Wednesday, March 29, 2023

Can Ms Patients Get The Flu Shot

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Q: What Are The Neurologic Manifestations Of Covid

How to Recommend Flu Vaccines to your Patients: A Time-saving, Evidence-Based Approach | ACP

A: A wide spectrum of neurologic symptoms have been reported in COVID-19 patients ranging from common symptoms such as dizziness, headache, cranial nerve palsies, anosmia, and ageusia, to less common but more severe symptoms such as stroke, encephalitis, acute demyelination, dysautonomia, seizures, and acute inflammatory demyelinating polyneuropathy. Neurologic symptoms have been reported in 3.6%-36.4% of cases. Additionally, many people who had mild COVID-19 infections not requiring hospitalizations have had a prolonged symptom duration, especially fatigue, and have not returned to their usual state of health when interviewed weeks after their diagnosis. The long-term consequences of this infection are not yet fully understood, and we will not know the total burden of disease for many years.

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Of those two injectable vaccines, the CDC isnt recommending any specific type or form unless youre very young or old or have certain allergies.

The National Multiple Sclerosis Societys website recommends getting a flu shot but has a special note for people who are being treated with Lemtrada :

The seasonal flu vaccine has been studied extensively in people with MS and is considered quite safe, regardless of the disease-modifying therapy they are taking. However, individuals being treated with Lemtrada® should be given the inactivated flu vaccine six weeks before receiving their Lemtrada infusion.

There is a small group of people who shouldnt get a flu shot at all, or who should speak with their doctor before getting one. People whove had Guillain-Barré syndrome are in that group. You can see the full list here.

Will There Be An Autumn 2022 Covid Vaccine Booster

There will be another COVID-19 vaccine booster available in autumn 2022 across the UK.

Everyone with MS can get this booster, as well as all adults over 50. You can get this autumn booster even if you’ve also had a booster in the spring this year. And you might get the seasonal flu jab at the same time.

You can’t book these autumn boosters yet. Follow the the links below to each nation for details closer to the time.

The rollout is expected to start from September, but could take several months.

You’re eligible for the autumn COVID vaccine booster if you’re:

  • aged 50 and over
  • aged 5 to 49 and in a clinical risk group. That includes including pregnant women and everyone with MS
  • a household contact of someone with immunosuppression. You’re likely to be in this immunosuppressed group if you were eligible for the ‘third primary dose’ of the vaccine
  • an unpaid carer aged 16 to 49
  • a resident or staff in a care home for older adults
  • a frontline health or social care worker

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Does Having Ms Increase Adverse Effects Of The Vaccine

Having MS is unlikely to increase the risk of adverse effects of the COVID-19 vaccine.

Adverse effects are not the same as side effects. Side effects include a fever, fatigue, and soreness. Adverse effects of the COVID-19 vaccine can include blood clots, myocarditis, and . All are rare. There is no indication that people with MS have a higher risk of these health issues. But if any concerning symptoms develop, a person should seek emergency medical care.

Three vaccines have been approved for use in the United States: Pfizer-BioNTech, Moderna, and Janssen, also called Johnson & Johnson. There is no evidence that any vaccine is more likely to cause adverse effects in people with MS.

A guide to different COVID-19 vaccines

CDC confirms, vaccines are safe and effective for preventing COVID-19, and they can reduce the spread of the underlying virus.

Vaccination lowers the risk of developing this disease. It is a safe way of building immunity against COVID-19 that can last for a long time. Getting the vaccine can also reduce the number of restrictions on daily activities.

In addition, being vaccinated reduces the risk of the virus passing on to other people. Preventing this transmission is critical for protecting vulnerable people from severe illness and death from the disease. Limiting the circulation of the virus may also reduce the likelihood of a new, more dangerous variant developing.

Are There Specific Risk Factors

Why Getting Children Flu Shots Is Even More Important This Year

According to a recent study , people with MS have a higher risk of infection than the general population. In addition, the steroids that doctors give to treat relapses can suppress or weaken the immune system.

