#MSCOVID19 Green Book update

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For those who have not been vaccinated yet you may be interested in the Vaccine Green Book update.

There is info on Pfizer Astrazeneca and Moderna vaccines

NaTHNaC - The Green Book

Individuals with immunosuppression may not make a full immune response to vaccination.
As there is no evidence on response in immunosuppressed individuals there is also no
evidence upon which to base advice on the optimal timing of delivery. A recent study
suggested immune responses were better, however, in patients with cancer who received
their chemotherapy at least two weeks earlier (Monin-Aldama et al, 2021). Specialists may
advise their patients based on their knowledge and understanding of their immune status
and likely immune response to vaccination, but should also consider the risk from
COVID-19 and the patient’s likelihood of exposure. The small number of patients who are
about to receive planned immunosuppressive therapy should be considered for vaccination
prior to commencing therapy (ideally at least two weeks before), when their immune
system is better able to make a response. Where possible, it would also be preferable for
the 2-dose schedule to be completed prior to commencing immunosuppression. This
would entail offering the second dose at the recommended minimum for that vaccine
(three or four weeks from the first dose) to provide maximum benefit that may not be
received if the second dose was given during the period of immunosuppression. Any
decision to defer immunosuppressive therapy or to delay possible benefit from vaccination
until after therapy should not be taken without due consideration of the risks from COVID19 and from their underlying condition. Although the immune correlates of protection are
currently unknown, post-vaccination testing for spike antibody may be considered. Until
further information becomes available vaccinated patients with immunosuppression should
continue to follow advice to reduce the chance of exposure, and their adult household
contacts should also be offered vaccine.

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MouseDoctor

11 comments

  • I have an immune-response question: routine bloods (Tecfidera monitoring) taken a few days after my first vaccine (Oxf/AZ) showed low white blood cell count (~0.6). Does that mean I will have had a blunted response to the vaccine and therefore have lower protection against covid?
    Thanks 🙂

  • 36y with OCR 6 cycles with mrna jab 5 month after last dose – just had second antibody test (dunno why we did it anyway as first was already without reaction) and surprise surprise the level stated <4.81 with threshold level of 33.6. t-cell elispot test done on monday and results pending…🤞🏼 maybe something happened there?

  • Just had 2nd vaccine this week – and my curiosity is going to get the better of me!! I’ve seen a few people online on Ocrevus who have a response when they’ve done the antibody test after the first one. Though I bet you guys must have an idea of this by now with the blood spots 😄 Are the anti body tests all created equal? The Lloyds pharmacy one looks similar to the blood spot one with the little finger prodder..

    • It is being done are the blood tests created equal. No they are not….I am still getting my head around some tests that are being reported as quantitaive when this doesnt seem correct. What is clear is that the second jab makes a big difference in response. As to being created equal I did a finger prick test but you had to collect 0.5mL of blood and my fingers were like pin cushions as the first did not work well enough. Some test are against nucleocapsid, which are useless for monitoring the US/UK/EU vaccines, Whole Spike, receptor binding domain etc.

      • That’s interesting about the second jabs making a difference. I know there was an update on the blood spot study recently but it didn’t have any proposed timescales, is there an idea of when any findings are likely to start coming out? Thanks!

  • You have to laugh when they say the recommended interval between the two jabs is 4 weeks!!

    And the bit where they say the entire adult household should be offered the vaccine is even funnier for the immunocompromised (ocrevus)patients!! What about a 16 year old who goes to a school of 800?
    I had to say my OH was my carer through the GP in order for them to get their first jab 8 weeks ago

    Wouldn’t it have been a good idea to get the immunocompromised tested after their first jab to see if there is a response or how will the scientific community ever know (anyone else other than Barts doing it with their patients)?

      • will they be on any use?
        Won’t the immunocompromised (sp) all have already had their 2 vaccines by then? or do you mean that they are already underway?

    • Yes – cardiff are doing blood spots- they have written to their patients requesting people to take part.

  • I take 1mg Siponimod and had a positive response to antibody testing. The test didn’t return a number, just that I was positive for IGG spike protein. I had Moderna 28 days apart, but my neurologist’s advice was unconventional. He had me stop dosing 1 week before and after each dose. My abs lymph before I stoped meds for the second shot was .7. I seem to usually be around .5 whenever I get that lab done. I’m very grateful to my neurologist for his advice, but I was very nervous. I know it was risky. I did not relapse, but I didn’t feel good at all. It was difficult.

    Any thoughts on if I’ll retain the antibodies like someone who doesn’t have low lymphocytes?

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