ProfB joins the club…for a few hours. Super spreaders..Super vaccinators as viral vaccines look to be coming your way

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Association of British Neurologists

Yesterday after visiting the ABN and seeing they were offering free membership, ProfB joined the Association of British Neurologists to try get a glimpse of their view for COVID-19 vaccines.

However, perhaps the men and a few women in grey were alarmed at the Plebs being let in, so no sooner had he thought about ordering grey suit he got an email to indicate that the membership wasn’t going to happen.

This was perhaps not surprising as ProfB is not a neurologist, but was it because he had suggested that the seahorses on the coat of arms should be replaced by a pair of amphioxuses. For those lacking zoological knowledge, this is a Lancelet which is a spineless fish. It has a primative spinal cord but no backbone….so a bit like some neurologists :-), who do not question the Status Quo.

Environmental Science: Amphioxus
Amphioxus

The question we ask is whether ther view on vaccines will be based on information or because the Government tells them its OK.

Will they recommend adenoviral COVID-19 vaccines. The view is that people on arthritis and multiple sclerosis treatments should not get live vaccines. The adenoviral vaccine is live but it is replication defective. So whats the deal there?

Superspreaders

If you cast your minds back to the time of the beginning of the pandemic, ProfG warned about super spreaders and suggested that people on MS drugs may have the potential to spread the virus for longer.

This idea was based on immunology 101. However I suppose it is good to have supporting data.

Now if you have the virus… you are asked to isolate for 7 days or 10 days if you live with someone who is infected. However this time limit is not based on how long you may be infective for and indeed on the eight day you re-enter society and some of you will be spreading. Therefore think about your fellow humans and be careful when you venture out after quarentine.

Most people will deal with the virus in 7 days, however many will not.

The 7 day idea is based on a risk benefit analysis with the cost to new infections balanced by the economic effect of removal from society. Some people shed for many more weeks than one.

If your immune system does not get rid of the virus this can shed for some time. This was seen in people with cancer

Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer N Eng J Med. DOI: 10.1056/NEJMc2031670.

Patients with profound immunosuppression after undergoing haematopoietic stem-cell transplantation or receiving cellular therapies may shed viable SARS-CoV-2 for at least 2 month.

So make sure you get tested and when you venture out think of other people. Remember the PCR tests can pick up viral fragments and may not be live virus but it gives you an indication if you may be infective.

Supervaccinators

You know me you cant have it both ways.

Now on the converse side. So if the immunosuppressed person can be a superspreader then will live virus vaccinations they will be a supervaccinator. If you are immunosuppressed you are probably not going to make as good a vaccine response as if your immune system was intact. However, remember some response may be enough to give you some protection. So if you get a live covid-19 vaccine then you may not get rid of it as quickly therefore the live vaccine is going to hang around for longer and so it will be drip feeding your immune system for longer to maintain a boosting effect abit like an adjuvant that is used with conventional vaccines to boost the immune response to a vaccine. That vaccine could be a live replication-deficient vaccine just like the “Oxford vaccine” and when a adenoviral vector was tested years ago in cancer in some people the virus could be shown to hang around for quiet some time and these people gave a vacine response

Viral Vaccines for Immunossppressed people

Why should this interest you after all the drug labels suggests that people should stay away from “live virus vaccines”. However the adenovirus vaccines in development are not live vaccines that can reproduce them selves they are replication deficient, because elements of the virus have been removed such as the E1 region of the virus , they are going to be considered safe for people who are immunosuppressed.

Therefore I believe the regulators are going to recommend that the adenoviral vectors be given to immunosuppressed people . (Source Government web site from MHRA) Yes you will have to wait, the care houses get the vaccine first, followed by Health care workers

As you can see MS gets a mention as does alemtuzumab, ofatumumab, rituximab

It is seemingly evident that it is considered that as the adenoviral vaccines are replication incompetent, meaning they cannot produce an infection

Novemeber variant

“Individuals who have immunosuppression and HIV infection (regardless of CD4 count) should be given COVID-19 vaccine in accordance with the recommendations and contraindications above. Although AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating and is considered safe in immunosuppressed people.

Other adenovirus vector vaccines have been trialled in populations with high prevalence of HIV and shown no serious adverse events (Kennedy et al, 2017).

Decemeber addition Although individuals with stable treated HIV infection
were not excluded from the phase 3 trial of the Pfizer BioNTech COVID-19 vaccine, data on safety and effectiveness in this group have not been presented.