For these reasons, it is even more important for those with MS to take extra precautions to avoid getting sick.

According to research from 2015 , the majority of people with MS experience two upper respiratory infections per year. When these occur, the person is twice as likely to experience an MS relapse.

As a result, taking precautions to prevent upper respiratory infections and, when appropriate, getting a vaccination can help prevent MS relapses.

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Q: What Is The Pathophysiology Of The Neurologic Involvement Of Covid

A: SARS-CoV-2, the virus that causes COVID-19, is a singled-stranded RNA virus that utilizes the angiotensin-converting enzyme 2 receptors for entry into the host cells. Once in the host cell, the viral RNA is translated into viral proteins which assemble into new viruses that are released from the infected cell. ACE2 receptors are expressed in the oropharyngeal epithelium, lung, heart, kidney, testicles and brain .

It is unclear exactly how SARS-CoV-2 affects the nervous system, though there are multiple theories including direct viral invasion, immune-mediated injury, hypoxic injury, endothelial dysfunction, and systemic hypercoagulability.

Can Children With Ms Get The Covid

Children with MS can now get the COVID-19 vaccine along with everyone else.

Since late December 2021, some 5 to 11-year-olds with MS have been able to get the vaccine. The NHS should get in touch with anyone eligible.

We agree with an MS International Federation recommendation that young people with MS should be offered the vaccine.

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Study Limitations And Strengths

Our findings regarding vaccine hesitancy in a cohort of MS patients need to be considered exploratory due to many reasons. First of all, the small sample size limited our power to draw firm conclusions on the evaluated objective. Second, more than 70 patients were excluded from our study because of missing information on vaccination status. This could have introduced biases in the evaluation of the results.

Notwithstanding these limitations, to our knowledge, this is the first study carried out in Italy to evaluate vaccination attitudes among MS patients. This is a new area of clinical investigation, considering that until recently vaccinations were not recommended for MS patients. In addition, we believe that our results should be analyzed in a broader sense, especially considering the historic pandemic moment we are going through and issues related to COVID-19 vaccinations that could potentially emerge among MS patients.

Vaccines That Are Probably Safe If You Have Ms

Doctors encouraging patients to get flu shot

There are a number of vaccines that are considered probably safe in people with MS. The primary concern is that many of these are live attenuated viruses or bacteria, which means that there is a small chance they could cause an infection if you are taking powerful immunosuppressants.

As with the safe vaccines, your body might not be able to mount the intended immunity if you are taking immunosuppressants.

Varicella is the virus that causes chickenpox. Varicella vaccine is a live attenuated virus, so there is a small chance that the virus can result in an infection.

If you have not had a chickenpox infection or been vaccinated for chicken pox, this vaccine is required six weeks prior to starting Gilyena or Lemtrada.

And don’t worry if you can’t remember whether you have had chicken pox. Your healthcare provider can check whether you have immunity by drawing a blood sample.

The measles-mumps-rubella vaccine is a live attenuated vaccine. According to the National MS Society, this vaccine is probably safe if you are not taking a medication that suppresses your immune system.

Your risk of contracting these illnesses from the community should be weighed against your chances of becoming infected from the vaccine. If you have already been vaccinated as a child, this should not be an issue, because you will not need a booster or another vaccination as an adult.

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Ms And The Shingles Vaccine: Can They Go Together

A post on another website, asking about whether it was wise for someone with Multiple Sclerosis to receive the shingles vaccine, caught my attention the other day.

Have any of you had the Shingles vaccine? Im still debating about it. Im concerned about insulting my immune system further, as my last flu shot triggered a relapse. Any advice or experiences would be greatly appreciated.

I was particularly interested in this because I received the shingles vaccine about three years ago. My primary care doc had recommended it, and my neuro had no concern about it. The shingles vaccine has had no obvious impact to my symptoms, test results, or the course of my disease. But, the journalist in me prompted me to look for some facts before I responded to that poster.

