This was addressed in ProfGs MS selfie I think
This issue is causing people problems. For people not on disease modifying drugs and therefore likely to have made a COVID vaccine response. You get your first dose and then your second dose 3-12 weeks later. You then can have a BOOSTER 6 months later.
This is currently open to anyone over 40 in UK. This in my mind should mean anyone with MS and their household contacts, but in some places they are offering boosters to anyone who wants one.
Why are they doing this?
A vaccination creates a B cell and antibody response and a protective T cell response.
Antibodies can directly target the SARS-CoV-2 virus and neutralize it and therefore can prevent infection from occuring.
In contrast the T cell does not see the virus but sees a cell that has virus particles, therefore you have been infected before your T cells start working.
Therefore the best bit of the vaccine is to create a high and long lasting level of antibodies. However, we have been hiding ourselves and so are not coming into contact with the virus when we have high levels of antibody. Doing this would give you a natural boost and perhaps explains why health care workers lose their antibody levels stower than someone older even if they have been naturally infected
In natural Infection antibody levels wane over time
Following vaccination the antibody levels will wane over time, you will about half of them each month. If you were vaccinated with astrazeneca and have not been infected your antibody levels start off at a lower place than pfizer/moderna and so have the opportunitity to wane.
In vaccinated people antibody levels wane over time
Now the important element is what is the level required to neutralise the virus. Once your antibody levels drop below this means you can get infected and pass the virus onto someone else. In most cases your memory B cells and plasma cells and T cells will then kick in to make more antibody and stat killing off infected cells.
No the problem is this information is not based on the the problem right now and this is DELTA
The proteotypic virus strain is Wuhan. But more recently the problem was alpha also known as Kent or UK strain. This has an infectious advantage over wuhan and by March 2021 nearly all infections was due to alpha. This requires twice the amount of antibody to get rid of it. But as you can see by July 2021 nearly all infections were delta or indian variant. This is highly infective and also has immune escape mutations and so you need 3 times more antibody to get rid of it. Now if you antibody levels are falling and delta is around then the chances of getting infected increases and that is why double vaxers are getting infected.
However you can now see why South Africa gave up on the Astrazeneca because it wasnt giving enough protection. This is because beta was circulating and it has immune escape variants and needs 6 times more antibody to get rid of it (Bottom right above). You can also see why people are concerned about Mu (Columbian) because it needs 7-12 times more antibody to get rid of it. At the moment this has not taken hold because it does not have the infectivity as seen with delta, but if if of the sun or daughter of mu arrives then infections will rise.
This is the reason why RNA vaccines are being used for booster jabs in the UK are using the RNA vaccines for the booster. This mix and match works and gives a better response than AZ/AZ when it is AZ/Pfizer or AZ/Moderna. So if you have been offered a booster (I got a text from NHS) take it and this is especially important if you have been JnJ or AZ vaccinated. The boost will get you antibody levels up. In my family those catching COVID after being double vaxed recieved AZ. The vaccine creating the highest antibody levels has oofered the best protection against delta infection.
However, the vaccines are protective against severe disease and this is why it is worth getting jabbed. especially as this virus is going to be with us for a long, long, long time.
As you can see the first wave in March was deadly as we reduced our pension requirements by infcting the old people in homes. We quelled the virus by lockdown and then everyone went mad of the summer holidays to give a deadly second wave as more people got infected and now we have vaccine confidence we are all let out again to go crazy and forget about the virus..until it infectes us but the vaccine is protecting most from death.
When the virus first arrived it was suggested that 60% of the population needed to be infected to get Hed Immunity where by the the virus ould not transmit. However experience in Brazil soon showed us that was wrong and the virus was going crazy with about 80% infection (see references above for details).
However in my opinion we will never get herd immunity to this virus unless it mutates to a dead end, or technology defeats it, because we will be constantly providing the virus with people that it can infect especially as the vaccination programes all over the world are not in synchronicity. For most it will turn into a cold and it will kill more than the flu ( unless treated). We will have to learn to live (and die) with this.
However if you are on certain DMT you may not have the luxuary of a protective antibody and T cell response and for such people the idea is to give a third dose of the vaccine. This is different to a straight boost as after the third dose you would get a booster 6 months later. But there is confusion. This becaus the decision to give a thrid dose is over six months for most people who had the second dose. However it is different from the booste.
Who can get the Boost: Currently anyone over 50 and people at high risk. This included people with chronic neurological disease (green book chaper 14a page 14) that includes MS. I am sure you could made the case to ask for a booster and remeber disability and progression are risk factors for more severe disease.
Who can get a booster
If you have MS you are eligible under table 3. But also note that you partners should be eligble too
Green Book Chaper 14a
You can make that argument that any DMT is immunomodulatory that is why it they are used, I would argue they are all immunosuppressive, but I guess they there is a definition, they would clearly aim to inhibit relapses that could be treated with steroids and so would be steroid saving. If arthrits , lupus, arthritis are included then multiple sclerosis must be also.
The Third Dose
In August 2021, JCVI recommended a third primary dose of vaccination for individuals who
were severely immunosuppressed when they received their first or second dose of COVID19 vaccination (see below).
So you would get Dose 1 4-8 weeks, Dose 2 4-8 weeks Dose 3 6 months Booster. The problem is for many people they are already past 6 months. However with a thrid dose the implication is that you will be offered a booster in the future. For some people e.g. those on anti CD20 it may take 3 (or more jabs) to get an antibody response
In my mind this this could mean alemtuzumab, cladribine, ocrelizumab, ofatumumab (other CD20 depleters), fingolimod, ozanimod, ponesimod, spiponimod and could also be dimethyl fumarate as some people exhibit notable lymphopenia. Remember I am not a Doctor and are not giving advice.
However you can consult the Association of British neurologist website for their recommendations however remember that last JCVI update was 15 Novemeber 2021 so advice before that maay be out of date
Once you are a few months after alemtuzumab and cladribine the cells have returned. You can make responses, typically as good as none-immunosuppressed people. However, we know that people taking sphingosine-1-phopshate modulators and CD20-depleting antibodies often do not make or make a weak response to vaccination.
The third dose is available for people who are
COI None considered relevant
General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry, nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice. Please note that Professor Gavin Giovannoni has no responsibility for this blog.