These individuals may not make a full antibody response and should therefore continue to follow advice to avoid exposure unless they are advised otherwise by their doctor. Consideration should also be given to vaccinating the adult household contacts of immunocompromised adults, i.e. individuals who share living accommodation or thosewho provide care for whom continuing close contact is unavoidable”. [Remvoed in the December update] “There are very few individuals who cannot receive the Pfizer-BioNTech or AstraZeneca COVID-19 vaccines. Where there is doubt, rather than withholding vaccination, appropriate advice should be sought from the relevant specialist, or from the local immunisation or health protection team”. “There is no evidence of any safety concerns from vaccinating individuals with a past history of COVID-19 infection, or with detectable COVID-19 antibody. Individuals with a history of past infection have similar adverse events after the AstraZeneca COVID-19 vaccine to those shown to be seronegative (unpublished data) and inclusion of antibody positive individuals in the Pfizer phase 3 analysis did not give any safety signals. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontechconclude-phase-3-study-covid-19-vaccine”

Adenoviral-based vaccines are particularly effective because high antigen-specific immune responses can be induced against encoded transgenes, providing protection against transmitted diseases and cancer. However, the activation of innate immune responses and the presence of pre-existing immunity to the most common human adenoviral vectors infecting the human population increase the potential to limit the efficacy of these vaccines. However, the oxford vaccine is from a chimpanzee Adenovirus to avoid this problem

Adenoviral vector-delivered transgenes are not considered to be efficiently incorporated into the genome of the host cells, thus adenoviral-mediated gene expression diminishes over time.

Now the issue to the Association of British Neurologists to Consider is this statement. Other adenovirus vector vaccines have been trialled in populations with high prevalence of HIV and shown no serious adverse events (Kennedy et al, 2017).

So in the minds of the regulators HIV is immunosuppressed but serological Human Immunodeficiency virus is not Acquired immunodeficiency Disease. Indeed in the Ebola trial there was 5% of the people with serological HIV so that is 25/500 people. 4/25 had serious adverse events, some linked to location e.g malaria. Now in the trials of the “Oxford vaccine” there it was planned that they examine in the COVID-19 vaccine in 100 people with HIV. So I guess 50 will get placebo and 50 vaccine. Is this all the evidence they have…Shame I can’t get into the ABN to see what they are going to do. I am sure the UK MS comunity will use their resource because it looks like the OXford vaccine is coming our way.

The Oxford Vaccine is undergoing additional trials, but it will eventually be approved as it has passed the FDA recomended target of 50% protection, but I am surprised with the Smörgåsbord of a clinical trial they did not examine immunosuppressed people. Maybe it did. Wonder what the ABN will recommend ?

Public Health December Vaccination Programme

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MouseDoctor

10 comments

  • I thought in a previous comment that you said the Oxford vaccine would be a no no for people with MS

    Also if your last alemtuzumab was in 2014 what do you need to check regarding bloods to insure a vaccine is safe and effective for you?

    • Biologically it is not the same as a live attenutated virus…but the body language of some neuros sound like it is and this stretches to rheumatologists…however you can read the draft from the UK government web site. Obviously the MHRA have yet to approved this and with the mess in the trial this may not be straight forward (i.e. Astrazeneca saying it was a mistake and Oxford saying no we knew it was a half dose…but it then say theys accepted product that was synthesized to specificiation and sounds abit desparate. The trial design was like those experiments I hate where it is all mix and match.

      • And typically it is that vaccine which they British government has bought the most of

        Could you please also so let me know the answer to my alemtuzumab question please

        • I would have thought that 6 years following Alemtuzumab, your immune system will have completely reconstituted and you should be fine with any vaccine, but maybe Mousedoctor can tell us exactly how long you need to wait to fully reconstitute.

          • 6 years is more than enough. For B cells it is 3-6 months max. That 60-85% of people make anti drug antibodies within a month says it all. Once alemtuzumab is gone (within a few weeks) whats left could respond

  • I am not surprised they didn’t examine immunosuppressed people. It is amazing they included the elderly in the race to the finish line. Pfizer will, no doubt, report sector leading profits, following early MHRA approval, but it’s a gamble with it’s logistic issues of new super-freezers. This will restrict it more than the crackpot anti-vaxxer movement could ever do, but once the freezers are in place, it opens up the possibility of new rapid RNA treatment development. AZ took a much safer approach, but I suspect, as a group, we’ll be offered the Pfizer vaccine first, because most of us can travel to centres of vaccination.

      • The whole idea of the new Pfizer RNA vaccine is that it’s supposed to quick and easy to manufacture in large quantities. This is a large part of why the gamble was taken on a new human vaccine technology that’s never been used before.

  • Thanks for the informative article, guess I will be under house arrest for the next couple of years. Better that however than being treated with a poorly tested vaccine.

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