I started my search with our own Multiple Sclerosis News Today website, which published a story a couple of years ago about MS and vaccines in general. Quoting a study published in the Journal of the American Medical Association, the story reported that the study could find no link between vaccinations and an increased risk of MS. Thats not quite the same as a link between a vaccine and MS progression, or an exacerbation, so I looked deeper.

The National Multiple Sclerosis Society in the U.S. has an excellent page about all kinds of vaccines and their use by MS patients. Regarding Zostavax, the shingles vaccine, it says :

Can I Get The Flu Jab And Other Vaccinations If Ive Got Ms

For most people with multiple sclerosis it makes sense to get the protection that vaccines offer, including the seasonal flu jab. If you get ill with flu or another infection it could make MS symptoms worse. It might even trigger a relapse. And of course the diseases themselves can be serious and in some cases fatal.

The seasonal flu jab is free of charge on the NHS for people with MS and their carer or partner. Find out more about free vaccinations.

You could be offered vaccinations for:

  • seasonal flu
  • whooping cough, if youre pregnant
  • yellow fever, if youre travelling

Talk to your doctor or MS nurse about which vaccines you should get. You might need to take precautions if:

  • youre having a relapse
  • youve recently taken steroids for a relapse
  • youre taking certain disease modifying therapies

Vaccines work best when everyone who can take them does take them. This even protects people who can’t get vaccinated, because the infection finds it harder to spread. So encourage people around you to have their recommended vaccinations too.

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The Oxford Vaccine A Viral Vector Vaccine

The other vaccine has been developed by the University of Oxford and drug company AstraZeneca. Its known as a “viral vector vaccine”. It uses a weak version of the virus that causes the common cold in chimpanzees. This helps it get into the body like an actual virus would. But in the vaccine, this virus has had its genetic code changed so that it cant actually cause disease in humans.

The change also means its got the genetic code for one particular part of the coronavirus – the “spike protein” Its just that, a spike on the outside of the virus that it uses to get inside our cells.

The vaccine makes the same spike so our immune system can recognise it if the actual coronavirus gets in – and then fight it off.

Are People With Ms At Higher Risk For Covid

Flu Patients Arrive in Droves, and a Hospital Rolls Out the âSurge Tent ...

, the director of MS information and resources for the National Multiple Sclerosis Society , tells Verywell that some of the indirect effects of MS and its treatment can increase a person’s risk for COVID-19.

Although MS itself isnt a risk factor for COVID-19, Fiol says that “certain factors associated with” it are. These include obesity, severe disability, heart conditions, and lung conditions.

Another consideration is disease-modifying therapy adherence. DMTs are the prescription medications, injections, and infusions that can significantly reduce the severity and frequency of relapses, but also dampen the immune system. This could increase COVID-19 risk.

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Q: Are There Neurologic Adverse Effects Of The Covid

A: In the BioNTech mRNA vaccine trial, 52% and 39% of younger and older participants, respectively, reported a headache in the vaccine group after the second dose vs. 24% and 14%, respectively, in the placebo group. In the trials of the mRNA vaccines, there have been a few cases of transverse myelitis and facial palsy. In the adenovirus trial, there was one report of worsening MS requiring hospitalization. It is not clear whether these events occurred at a rate greater than unexpected for the size of the trials.

It is important to inform patients about the potential for a pseudo-relapse or other transient worsening of their MS symptoms related to vaccination due to the constitutional symptoms from the immune response. Patients should be counseled to take over-the-counter anti-pyretics for fever as needed, to treat these symptoms.

