#Booster vaccinations


SARS-CoV2 refresher/booster vaccinations are among us, and as a result, we have updated our respective advice once again. Here it is:


The key changes are on pages 3 & 4.

This is the result of discussions involving members of BartsMS, consultants, junior doctors, nurses, allied healthcare professionals. Thanks to all of them.


Conflicts of interest: multiple

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  • Hi Prof K, I am on ocrelizumab and waiting to hear whether this makes my eligible for the 3rd primary dose of the COVID vaccine. You don’t specify this here though. Are you advising that your pwMS on ocrelizumab are eligible for the 3rd primary jab and then a booster 6 months later?

    • Being on ocrelizumab should make you eligible rituximab is mentioned in the green book. What is not clear is the booster after a third dose

      • Hi MD, thanks for that.
        My GP doesn’t want to make the decision about whether I am eligible even though I have pointed her towards the JCVI advice. The problem is the MS Society states that ocrelizumab may make you eligible for the 3rd dose. I think I read that there would be a booster 6 months after the 3rd dose. I am due my next infusion in Jan but would be willing to delay and not receive my 3rd jab until more time has passed from my June infusion to elicit the best response

  • Does anyone know how a patient will respond to any of the vaccines if they are currently taking one of the trial Tyrosine Kinase Inhibitor drugs, Tolebrutinib? Thank you.

    • Short answer: unknown. However, Tolebrutnib does not deplete B lymphocytes and does not seem to exhibit significant cellular off-target activity in human T lymphocytes. In the completed Phase 2b study, mean counts of CD19 + B cells, CD4 and CD8 T cells, CD16 + 56 natural killer cells, and IgG & IgM remained stable at the end of the 12 week treatment period.

  • How will we know if we have any immunity after third dose? Is there a specific blood test we should request? Thanks

    • No routine testing offered, however if you’d like to join our serology study (antibodies against SARS-Cov2), please email the address in the document above.

  • Thanks Prof K. i had my 3rd Pfizer dose Monday + ‘flu. One in each arm. Dr Ruth’s blood spot research reveals the antibody response. Is it intended that we participants will be informed either now or later. It’s my understanding that no feedback would be give during but maybe after the research finishes. Is that right?

  • Only two pathways are indicated above.
    What if Covid jab, 4 weeks later Ocrevus, 4 weeks later Covid jab…………22 weeks later Ocrevus at start of Sept

    Am I right in thinking it will be beginning of December before the booster (which seems as hard to find out how to get a hold of as a unicorn) then?

    • Your protection would probably rest on your first immunisation since 4 weeks after ocrelizumab your B cells are quite flat and unlikely to facilitate an antibody response. If you had another dose of ocrelizumab in Sep, your B cells are unlikely to bounce back in significant quantities before March. However, the many unknowns would still make me recommend you taking the jab sooner. Protecting yourself and others via non-vaccine measures remains also important (masks, ventilation, hygiene).

  • Had the pfizerjabs 2 and 3 months after rituximab, respectively. 7 months since last dose now, did Moderna as booster. Fingers crossed.
    Also prof K, are you aware of any clinical data on how anti-CD20 treated patients who get Covid after double jabs actually do? Even case reports? Surely some must be emerging soon, considering how many pwms take these treatments and long it’s been since the first reports showed a robust T cell response in these patients? If actually unprotected w/o antibody seroconversion, i reckon we would know soon?

  • To update on my position. My neurologist has written to say I’m eligible for the booster with no mention of the 3rd jab. I’m so annoyed as I specifically asked about the 3rd jab. I’ve now emailed her the link to the JCVI guidelines which does mention rituximab. I’ll not book my booster until I hear back from her ☹️
    Oh and her advice is to have the jab either 4 weeks before or after my infusion which obviously goes against all the evidence. No mention about delaying my next infusion either to get the best response 🙄

    • Not sure I get the difference between booster and 3rd jab? End result would be the same, no?

      4 weeks before rituximab sounds worth a shot (still not guaranteed), 4 weeks after is clearly nonsense

      • My understanding is around timing. The 3rd jab is 8 weeks after 2nd jab and a booster 6 months after the 3rd jab. Whereas if just a booster it’s 6 months after 2nd jab. I had my 1st and 2nd in March and April 3 weeks apart and infusions in Jan and June. 2021. Think I’d like to discuss pushing my Jan 2022 infusion back to have my 3rd jab in Jan or later (6 months + after my last infusion) Judging by the initial reply I don’t think my neurologist is that up to date on the latest research though.

        • Waiting longer after infusion definitely increases chances you get a response but no real guarantee, either.

          Personally, 8 months after ocrelizumab sadly wasn’t enough. I understand rituximab (probably) depletes less long though.

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