Vaccine Considerations for Multiple Sclerosis in the COVID-19 Era

Abstract

People with multiple sclerosis (MS) are at risk for infections that can result in amplification of baseline symptoms and possibly trigger clinical relapses. Vaccination can prevent infection through the activation of humoral and cellular immune responses. This is particularly pertinent in the era of emerging novel vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). MS disease-modifying therapies (DMTs), which affect the immune system, may impact immune responses to COVID-19 vaccines in people with MS. The objective of this article is to provide information on immune system responses to vaccinations and review previous studies of vaccine responses in people with MS to support the safety and importance of receiving currently available and emerging COVID-19 vaccines. Immunological studies have shown that coordinated interactions between T and B lymphocytes of the adaptive immune system are key to successful generation of immunological memory and production of neutralizing antibodies following recognition of vaccine antigens by innate immune cells. CD4 + T cells are essential to facilitate CD8 + T cell and B cell activation, while B cells drive and sustain T cell memory. Data suggest that some classes of DMT, including type 1 interferons and glatiramer acetate, may not significantly impair the response to vaccination. DMTs—such as sphingosine-1-phosphate receptor modulators, which sequester lymphocytes from circulation; alemtuzumab; and anti-CD20 therapies, which rely on depleting populations of immune cells—have been shown to attenuate responses to conventional vaccines. Currently, three COVID-19 vaccines have been granted emergency use authorization in the USA on the basis of promising interim findings of ongoing trials. Because analyses of these vaccines in people with MS are not available, decisions regarding COVID-19 vaccination and DMT choice should be informed by data and expert consensus, and personalized with considerations for disease burden, risk of infection, and other factors.

Case Report: Multiple Sclerosis Relapses After Vaccination Against SARS-CoV2: A Series of Clinical Cases

“…Patients with multiple sclerosis (MS) have an increased risk of respiratory infections, especially patients presenting severe disability and on disease-modifying treatments (DMTs) (1). Infections can trigger MS relapses (2), and thus, vaccination in MS patients should be pursued as a general policy in order to reduce the risk of infections (3). Despite the long-standing debate over an increased risk of relapse occurrence after vaccination, the existence of this phenomenon has not been confirmed (4).…”

Multiple Sclerosis Patients and Disease Modifying Therapies: Impact on Immune Responses against COVID-19 and SARS-CoV-2 Vaccination

“…Patients with MS, especially those with the severe forms of the disease, have a higher risk for acquiring certain types of viral and bacterial infections. It has been shown that there is a link between bacterial and viral infections and greater chance of occurrence of relapses or pseudo-relapses in MS patients [34][35][36][37]. Additionally, almost all MS patients are under treatment with immunomodulatory or immuno-suppressive disease-modifying therapies (DMTs) to lessen disease activity, severity and to prevent or slow disease progression.…”

An Update on the Status of Vaccine Development for SARS-CoV-2 Including Variants. Practical Considerations for COVID-19 Special Populations

“…COVID-19-related MS mortality has been reported to be approximately 1–4%. 323 Several studies have shown that some DMTs are associated with increased risk of COVID-19. However, patients who are not receiving DMTs have also been shown as a high risk for COVID-19 infection in some studies.…”