Multiple sclerosis (MS) is a chronic, predominantly immune-mediated degenerative disease of the central nervous system. Due to prolonged use of immunomodulatory and immunosuppressive medications, vaccine hesitancy could be common among MS patients. Our main aim in the current study was to evaluate the willingness and acceptability of COVID-19 vaccination in patients with MS. In our multicenter cross-sectional questionnaire-based clinical study, 892 patients completed the questionnaire between May to June 2021. The questionnaire consisted of demographic data, MS disease-related factors, history of COVID-19 infection/vaccination, and any existing comorbidities. Statistical analysis was performed using SPSS software version 19. Overall, 68% of the participants expressed willingness to be vaccinated. Major causes of vaccine refusal in our patients were the fear of reducing the efficacy of disease modifying drugs (DMDs) upon vaccination as well as distrusting the vaccines and overestimation bias in the power of their innate immunity and potential COVID-19 resistance. Some demographic factors affected vaccination enthusiasm in our study. Our findings did not show significant correlation between the age and comorbidity and vaccine willingness. Only one-third of our patients received their vaccine information from healthcare providers. The majority of them received these data from official broadcasting channels and social media. However, despite several concerns, the willingness of COVD-19 vaccination in the Iranian MS patients is remarkable.

Coronavirus disease 2019 (COVID-19) is more common in patients with multiple sclerosis because of receiving immunosuppressive or immunomodulating diseasemodifying therapies (DMTs). On the other hand, some of these drugs may interact on COVID-19 vaccines. In this commentary, first we introduce some available COVID-19 vaccines and then discuss the effect of different DMTs on immune responses after vaccination. We have not found a connection between vaccination and MS relapses, so we suggest that the benefit from the vaccine outweighs any potential risks in these patients.

BACKGROUND Patients with Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disease (NMOSD) may have higher risk of contracting COVID-19 infection than the general population which may be due to disease modifying drugs (DMDs), disability and other comorbidities leading to immune system dysfunction. Not only COVID-19 may aggravate or lead to progression of MS, re-infection and different amount of antibody formation against COVID-19 may also be seen in these population. OBJECTIVE We investigated the clinical characteristics of COVID-19 infection and the relationship between using DMDs and other possible contributing factors with the rate and severity of COVID-19 infection in 2878 MS/NMOSD patients. METHODS Within 12 months follow-up, we also assessed the relapses, progression of the disease (MS), COVID-19 reinfection and sero-positivity of the patients. RESULTS Our study demonstrated that MS and NMOSD patients are generally not at a higher risk of COVID-19 infection compared to general population. Although, some patients treated with DMDs such as Rituximab, Fingolimod and Natalizumab were at a higher risk of COVID-19 infection or even re-infection compared to other DMDs. CONCLUSIONS It is probable that some drugs could have relatively protective effects. We had limited report of exacerbation of MS and NMOSD among confirmed cases not close to the infection time, at least in our short-term follow-up.

BACKGROUND Patients with Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disease (NMOSD) may have higher risk of contracting COVID-19 infection than the general population which may be due to disease modifying drugs (DMDs), disability and other comorbidities leading to immune system dysfunction. Not only COVID-19 may aggravate or lead to progression of MS, re-infection and different amount of antibody formation against COVID-19 may also be seen in these population. OBJECTIVE We investigated the clinical characteristics of COVID-19 infection and the relationship between using DMDs and other possible contributing factors with the rate and severity of COVID-19 infection in 2878 MS/NMOSD patients. METHODS Within 12 months follow-up, we also assessed the relapses, progression of the disease (MS), COVID-19 reinfection and sero-positivity of the patients. RESULTS Our study demonstrated that MS and NMOSD patients are generally not at a higher risk of COVID-19 infection compared to general population. Although, some patients treated with DMDs such as Rituximab, Fingolimod and Natalizumab were at a higher risk of COVID-19 infection or even re-infection compared to other DMDs. CONCLUSIONS It is probable that some drugs could have relatively protective effects. We had limited report of exacerbation of MS and NMOSD among confirmed cases not close to the infection time, at least in our short-term follow-up.

Introduction: Vaccination against SARS CoV-2 started on March 2020 in Iran and people with multiple sclerosis (pwMS) have a priority to be vaccinated in line of other high-risk population. Up to now, BBIBP-CorV (Sinopharm) is the main vaccine which have been used in Iranian population, and in high risk population such as pwMS. Method: In this survey, the safety and possible side effects of this vaccine after the first or/and second doses in 520 pwMS have been assessed from July to August 2021. MS Patients who have received one or two doses of Sinopharm vaccine were evaluated. Results: Around 44% of pwMS who received Sinopharm reported few minor side effects, whereas its side effect have been reported in 60% of patients who received the second dose. All side effects have begun within the first 24 hours and subsided between 48-96 hours afterward. No serious side effects or mortality have been reported. There was no correlation between the side effects and age, the disability status, and the type of first or second line DMDs (disease modifying drugs). Only some side effects were significantly higher in the progressive form of the disease. Conclusion: MS patients can receive Sinopharm vaccine safely and the minor side effects should not scare them. Keywords: Sinopharm BBIBP-CorV, multiple sclerosis, disease modifying drugs, safety