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Covid-19 / Vaccine: Clarifications for patients with neuromuscular and autoimmune diseases

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Covid-19 / Vaccine: Clarifications for patients with neuromuscular and autoimmune diseases

As the first vaccinations against SARS CoV-2 in Europe and Cyprus started at the end of December 2020, many questions have been raised among patients with neuromuscular, other chronic and mainly autoimmune neurological diseases about the suitability and safety of vaccines, especially in case they are taking medication, which often includes immunosuppressive drugs.

Below is some information and answers to the most frequently asked questions submitted to the Institute of Neurology & Genetics by patients based on current international data as well as suggestions from other specialists for these diseases. The information applies to patients with myasthenia gravis, multiple sclerosis, patients with other related chronic autoimmune neurological problems such as chronic inflammatory polyneuropathy CIDP, NMO and others, as well as patients with inherited and degenerative neuromuscular diseases such as hereditary and hereditary neuropathy. myoatrophic sclerosis (ALS).

It is emphasized that at present there are no published data on SARS CoV-2 vaccination in patients with these neurological diseases. Therefore, our recommendations are based on the literature data on other vaccines such as H1N1 influenza, and on the recommendations of other organizations.

In any case and due to the particular problems of each patient, the advice of the treating physician is recommended.

Indicative categories of diseases treated at the Center for Neuromuscular Diseases and at the Center for Multiple Sclerosis and Related Diseases ING:

  1. Hereditary myopathies and hereditary neuropathies
  2. Degenerative diseases, mainly lateral myotrophic sclerosis (ALS)
  3. Autoimmune neuromuscular diseases such as Myasthenia gravis and polyneuropathy (Guillain Barre Syndrome -GBS or Chronic Inflammatory Demyelinating Polyneuropathy-CIDP)
  4. Multiple sclerosis
  5. Optical Neuromyelitis
  6. Other autoimmune diseases of the central nervous system

It is recommended that people belonging to the first two categories be vaccinated. Elderly patients with other underlying diseases that increase the risk of severe SARS CoV-2 disease and with respiratory distress or severe motor disability should be vaccinated as a matter of priority (vulnerable groups).

Regarding patients in categories 3-5 with autoimmune diseases, it is noted that in phase 3 studies for the approval of vaccines available in Cyprus today (BioNTech / Pfizer BNT162b2-comirnaty and mRNA-1273 vaccine of Moderna) did not include people receiving immunosuppressive drugs. Therefore, we do not know if the high levels of efficacy observed with mRNA vaccines to date will be achieved in immunocompromised patients. However, based on the literature and experience of vaccinating our patients with other vaccines, we believe that the above vaccines will be sufficient to protect them from SARS CoV-2 infection.

Especially in myasthenia gravis and multiple sclerosis, it is known that an infection can cause recurrence in both diseases and in the case of myasthenia gravis, a risk of respiratory failure. Therefore, vaccination against SARS CoV-2 is recommended. With regard to autoimmune polyneuropathy, there have been reports of vaccinations against other viruses that have caused GBS and possibly recurrence of CIDP. It is noted that the virus itself can also cause an autoimmune reaction in the nerves. For example, an increase of 1-2 GBS cases per 1,000,000 doses of influenza vaccine has been observed. However, studies have shown that GBS is more likely to occur after a flu infection than after the vaccine. There are currently no reliable publications showing the exact possibility of recurrence of neuropathy after vaccination for SARS CoV2. From the data published to date and the reality of the millions of people vaccinated with the above 2 vaccines, it seems that the SARS Cov-2 vaccine is safer than COVID 19 disease itself and its complications.

As currently approved vaccines are not based on live virus, there is no risk of developing active disease from the vaccine. Therefore, immunosuppressed patients can be vaccinated with the two aforementioned vaccines which are currently available at the local Vaccination Centers of the Republic of Cyprus as there is no risk of contracting COVID-19 infection from the vaccine. However, it is not known whether the immunosuppression that each patient experiences during vaccination affects the effectiveness of the vaccine, ie the development of antibodies to the SARS CoV-2 virus. If possible, measuring the antibody titer 4-8 weeks after the second dose of the vaccine would be desirable.

In general, the vaccine should be given to immunocompromised patients unless they have a serious, other type of contraindication as cleared by the European Medicines Agency and the Ministry of Health, and basically include cases of known allergy to the vaccine ingredients. From our experience with other vaccines, we suggest that vaccination, if possible, should be as far away from immunosuppressive therapy as possible in order to increase the response to it. In practice, where possible, it is recommended that vaccination be given at least 4 weeks before the start of immunosuppressive therapy.

If the patient is already receiving stable immunosuppressive therapy, there is no time limit on the administration of the vaccine. In patients receiving intravenous immunoglobulins (IVIG) it is recommended that the vaccine be given at intervals between regimens and at least 2 weeks after the last or next dose.

In patients with Multiple Sclerosis receiving Tysabri, it is recommended that the vaccination be given one week after the last Tysabri and completed 2 weeks after the next. Therefore, and considering that the two doses of the vaccine should be given 3 weeks apart, the next Tysabri treatment will be 5 weeks after the first dose of the vaccine and therefore 6 weeks after the previous dose of Tysabri.

In patients receiving half-life B-cell suppressor therapy, such as rituximab or ocrelizumab, it is recommended that the vaccination be completed 4 weeks before the start of treatment, and that if it is a repeat treatment, the vaccination should be given at the end of the semester. from the previous dose provided we have normal immunoglobulin levels and have completed (both vaccine doses) at least 4 weeks before the next dose.

In conclusion, vaccination coverage as soon as possible in patients with neuromuscular and autoimmune diseases is desirable. Priority should be set by other risk factors for serious COVID-19 disease such as age, respiratory and heart disease, immunosuppression and other comorbidities.

It is emphasized that patients with neuromuscular and other chronic neurological diseases should always faithfully follow the instructions of the Ministry of Health for protection against the SARS CoV-2 virus that concern the general population even after vaccination. Caregivers of people with neuromuscular disease should also be vaccinated so that they can continue their work.

Finally, it is emphasized that:

Before you are given a COVID-19 vaccine, find out about your neurological condition and the medication you are taking, and give any other important medical information, such as:

History of allergies, especially to vaccine ingredients

– allergic reactions to previous vaccines (for example the flu vaccine)

– if you have a fever or if you have had a fever or infection in the previous days

-the medicines you are taking, especially if you are taking immunosuppressive drugs or anticoagulants,

– if you are pregnant or breast-feeding

As with any vaccine, you should not get the COVID-19 vaccine if you are allergic to any of its ingredients. You should not take the second dose if you have had an allergic reaction to the first dose.

If you have already been vaccinated against COVID-19, it is important that you continue to wear a mask and keep your distance. Currently approved vaccines reduce the risk of COVID-19 infection by up to 90%, depending on the vaccine, but people who have been vaccinated may be able to pass COVID-19 to others without knowing they are carriers.

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Source: politis.com.cy

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