BartsMS COVID-19 vaccine advice

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Following on from ProfG’s vaccine-post yesterday, I’ve now uploaded the vaccine advice BartsMS have produced for pwMS. As always with such documents, it is going to age rather quickly as new evidence emerges.

COVID-vaccine-guidance-in-MS_final_1.3

I support ProfG’s view 100% that you should have the vaccine, unless there are specific contra-indications. I also agree that “some immunity is better than no immunity” since ‘blunted’ vaccine immunity on some disease modifying treatments may be sufficient to prevent SARS-CoV-2 infection, developing COVID-19 and – most importantly – severe COVID-19. 

However, if you would like to adapt the schedule of your vaccination and/or MS treatment against the backdrop of our and/or the MS Society’s guidance, do speak to your team about what can be done.

CoI: None

@klausschmierer

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36 comments

  • I am disappointed that carers are not receiving the vaccination
    I rely my 100% on my carer and if he contracted covid without the vaccination he could still be be very ill which would impact on my care
    Also no vaccination is 100-percent so the clinically vulnerabe will still be vulnerable even with vaccination so why on earth do carers not qualify as key workers?
    I expected the covid vaccinations to be distributed the same as the annual flu vaccination

      • I don’t see how that would have been a logistical nightmare when many carers will take the clinically vulnerable to have their vaccinations

        • They are trying to do the vaccines so that it is transparent and queue jumping is avoided, I think the plan was originally to do the whole household but this was dropped from the November Green book in the december variant. Maybe now they have access to 100 million doses of oxford vaccine they will change the plan but if 4/5 of vaccine supplies go on other individuals the plans on vaccine strategy would have soon floundered

  • Can we have a “pfizer vs oxford vaccine” chart of pros and cons by DMD please?

    I have just been told by a hospital administrator (who never meets patients) that the Pfizer is for first line staff (including he and her colleagues!) and we, MSers, “have to wait for the Oxford vaccine to come out”.

    This is not encouraging really – and I have no desire to wait for a public enquiry on the way the NHS is distributing those vaccine, But I am certainly keen to know what I am having, and how it compares to what I am not having.

    I am better off otherwise being part of the 30%-40% free riders who will simply benefit from herd immunity.

    • Until it is approved you can only have the pfizer in the UK. The oxford is not yet approved and so we dont know the dosing scedule and dose. I suspect 2 x full dose 50 billion particle o and day 28.

          • Unfiltered….
            1. They have both done an amazing job to get vaccine approved within a few months. Remember the Moderna was ready for human use by the end of March. So the next time a virus comes along what a technology. Listening to some talks, the technology to keep the RNA vaccine at standard temperatures for RNA vaccines is already a reality so Wow2…Maybe your EBV vaccine is not that far away. However for now the need to keep the vaccine cold means it is not easy to distribute and so the adenoviral variant has advantages as a wordlwide vaccine. Sinovac is an inactivated vaccine approaved in China, but had an adverse event in Brazil so I am told

            2. They both make most/all people get an anti-spike response which you want for protection

            3. You can’t do it without pharma….most University vaccine approaches have fallen by the wayside unless picked up by pharma or without alot of Government backing.

            4. The Oxford vaccine trials appears to me to be a dog’s breakfast, because of the mistakes they made in the assay of the virus leading to inconsistent doses beiing used and because delays in getting the vaccine for study meant non-standardised dosing schedules…leading to the endless splitting of the groups. A problem for a rolling trial. Pharma have a protocol and they aim to stick to it. When I did my trial, a batch of drug had a differet glass bottle cap on it, they were sent back to be done per specification, with time pressure on…they have used what ever was there.

            Therefore I suspect the moderna/Pfizer data is cleaner and more regulator friendly. More trials are now being done….Therefore without the data to hand it is hard to know what is being recommended yet. I can’t see the half dose being approved. However the full dose still hits the original brief and people are dying whilst we hang around.

            On face value the BioNT tech and Moderna vaccines (95%) are more active than the Oxford vaccine (60-65%) so you would say give me Pfizer. Oxford vaccine is a virus and so you waste immune response targetting the adenoviral parts. The RNA should be gone in a couple of days, I suspect the virus will hang around for longer,how long in immunosupressed person is unknown? Is this better for a T cell response etc?

            However the groups cannot be comparable in the BioNT vaccine you had 170 people infected from 40,000 people, but about 131 out of 11,000 for the OxAz vaccine. The oxford (OXAz) vaccine was being tested in health care professionals. These people are being exposed to more virus than Jo Schmo public and therefore it is not like with like. Maybe a reason why the UK half dose group was 90% protected. This (p0%) is the level claimed with Sputnik 5 another adenovirus on the way. However this is based on data from 20 people. They use two doses of different viruses so says one suspects you will get infusion reactions to the adenovirus bits and it is known that past exposure to adenovirus can influence response. However that is why the OxAZ it is a chimpanzee virus.

