I would have very much wished not to have to write about this complex of topics anymore – but the current situation makes the topic of vaccination against COVID19 very topical again – and the questions from MS patients about the right vaccination strategy are increasing.
The current infection situation is worrying, even if the current numbers and the situation cannot be compared with the situation in the pre-Christmas period 2020, when there was no vaccination protection yet.
Even though the federal and state governments decided on far-reaching measures to contain the pandemic yesterday, I believe that only consistent vaccination will bring us closer to the end of the pandemic and normality.
Those who are undecided should now get vaccinated against SARS-CoV2
Here two different approaches need to be considered – on the one hand, that as many of the still undecided as possible get vaccinated as quickly as possible – and the tightened rules will probably convince some citizens to get vaccinated quickly. Nevertheless, many millions of people in Germany – as the experience of the last months has shown – will not be convinced of the sensibility of vaccination and therefore will still not have effective protection against a disease-causing virus infection. In a small percentage, these people face a stay in intensive care or even death from the virus – but even a small percentage can become a problem with a large number of unvaccinated people, which we are currently experiencing live.
Therefore, in my view, another measure is of paramount importance – namely the booster vaccination of those who have already received double vaccination protection – the so-called booster vaccination or 3rd vaccination against SARS-CoV2.
3rd vaccination reduces severe courses to almost zero
In the prestigious scientific journal The Lancet, data from Israel on the third vaccination with the Biontech/Pfizer vaccine was published on 29.10.2021 (Barda N. et al. Lancet 2021 Oct 29: S0140-6736(21)02249-2). These data clearly show that the 3rd vaccination in terms of hospital admissions, severe COVID19 courses and death makes a significant difference compared to 2 vaccinations with the Biontech/Pfizer vaccine: The numbers are almost zero after the 3rd vaccination. This result of this study was not to be expected a few months ago – it has significantly changed and sharpened my view on the 3rd vaccination.
In early autumn I was not sure yet if I would really recommend a 3rd vaccination to everyone – given the current infection numbers in Germany and the experiences from Israel, which have literally vaccinated themselves out of another Corona wave. I would recommend a booster vaccination to every German who wants it (and I assume that these are all those who have already received a vaccination against SARS-CoV2).
The great value of this strategy lies in the realization that vaccinated people can also get infected – this is due to the infectiousness of the Delta variant, and the fact that mucosal immunity drops faster than hoped. Vaccinated people hardly get seriously ill anymore and are also less infectious and for a shorter time than unvaccinated people, but they can still transmit the virus and thus infect unvaccinated people and put them in a dangerous situation. It is sad that with the recommendation for the 3rd vaccination, the burden is again put on the solidary and responsible citizens, but there is probably no more effective strategy to break the 4th wave.
3rd vaccination also recommended for all under MS therapy
For those affected by MS, the following recommendations can be derived from what has been said: A 3rd vaccination is basically recommended and it should take place as soon as possible – the minimum interval of 6 months to the 2nd vaccination should not be taken too strictly, the Bavarian state government has even already officially announced this, because we need the additional vaccination protection now. (It is also not dangerous to receive the 3rd vaccination at a shorter interval).
This statement also applies to all persons with MS who are receiving immunotherapy and especially for those who are receiving B-cell depletion (Ocrelizumab, Ofatumumab, Rituximab) or an S1P modulator (Fingolimod, Ozanimod, Siponimod, Ponesimod) – under these medications the antibody protection is known to be not quite as good from the start. It should be emphasized again that vaccination is not dangerous and does not trigger relapses per se, therefore it can be given at any time during therapy, especially in patients who are stably treated. With treatment with Ocrelizumab/Rituximab (6-monthly infusions), a window of “3 months after the last infusion to 2 weeks before the next infusion” is particularly suitable, but if this is currently not possible, one should still vaccinate, or ask their neurologist if the infusion appointment can be adjusted, a delay of a few weeks is possible.
Despite these general recommendations, it is of course always advisable to consult with your own neurologist in individual cases.
