Covid-19 vaccination, the pandemic, discussions about various vaccines – all these topics seem to be miles away already. However, with the onset of the autumn season, the question will arise as to how one should behave as an MS patient, especially if one is receiving immunotherapy, with regard to possible booster vaccinations.
Accordingly, the COVID-19 vaccination recommendations published by the Standing Vaccination Commission at the Robert Koch Institute (STIKO) on 25.05.2023 (https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2023/Ausgaben/21_23.pdf?__blob=publicationFile) are a good last topic before the summer holidays. – Practically in preparation for the colder season.
According to the general recommendations of the STIKO, all persons aged 18 and over are recommended to have a basic immunity consisting of 3 antigen contacts: vaccinations or infections, but at least two vaccine doses. Persons at increased risk of severe Covid-19 disease are recommended further booster vaccinations – usually at intervals of >12 months since the last antigen contact – preferably in autumn. Among those at increased risk of severe Covid-19 disease are people aged > 60 and residents in care facilities, but also persons from the age of 6 months with relevant underlying diseases and persons under immunosuppressive therapy and their contact persons (family members). Conversely, therefore, people without underlying diseases aged < 18, from 18 to 59 and pregnant women (without underlying diseases) are not recommended to have a booster vaccination.
People with Multiple Sclerosis: vaccinate once a year
The underlying diseases with an increased risk of severe Covid-19 disease include, according to the definition of the STIKO, among other diseases, diseases of the central nervous system (CNS), such as chronic neurological diseases, dementia, mental disabilities, psychiatric diseases or cerebrovascular diseases. Accordingly, persons with multiple sclerosis fall under the general recommendations of the STIKO for a booster vaccination. The STIKO prefers the use of variant-adapted mRNA vaccines for this purpose. The mRNA vaccines from Moderna (Spikevax) are recommended only from the age of 30 due to the increased peri-/myocarditis risk in children, adolescents and young adults.
In summary, there is now a longer-term recommendation for MS patients to get vaccinated against Covid-19 annually with an adapted vaccine – this is comparable to the recommendations for the flu vaccination. But like the flu vaccination, it remains a personal decision.
Since MS patients have coped well during the pandemic and MS immunotherapies – with the exception of CD20 antibodies – have not led to severe Covid-19 courses, I can of course understand that a large number of MS patients – similar to the flu vaccination – will have no interest in a booster vaccination in the autumn. However, I would like to take up and reinforce this recommendation – analogous to the flu vaccination – because a wild-type virus infection is always associated with more “trouble” than a (usually well-tolerated) mRNA vaccination. See also the MS-Docblog post No connection between COVID19 vaccination and MS flare-ups.
And, as already mentioned, the data from the pandemic has also taught us that older MS patients, patients with pronounced disabilities and patients treated with anti-CD20 antibodies have a higher risk of severe Covid-19 disease – these groups should definitely consider getting vaccinated in the autumn.
