#MSCOVID19 Barts Health was right to overturn the JCVI

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The JCVI is the joint commitee for vaccine and immunization who advice on vaccination policy and have done what I have called cowboy/cowgirl science and over-ruled the drug labels. Their advice is vaccinate at 12 week intervals when the green book says 3-4 weeks for immunosuppressed people. For the Astrazeneca vaccine there is data but for the pfizer jab there was no data past 6 weeks from the trials and 3 weeks was the planned and requested interval.

It seems the publishing media is out the window so not sure where the details are arriving from as the BBC seems to be the publication vechicle (However, the problem is there are so many pre-print sites these days), but the London group set themselves up as a vaccination centre to get their own “prick and data collect” science service, that has shown us what we already know, in that people with blood cancers will not make a very good antibody response and this applied to vaccines.

From the larger studies (2 papers with between n=10-20 so not large) in MS the seroconversion rate after B cell depleteters notably ocrelizumab and rituximab the seroconversion rate has been 15-20%, but with the previos of there is not enough information of timing of infection to blood test. It is about 3 months, which is enough time for antibody response and loss of it with time in some people. In people not on disease modifying drugs it was about 68% Zabalza et al COVID19 in multiple sclerosis patients: susceptibility, severity risk factors and serological response. Eur J Neurol. 2020 Dec 19. doi: 10.1111/ene.14690.

However to the data from the “prick and collect” study

The researchers tested volunteers for antibodies and T-cells in their blood, which signals that the immune system can protect against illness from the virus in the future.

Three weeks after one Pfizer dose, an antibody response was found in:

  • 39% of people with solid cancers
  • 13% of people with blood cancer (This is more relevant to MS)
  • 97% of people with no cancer

Following a second dose three weeks after the first, which some cancer patients received, there was a sharp rise in their antibody response against the coronavirus, to 95%.

But among those who had to wait longer for their second dose, there was no real improvement in protection.

Five weeks after the first dose, an antibody response was detected in:

  • 43% of people with solid cancers
  • 8% of people with blood cancer
  • 100% of people with no cancer

After the green book changed in version 6. BartsHealth overruled the JCVI (Government) to aim to provide vaccines at 3-4 week intervals for people on immunosuppressives and we have not had a policy change for 4 weeks which is amazing as this was changing every few days.

However, this is all about antibodies and we need to know about the T cells and goes back to previous stories in blood cancers, if you have no T and B cells there is a fatality risk, but as long as you have a CD8 response in blood cancer and in the blood cancers treated with anti-CD20 there was not a fatality risk. There was no mention of T cells in the Beeb Journal

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MouseDoctor

8 comments

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  • Where does that leave patients who have had one dose and are awaiting a second dose – which will be at 12 weeks?
    Will a third dose be recommended?
    Is that dangerous?

  • Sorry MD but I’m struggling a bit with the correlation with MS – does the cancer data shared by the beeb indicate that the 12 week gap between jabs means that we are not likely to have a decent enough antibody response due to being immunosuppressed OR is at this point is there insufficient data preventing you being able to make a reasonable call on it due to a lack of details such as that regarding T’cells.
    Does seem to me that anyone who is immunocompromised should have been getting their second dose within a month of the first!

    • Yes this is the implication that people that are lymphocyte immuno supressed make a poorer vaccine response and you benefit of having two vaccine doses. If you have a weak response on first does you are at risk from infection and that means a 13 week risk (12 + 1). I would view this as applying to ocrelizumab where you are continually suppressed and alemtuzumab/cladribine prior to reconstition that occurs within 3 months or probably less.

      The data will surface soon in relation to MS. Based on the data within the label, I suspect anti-CD20 and fingolimod will be most be influenced. I have high hopes for a good response with alemtuzumab and cladribine

      • Thanks for reply.
        I’m three and half years post Alem and still have monthly lymphocytes levels around 0.75 so I guess I’ve gotta be honest with myself that I remain a little concerned at the lack of response in people with cancer who received their second dose subject to the longer timeframe, and whether this highly blunted response will be true for all of us without normal lymphocytes levels, especially as I’m no spring chicken with MS age 57🙃 I’m not riddled with anxiety, but am definitely a need-to-know type of person, so the MS data sooner rather than later will be welcome.
        It’ll be of some value to know the experience of Long Covid among PwMS too.

      • Sorry to jump on someone’s else’s post but I don’t understand your response in relation to Fingolimod. I am on it with lymphocyte count of 0.2. Could you clarify what you mean by ‘most be influenced’. Thank you very much

        • Your low count in the blood may be because your cells are trapped in lymph glands or bone marrow. These are places where antibody responses will form and therefore you may think all is OK. However sphingosine-1-phophate in involved in B cells movement within the lymph glands notably the follicles where antibody cells are formed. As such in the label it says vaccination responses may be blunted. Maybe I will do abit or research on this and do a post. However if we look at people infected with COVID virus, although the response maybe diminished it is often positive,

          • Thank you, yes, exactly right. Cells are trapped in the lymph nodes. I’m about to read your other post with a cuppa and Google at hand for some of the technical talk 🙂 Thanks very much for taking the time to further investigate and write up. much appreciated

  • Sorry I’m not sure I understand. If someone is taking immune suppressants surely it would stop a vaccine from being as effective and they are more susceptible to Covid. Maybe that was the reason those people were asked to shield. The extended gap between vaccination reduces the likelihood of coming in contact with the virus. It’s not just MS it includes transplant recipients etc. The infection rate is reducing, so it could be that JCVI were justified in their decision. Dammed if you do and dammed if you don’t.

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