            There are otheres in the pipeline

            Do I have my favourites…sure I do, but I will take what I am offered as it will give me protection. In UK this is likely to be the oxford vaccine (in EU /USAand RNA vaccine) is more likely, as the UK has ordered 100,000,000 doses of this.

          • So to summarise mRNA if offered both (highly unlikely, as you say), followed by OXAz as a better than nothing option (K Starmer’s Brexit deal kind of approach)?

            I would not touch Sputnik or Sinopharm with a barge pole personally. No amounts of blog posts here can convince me otherwise.

          • You are not going to get sputnik or Sinopharm in the near future and low chance of Moderna until Q2 I suspect, but you may be aware of deal making beween Zeneca and Sputnik manufacturers, so be careful what you wish for. Sinopharm is an inactivated virus so is more than just Spike and for T cells activity could be better, Who knows

            Which is best, time will tell and it is what you base it on (Efficacy of antibodies? T cells?, Cost?, Maximum profit?, Distribution to the World?)….OXAz made from embryonic Kidney cell products (Catholic?) and contains alcohol (Halal/Haram?)

          • just efficacy (assuming a similar safety profile across the board) ceteris paribus all other factors.

          • If they plan on messing around with the dosing schedule then efficacy data goes out of the window. Delaying second dose of Pfizer vaccine to 12 weeks will probably affect efficacy.

          • OXAz contains alcohol? Is that the same as booze alcohol? Would someone who goes into anaphylactic shock if they drink booze alcohol need to avoid this vaccine too?

          • Yes booze alcohol = ethanol. If you develop anaphylaxis from ethanol inform your health care professional and enquire about the BioNTech variant which does not have ethanol in it

            Chemicals in the injection fluid OXAz vaccine

            L-Histidine
            L-Histidine hydrochloride monohydrate
            Magnesium chloride hexahydrate
            Polysorbate 80
            Ethanol
            Sucrose
            Sodium chloride
            Disodium edetate dihydrate
            Water for injections

            BioNTech/Pfizer vaccine
            contains polyethylene glycol/macrogol (PEG) as part of ALC-0159.
            ALC-0315 = (4-hydroxybutyl) azanediyl)bis (hexane-6,1-diyl)bis(2-hexyldecanoate),
            ALC-0159 = 2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide,
            1,2-Distearoyl-sn-glycero-3-phosphocholine,
            cholesterol,
            potassium chloride,
            potassium dihydrogen phosphate,
            sodium chloride,
            disodium hydrogen phosphate dihydrate,
            sucrose,
            water for injections

    • Tonight as I listen to newscasters reporting on local icu fill rates, stagnant distribution of a small supply of vaccines, and my State of Texas reaching a record number of those hospitalized, I’m not amused by Anonymous’s real or pretended ignorance or gross attempt to gAslight MSers seeking real advice about vaccination. I fear Too that Anonymous is one of my own countrymen. Did you not get the memo from The Institute for Health Metrics and Evaluation out of University of Washington that forecasts 35,000 Texans will die of Covid by February 1st in light of the lack of wearing masks and increased mobility? And in the US, Johns Hopkins University puts the observed fatality ratio at about 1.8%. At that rate, if every American got COVID-19, it would equal almost 6 million deaths.

  • Thanks so much for this post. Very helpful! On Ocrevus here – and avidly reading the BartMS blog for updates along the way.

  • I had a 5-day course of oral steroids in the middle of October so is it it dangerous to have the Oxford vaccine?
    Also if I I reject the Oxford vaccine if invited, will I be able to get the Pfizer vaccine?

    • Good question I dont know, remember UK ordered 40 million doses I think 5 million before New Year and then after March

      • What would professor k or professor.g advise their patients?
        Would having had steroids 3 months ago be a problem? And would I be able to say no to the Oxford vaccine and get the Pfizer vaccine?

        • I dont know it depends if they comment during their sick leave, busy scedule or holiday. If you can no to the oxford vaccine it is not clear what happens at present.

    • In terms of Danger the virus is not replication competent so the only question is is how long does it take to get rid of the virus

  • My next ocrelizumab is due on 5th Jan and I’ve had the call offering me the vaccination next week. My concern is that I need to leave 6 weeks before or after my infusion when timing the vaccinations and I’m now concerned with the 12 week delay in the 2nd dose. I cannot go 18 weeks without my treatment.

