Vaccine hesitancy among people with multiple sclerosis

Abstract

Background:The current severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has raised awareness of vaccine hesitancy. Specific reasons for vaccine hesitancy among people with multiple sclerosis (pwMS) have not been fully described. Notably, pwMS may experience higher morbidity from vaccinepreventable diseases such as influenza, pneumococcal disease, and human papillomavirus (HPV)-associated warts and malignancies. Furthermore, screening for immunity against measles, mumps and rubella (MMR) is not standard practice, despite a resurgence of measles and mumps outbreaks in Europe and worldwide. We aimed to evaluate general vaccination status among pwMS to better inform vaccine practices in this cohort. Methods: This was a prospective audit of pwMS attending an Irish tertiary referral MS centre. We designed a questionnaire that explored awareness, uptake, and hesitancy for the influenza, pneumococcal, SARS-CoV-2, HPV, and MMR vaccines. The clinician administered the questionnaire during the outpatient MS clinic. Results: One-hundred-and-five pwMS participated in the audit, mean (SD) age 47.3 (12.8) years, mean MS disease duration 14.1 (9.5) years, median Expanded Disability Severity Scale (EDSS) score 2.0 (IQR 1.0-6.0), forty-nine (46.7%) were taking either maintenance immunosuppressive or immune reconstitution therapies. SARS-CoV-2 vaccine willingness among pwMS was higher (90.5 vs 60-80%) than that reported in other Western countries, and higher than that for the influenza and pneumococcal vaccines (~80%) for which perceived unnecessity and unfamiliarity respectively were the main limiting factors. The primary reason for SARS-CoV-2 vaccine hesitancy was safety concern. PwMS who were explicitly advised by a healthcare professional to obtain the influenza vaccine were more likely to do so than those who were not (odds ratio, 8.1, 95% CI 2.8 -23.4, p<0.001). Of pwMS currently receiving B-cell therapy (ocrelizumab/rituximab, n=12), all but one (n=11, 91.7%) have never received the pneumococcal vaccine, and a quarter (n=3) were uncertain whether to obtain this in the future. Patient-reported uptake of HPV (1.0%) and MMR (51.4%) vaccines were suboptimal. Prevalence of vaccine promotion among healthcare professionals was low (influenza vaccine, 4.8 -32.4%; pneumococcal vaccine, 0 -18.1%). Conclusions: Vaccine hesitancy is common (10-20%) in pwMS, consequent to insufficient knowledge and misconceptions about vaccination among pwMS and suboptimal vaccine promotion by healthcare professionals who manage pwMS. Conscientious and context-specific vaccination counselling is necessary to tackle vaccine hesitancy among pwMS, including (i) avoiding infection-associated disability accrual during MS relapses, (ii) reducing the potentially higher risk of life-threatening/treatment-refractory complications that may be observed in those who develop vaccine-preventable infections while receiving certain DMTs, and (iii) avoiding attenuated vaccine responses or delayed/interrupted DMT with early pre-treatment vaccine deliv...

COVID-19 vaccine hesitancy in Iranian patients with multiple sclerosis

“…In general, the greatest vaccine-hesitant respondents’ concern was about the possible vaccine side effects which are confirmed by other studies ( Yap et al., 2021 ; Ehde et al., 2021 ; Xiang et al., 2021 ; Uhr and Mateen, 2021 ). Therefore, informing the patients about vaccine safety sounds necessary.…”

“…They found its association with higher awareness of one's risk of infection with COVID-19 and a higher level of education. Safety concerns were also found as the main cause for SARS-CoV-2 vaccine hesitancy in the study by Yap et al. (2021 ).…”

Implementing education: Personal communication with a healthcare professional is a critical step to address vaccine hesitancy for people with multiple sclerosis

“…This rate of vaccine hesitancy is lower than reported in several countries at a similarly early stages of vaccine accessibility (20-40%) ( Diem et al, 2021 , Ehde et al, 2021 , Xiang et al, 2021 , Serrazina et al, 2021 ). We found no effect of age, sex or educational level on attitudes, which was similar to some reports ( Ehde et al, 2021 , Serrazina et al, 2021 , Yap et al, 2021 ) but not others ( Ehde et al, 2021 , Xiang et al, 2021 , Ghadiri et al, 2021 , Huang et al, 2021 , Uhr and Mateen, 2021 ). Our findings were consistent with evidence, except for one early paper, that lockdowns don't decrease hesitancy ( Caserotti et al, 2021 , Cascini et al, 2021 ).…”

“…This mirrors the lack of general vaccine promotion by healthcare professionals reported in the UK. ( Yap et al, 2021 )…”

COVID‐19 vaccination hesitancy among people with chronic neurological disorders: A position paper

“…This rare postvaccine entity was observed with the vector‐based ChAdOx1nCoV‐19 and Ad26.COV2.S SARS‐CoV‐2 vaccines is probably caused by platelet‐activating antibodies against platelet factor 4, mimicking autoimmune heparin‐induced thrombocytopenia and currently named vaccine‐induced immune thrombotic thrombocytopenia (VITT) [ 37 , 38 ]. However, even though decision‐making can be supported by an advantageous risk–benefit profile from phase 3 trials and real‐world evidence, vaccine skepticism is reported among people living with neurological disorders, for example, epilepsy and MS [ 39 , 40 , 41 , 42 ]. Morover, diminished humoral immune responses after SARS‐CoV‐2 vaccination in people with neurological disorders on CD20‐depleting agents and S1P receptor modulators call for individualized vaccination strategies [ 43 , 44 , 45 ].…”