Gam-COVID-Vac or Sputnik V)

3.Inactivated virus vaccines

In this an inactivated form of the whole coronavirus used. 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. 

Covaxin (Bharat Biotec)

Sinovac (CoronaVac)

Sinopharm (BBIBP-CorV)

4.Protein vaccines

This 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.

• Novavax (NVX-CoV2373)

5.Live attenuated vaccines

This use 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 , 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 vWorld Multiple Sclerosis Day 2022 May 30th

COVID-19 VACCINES AND MS

- M.A.Aleem Neurologist ABC Hospital Trichy , 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) 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. 

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 (1-4), 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 (see section further down the page). 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

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.

The science has shown us that the COVID-19 vaccines are safe and effective. India at present  recommend COVID-19 vaccination for all above 18 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.

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 18 in India. 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, (see the list near the beginning of this advice on groups who are more at risk), 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, natalizumabIf you are about to start one of these 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, ponesimodIf 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.AlemtuzumabIf 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 cladribineIf 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, rituximabIf 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*.OfatumumabIf 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 steroidsConsider 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 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.