Human Papillomavirus Vaccine And Multiple Sclerosis/central Demyelinating Disease

Frisch M, Besson A, Clemmensen KKB, Valentiner-Branth P, Molbak K, et al. Quadrivalent human papillomavirus vaccination in boys and risk of autoimmune diseases, neurological diseases and venous thromboembolism. International Journal of Epidemiology 2018 47:634-641.The authors investigated the association of quadrivalent HPV vaccination and the risk of 39 autoimmune diseases, 12 neurological diseases, or venous thromboembolism over a 10-year period in more than 7,000 Danish boys who received at least one dose of qHPV vaccination at the age of 10 to 17 years by comparing them to more than 560,000 boys who did not receive the vaccine. Receipt of qHPV in boys aged 10-17 years was not associated with an elevated risk of autoimmune diseases, venous thromboembolism, or neurological diseases including multiple sclerosis, optical neuritis, transverse myelitis, and other demyelinating disorders.

Mouchet J, Salvo F, Raschi E, et al. Human papillomavirus vaccine and demyelinating diseasesa systematic review and meta-analysis. Pharmacol Res 2018 132:108-118.The authors conducted a systematic review of all published literature through May 2017 to assess the risk of developing demyelination after HPV immunization. They found no significant association between HPV vaccination and central demyelination, multiple sclerosis, or optic neuritis.

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The Best Flu Vaccines For Ms

According to Bar-Or, all recombinant flu vaccines the inactivated, or killed, type are safe for people with MS, even those on DMTs.

Other commonly used drugs in the treatment of MS including the muscle relaxant baclofen, the stimulant Provigil , and low-dose naltrexone dont affect the flu vaccine, or its safety, in any way, according to the National MS Society.

Still, you should talk to your doctor about which flu vaccine is best for you, given the medications you take for your MS or for any other medical condition you may have.

In addition, although its fine to get the vaccine at a doctors office, pharmacy, or clinic just like anyone else you should mention to whoever is administering the vaccine that you have MS to make sure you get the correct product, Bar-Or advises.

Factors Associated With Receiving Influenza Vaccination

Survey: Not Enough People Vulnerable To Severe Flu Illness Are Getting Vaccinated Against It

On univariate logistic regression, several demographic factors and health behaviors were associated with the likelihood of influenza vaccination. Compared with persons aged â¥65 years, those younger than 65 years had lower odds of being vaccinated . Postsecondary rather than high school education, a higher level of annual household income, a higher level of alcohol intake, being physically active, and using any DMT were also associated with increased odds of being vaccinated. In contrast, being male, symptoms of depression or anxiety, and currently smoking were associated with reduced odds of being vaccinated. Race, disability status, and disease duration were not associated with being vaccinated.

ORs for the Association Between Participant Characteristics and Receipt of the Influenza Vaccination

On multivariable analysis, postsecondary education, household income > $100,000 vs < $50,000 remained associated with increased odds of being vaccinated. Compared with no alcohol intake, alcohol intake 2â4 times per month was associated with increased odds of being vaccinated, as was physical activity. Younger age and currently smoking continued to be associated with reduced odds of being vaccinated. Sex and symptoms of depression or anxiety were no longer associated with the odds of being vaccinated. Of MS characteristics, only use of a DMT was associated with vaccination. Participants reporting any use of a DMT had 41% increased odds of receiving influenza vaccination.

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What Are The Risks

With MS, your immune system mistakenly attacks your central nervous system. The medicines you take can help manage the amount of inflammation in your body and stave off attacks that worsen your symptoms. Itâs a careful balancing act that some vaccines can upset.

Years ago, people worried that some vaccines, like those that prevent hepatitis B, caused MS. Many studies showed that this wasnât true. Yet some shots may trigger an infection that causes you to relapse. If you get a live vaccine , this is more likely to happen.

Some MS drugs, such as mitoxantrone, also change how your immune system works. If youâre exposed to a live virus while youâre taking them, you may actually get the disease that the vaccine works to prevent. Other treatments, like steroids, may curb how well the vaccine works.

Vaccine guidelines for two newer drugs given for MS are:

  • alemtuzumab — You should not receive a live or weakened vaccine after a course of this medication.
  • ocrelizumab — Any required live or weakened vaccine should be given at least 4 weeks prior to starting treatment.

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