Although the availability of information is currently excellent, I find that there is still a great deal of uncertainty among MS patients, whether with immunotherapy or without, regarding vaccination against SARS-CoV2. Therefore, once again, a clear message: Vaccination against SARS-CoV2 is recommended for patients with multiple sclerosis without restriction.
Vaccination protection is also achieved under immunotherapy
Immunotherapeutics can impair the vaccine response. However, since vaccination with (inactivated) vaccines under immunotherapy is not dangerous, vaccination should be done in any case. In most MS patients, sufficient vaccination protection is achieved despite immunotherapy. And even for those who may not develop a sufficient antibody response after vaccination, it can be assumed that contact with the vaccine and the resulting T-cell response provide such a high level of individual protection that severe cases of COVID19 are prevented.
Accordingly, headlines like those of the ARD magazine BRISANT from 15.05.2021 are not necessarily helpful. Especially since public broadcasting has a wide reach and enjoys a lot of trust in the population. The headline here is “NO ANTIBODIES: CORONA VACCINATION IN MANY IMMUNE DISEASES INEFFECTIVE” (with immune diseases here referring to rheumatoid arthritis patients – but the term generally refers to all patients with autoimmune diseases, including MS patients). What’s behind it: An absolutely serious work from the Center for Immunotherapy at the University of Erlangen (https://ard.bmj.com/content/annrheumdis/early/2021/05/05/annrheumdis-2021-220461.full.pdf) The authors examined the vaccine response (antibody formation) to a complete vaccination with the Biontech vaccine in 84 patients with immune-mediated inflammatory diseases (IMIDs) and compared it with the vaccine response of 182 control persons. While an antibody response was detectable in 99.5% of the control persons, SARS-CoV2 antibodies were detectable in only 90.5% of the IMID patients (among whom, by the way, there were no MS patients, but predominantly patients with rheumatoid arthritis). Since more than half of the patients were not treated with immunotherapies, the authors conclude that autoimmune diseases themselves could be a risk for a diminished vaccine response and therefore recommend a 3rd vaccination in this patient group.
I think with this explanation everything sounds quite plausible and far less dramatic – and actually I demand such an information strategy also from a public broadcaster. A vaccination response of 90% can hardly be labeled as “ineffective” even by the editor of a tabloid magazine – that’s really unworthy and a poor level. More can’t be said about it.
Vaccination and Pregnancy
Another point currently being discussed in public, and also affecting young MS patients, is the vaccination of pregnant women. Current data indicate that pregnancy is a risk factor for severe COVID 19 cases and that pregnancy complications can be associated with a COVID19 infection. Based on this data, contact persons of pregnant women are currently being vaccinated preferentially in Germany. Unfortunately, there is still no general recommendation by the STIKO to vaccinate pregnant women, which is justified by an insufficient data situation. Nevertheless, a more pragmatic approach would be desirable here soon, as vaccination during pregnancy is explicitly recommended for many other (inactivated) vaccines, such as whooping cough and influenza, also because the transplacental transfer of maternal antibodies to the fetus provides a “nest protection” and the antibodies also pass into the breast milk.
At this point in time, pregnant women who have additional risk factors for severe COVID 19 cases, e.g. with active MS disease, if the administration of high-dose steroids may become necessary, or previous therapy with cell-depleting antibodies, can consider vaccination against SARS-CoV2 despite the lack of official recommendations (after consultation with their neurologist).
In any case, the current situation leads to the recommendation that all women who wish to have children should get vaccinated before becoming pregnant. (Covid-19 vaccination does not make you infertile.) It is to be hoped that there will soon be reliable recommendations on this complex of topics, as after all, more than 100,000 pregnant women are said to have been vaccinated against COVID19 in the USA.