    Does anyone know more about the 12 week delay for the 2nd dose?

    • vaccine 1 next week, vaccine 2 = 3-weeks later (i.e. 3 weeks).
      “The drug label now advises that all immunizations should be administered according to immunization guidelines at least 4 weeks prior to initiating treatment with ocrelizumab for live or live-attenuated vaccines. When possible, non-live vaccines should be administered at least 2 weeks prior to treatment initiation”.

      (3 + 4 = 7 weeks or 3 + 2 = 5 weeks) So where does 12 weeks come from?

      • The new guidelines today says 2nd dose can be up to 12 weeks later. I was prepared to push my infusion back by 9 weeks but not 18 😞

        • For BioNTtech data submitted was seemingly from 19-42 days to second dose according to MHRA website with a protocol recomendation for 21, so I do not understand why they MHRA (JCVI) would support use of second injection at 84days, but they have done bonkers things in the past…I guess thats why we are in wave 2. However, this is why you do trials. For the oxford vaccine there is perhaps merit in delaying the second shot because their trial has data from greater than 12 weeks. However the vial for the zeneca vaccine contain 4 or 5 doses (again bonkers and taylor make for mistakes)

          I guess you have to talk to your team

          • Thanks MD. I’ve spoken to my MS nurse who wouldn’t commit except to say not to agree to a 12 week delay between doses. What I was wondering too was whether I could have a jab either side of my ocrelizumab to allow for the 6 weeks before or after

          • Remember I am not a Neuro. But I like your way of thinking. Scientifically the vaccination will make T cells and plasma cells if you have B cells capable of responding, neither should be targeted by ocrelizumab once generated, if it truely is a boost you will be boosting your plasma cells and T cells. There is no guarentee that you will make an antibody response but you may, and also you may be able to get a supply so you know when the next dose would be before of after. In the oxford data the delay past 12 weeks allowed for an even bigger antibody response.

            The British Rheumatologists have made a suggestion about arthritis vaccine and rituximab..I wonder when the ABN does

            This new paper may interest you and may help allay your nerves if there is any delay.

            Influence of delaying ocrelizumab dosing in multiple sclerosis due to COVID-19 pandemics on clinical and laboratory effectiveness.
            Barun B, Gabelić T, Adamec I, Babić A, Lalić H, Batinić D, Krbot Skorić M, Habek M.
            Mult Scler Relat Disord. 2020 Dec 21;48:102704. doi: 10.1016/j.msard.2020.102704
            The mean time between two ocrelizumab infusion during the lockdown was 7.72 ± 0.64 (range 6.07 to 8.92) months (6-9 months i.e 0-12 week delay). In this period, none of the studied patients had a relapse. Maybe get you nurse neuro to write to Doctor Ruth (Dobson) to get a blood spot get tested before and after

          • Thanks MD, I’ve had 2 previous infusions delayed. Last year to allow for 6 weeks after my flu jab and then was hospitalised with skin infection and/or widespread shingles. Then this year due to the pandemic. Both only 1-2 monty delays but I know delays don’t generally cause any ill effects.
            I just wish there was better guidance but guess it’s all too new. It’s just all come at the same time for me with it being offered next week. I spoke to my MS nurse today and left it that I’d sleep on it and call her tomorrow to talk it through again. I just wish I had a definitive answer for the 2nd vaccine so would know how long I’m likely to have to push my infusion back. Plus knowing I probably won’t make an effective response sways me towards having my MS treatment over the vaccine if I’m honest

          • I guess you could ask what vaccine you are having being offered Pfizer/Oxford. The pfizer vaccine comes in a Pizza box of 900+vials and it has to used there and then, the astra zeneca vaccine can be stored I think in the Fridge.

            The only guidance people can give is based on hunches. There simply is not the data and until people have the vaccine and have their immune response measured we can’t tell if it works or how well it works. We know the manufacturers are interested.

            Importantly people with have to come into contact with SARS-CoV-2 to get the answer. Sadly the news we will get will probably be the failure when somone who was vaccinated on ocrelizumab and gets COVID-19. We will not hear about the cases where people get infected and nothing happens. However, people will get infected and then the question will be if it is severe or not. If the vaccination has worked it will not be severe.

            I suspect the vaccine bods have not considered your situation when thinking about the plan to give people one dose. There is data on the protection of one dose

          • My understanding now is that both the Pfizer and Oxford vaccines are being given with a 12 week interval which does mess slightly with the advisory timings of the 6 week interval between ocrevus and any vaccinations as per my neurologist. Tho I do know this advice varies by neurologist

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