COVID 19 Vaccination and Multiple Sclerosis – Review

I recently participated in the AMSEL expert chat on the topic of “COVID 19 Vaccination and MS”. I had already given many answers to the most common questions in the MS-Docblog – in short: The vaccination is useful in MS, it is not dangerous and can also be given during ongoing immunotherapy, albeit with the possibility of not achieving a 100% vaccination success.This limitation of vaccination success, which can occur especially when using B-cell depleting therapies (Rituximab, Ocrelizumab), was a concern for many participants in the chat. Frequently the question was asked whether one should not carry out titer controls after vaccination under ongoing immunotherapy to document the success of vaccination. In principle, this is a very good suggestion. However, at the moment it is not at all clear how the titer level correlates with efficacy – especially since the development of T-cell immunity can also provide effective protection. Furthermore, I cannot imagine how titer controls could currently be established logistically. Perhaps such an approach will play a role in the future, but certainly not now, as the entire system is only designed to vaccinate as many people as possible. And because one can assume that a vaccination will work in the vast majority of cases even under immunotherapy, one should get vaccinated first – the question of vaccination success can then be clarified later and possibly adjusted if necessary.

The question of the optimal vaccine

Another important question was which is the optimal vaccine for MS patients. Ultimately, this question is pointless, because there is no choice in this sense, the vaccine is simply distributed according to availability. Currently, there are three vaccines from different manufacturers available in Germany, two mRNA vaccines from Biontech and Moderna, which had very good efficacy data in all age groups, and a vector vaccine from AstraZeneca. The effect of the vector vaccine was slightly lower in the studies, and the AstraZeneca vaccine was also tested on relatively few patients above the age of 65. This is the reason why the Standing Vaccination Commission (STIKO) recommends the use of the vaccine in Germany only for people under 65 years, although the European Medicines Agency (EMA) has approved the vaccine for all age groups. This discrepancy and the whole discussion about the efficacy data certainly does not contribute to the population’s confidence in the vector vaccine. This is actually quite senseless, because the data of the AstraZeneca vaccine are objectively very good for a vaccine (although not as good as for the mRNA vaccines).

Now many MS patients would like to get vaccinated – many are really disappointed that despite their chronic disease and treatment with immunotherapies, they do not belong to the group with the highest priority, but are listed only in the 3rd priority level, i.e., behind the elderly > 80 years old (1st priority) and older citizens > 70 years old (2nd priority). Soon the AstraZeneca vaccine will be available in larger quantities, which is not currently recommended for > 65 years. This could lead to many MS patients, especially if they are treated with immunomodulators, being younger, being vaccinated earlier than expected – but primarily with the vector vaccine from AstraZeneca. My recommendation is: Forget all the negative headlines, this vaccine is also effective and a step back to normality. So, take advantage of the possible offer and don’t speculate about the different vaccines.

Covid-19 does not lead to increased MS activity

Apropos, negative headlines: often all that remains is shaking one’s head – the newspapers and news portals outdo each other with bad news and problematize without respite. Actually, the time is difficult enough for all of us – nobody needs poorly researched reports about “virus mutants” or “vaccine disasters” with the same aim of outdoing each other in scandalizing. After all, it is fantastic that we have effective vaccines at all and can foresee that – perhaps with a little delay – large parts of the population will be vaccinated in the summer and the pandemic will come to a halt.

Scientific journalism also has a responsibility here – a scientific work is not worth more when it is marketed by the media – which is currently quite easy when COVID 19 is in the headline and potentially threatening things can be constructed. This happened in a press release from the press office of the University Hospital Mannheim (https://idw-online.de/de/news762033) about a scientific work published in the specialist journal Neurology Neuroimmunology Neuroinflammation (Fuchs et al. Neurol Neuroimmunol Neuroinflamm 2021;8:e957) by authors from Mannheim/Heidelberg and Basel, which describes the histological section findings of a 67-year-old patient with long-standing secondary chronic progressive MS who died from a COVID 19 infection.

The press release is titled “Does SARS-CoV-2 infection influence multiple sclerosis?” and poses the following questions: “Associated with the disease (note of the author: MS) is also a disruption of the blood-brain barrier, which allows misguided immune cells to overcome the barrier between the bloodstream and the brain and damage the nervous tissue in the brain and spinal cord. Does the coronavirus also take advantage of this weakness to invade the nerve cell tissue of the host?” – One can imagine what certain media make of this announcement, and what I will probably be asked by MS patients in the next few days.

However, the work rather confirms the already communicated view that SARS-CoV is usually not neurotropic (i.e., does not penetrate into brain tissue) and does not lead to an increase in MS activity. Because although the patient was seriously ill with COVID19, histologically there are no signs of an activation of MS lesions in the patient’s brain and virus RNA was not detected in the patient’s brain tissue, but only at certain interfaces to the brain. The authors therefore conclude: “Although this is a single case of a COVID-19-affected patient with a long-standing history of progressive MS, our findings provide no evidence for MS disease exacerbation or lesion (re)activation. These results are in line with recent clinical studies on stable disease in patients with COVID-19 with other autoimmune diseases.” (Translated: Although this is a single case of a COVID19 infection in an MS patient with a long history of progressive MS, our results do not show any indications of an exacerbation of MS or (re-) activation of MS lesions. These results are in line with recent clinical study results that autoimmune diseases remain stable in COVID19 patients.)

This is actually quite an encouraging and interesting finding – so the title could also have been: “COVID 19 does not lead to an increase in MS activity” – but this is a positive message and attracts much less attention.

 

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