The vaccination campaign against COVID19 has been underway for quite some time now. It is somewhat disappointing that fewer people could be convinced of the usefulness of a vaccination than one had hoped – but the vast majority of the German population has followed the call and has been vaccinated. The data on the effectiveness and side effects of the vaccine, which are currently available, fully meet expectations. The vaccine effectively protects against severe COVID19 courses, serious side effects have only been observed in a few individual cases
There is no doubt that the benefits of vaccination far outweigh the risks. Therefore, people with autoimmune diseases like MS, where wild-type infections often go hand in hand with a significant worsening of the disease, should get vaccinated. However, there is still some uncertainty that keeps some people with MS from getting vaccinated against COVID19. Above all, there is concern about the triggering of relapses and the occurrence of autoimmune inflammation of the central nervous system.
The Data Situation
Against the background of the available data, although these are still limited, one can actually
allay these concerns: A study from Israel on the COVID19 vaccination of over 500 patients with MS showed that in connection with the first vaccination with the Biontech/Pfizer vaccine
2.1% of the vaccinated people with MS suffered a relapse. After the second vaccination, 1.6
% of the cohort documented MS relapses. This percentage corresponds exactly to the proportion of MS
patients with relapses during the comparative period of the years 2017 – 2020, i.e. before the availability of the
COVID19 vaccine. The figures therefore make a causal link between vaccination
and disease relapses unlikely. A very similar observation was also made by an Italian study. Of 324 people with MS who were vaccinated with mRNA vaccines against COVID19, the relapse rate in the period after vaccination did not differ from the period before vaccination.
There are now also systematic data on the feared acute spinal cord inflammation (Acute Transverse Myelitis, ATM), which were discussed at the beginning of the vaccination campaign. These
show that the vast majority of spinal cord inflammations occurred after a wild-type
infection with SARS-CoV2 (43 cases with SARS-CoV2 infection vs. 3 cases after vaccination). This confirms the statement that the current dangers are more likely to come from
an infection with COVID19 than from the vaccination against this disease.
Accordingly, I would like to recommend vaccination against COVID19 for people
with MS at this point. I think there is still time to get vaccinated to safely get through the
upcoming autumn and winter. And also remember to get the
flu vaccine. From my clinical experience, I can really think of very few individual
situations where it was difficult or possibly not sensible to vaccinate an MS patient against
COVID19 or flu. As I said, such situations do exist, and they must
be discussed individually with an MS expert. However, a warning against issuing blanket certificates
against vaccination based solely on an MS diagnosis – this completely misses the point.
This statement also applies to people with MS who are being treated with immunotherapies. Inactivated vaccines, like the COVID19 vaccines, can also be safely used in immunosuppressed patients. The only problem might be that the vaccination does not lead to the desired vaccination success. But for this case, the STIKO has now recommended a booster vaccination.
So, once again, an urgent appeal from me at the beginning of autumn: if you haven’t done so yet,
get vaccinated against COVID19, and get your flu shot for the 2021/22
season while you’re at it.
