It is clear that the SARS-CoV-2 delta variant is a partial vaccine escape variant. This means that people with MS who have been vaccinated in the past are likely to need a booster.
Prof - I actually caught covid despite being double jabbed but I am on ocrelizumab so it wasn't a big surprise. I've since had another round of ocrelizumab (possibly a mistake but I was worried about the virus kicking off a relapse) Does my infection effectively act as a booster jab? I probably had no bcells at the time and almost certainly won't now. Does this leave me as vulnerable to reinfection? Reinfection rates appear fairly low generally but for the anti CD20 users, are we just constantly vulnerable to the virus?
Yes, wild-type infection is a booster and maybe better than the vaccine. Anti-CD20 therapy is likely to blunt vaccine responses to wild-type infections as well, but not CD8+ T-cell responses that you need to recover from infections.
Thank you. This is what i thought....my t-cells have been given a boost. However, are they likely to prevent reinfection? my understanding was that it was the antibody response that performed this role. So in theory, i have no protection from infection but i am ready to fight it
These are giving me a lot to think about. I’m 61 and have been using DMTs since1997, (I’m in the UK) I had a 5 year break from 2005-2010, not my choice! (Postcode lottery) Much better care from neurology department in Sheffield meant I could try them again after a major relapse in 2010. I’ve had Avonex, Copaxone, Gilenya and then in late 2019 started Orcrevus infusions. I’m due to go for my 4th round of treatment in September. I’ve decided to put that on hold. Because of ‘immunosenescense’ (a new word for me, hope I’ve spelt it right) I think it’s time for me to stop taking DMTs (I’m going to talk this through with consultant). I’m going to try and offer a one off payment to offer some support
When I get some time I will do a specific post on immunosenescence to explain it to you in detail. In summary, as you get older your immune system is less responsive to vaccines and infections and is one of the reasons why older people are so susceptible to COVID-19 (severe infection and death).
That would be great. I'd also love to hear your thoughts on what this all means for those of us on anti-CD20, especially now with COVID. Should we view anti-CD20 as an inherently time-limited treatment, and have an exit strategy in mind from the beginning?
I understand that other therapies like Natalizumab work differently but will I be likely to need a covid booster too? I am double vaccinated with Astrazeneca vaccine. I do have my annual flu vaccine today - never been offered a Pneumonia jab though.
On the BBC news this morning they said that both the Pfizer and the Oxford offer the same protection against delta as the original variant which is not what you are saying
The Pfizer and AZ vaccines protect against severe infection if you have had both doses. What it doesn't do is protect you from getting infected and possibly spreading the virus.
What the BBC did not mention is what is happening in Israel, i.e. older people who were vaccinated 6+ months ago are now getting reinfected and are getting severe COVID-19. This is not good news and is likely to happen in the UK. Israel is ahead of us by a few months; so this is likely to repeat itself in the UK in the next few months.
Yes, it should as their antibody levels are waning. But unlikely to help if they are B-cell depleted or on an S1P modulator.
I suspect as the delta variant evolves we may also need to adapt the vaccine to include the new emerging strains. This is the advantage of the mRNA vaccines, they are relatively easy to adapt, update and produce a new vaccine. I hope the regulators license the technology and allow safety studies to be done on the fly as the vaccine is being rolled out.
It may help, but it won't be as good and as predictable as people who are not on fingolimod or a related drug. You have done the right thing. Coming off fingolimod for a vaccine is not really feasible.
I paused my Kesimpta (ofatumumab) injections for almost 4 months. During that pause I got my two Pfizer doses after 4 and 3 weeks. Three weeks later I tested my B-cell (4 cells/microliter) and antibody counts (9.5 U/mL), and found that both were measurable but low. Six weeks later I got a booster shot of the Pfizer vaccine, and three weeks after than retested. My B-cell count was higher but still low (17 cells/microliter), but my antibody count was high (> 250 U/mL). I resumed my Kesimpta shots a week later, but I plan to instead take them every 3 months, not every one month, admittedly in part due to some of the concerns you've voiced about the long term risks of the therapy.
So clearly, taking a break helped my immune response.
Note: I didn't wait for FDA and CDC approval, as I was already on a pause of my ofatumumab injections, so got my booster shot a couple of months sooner that I would have if I had waited for what seemed like an eventuality, and, to me, frustrating bureaucratic delays.
My MS doctor of 15 years has been ordering the labs. B-cell tests are not cheap and my share after insurance is ~$90. The antibody tests are being contested, so I'm not sure what those will cost me yet. As the booster was not yet approved I had to pretend I was getting my first dose again.
B-cells counts have to be done by an immunology laboratory and the anti-SARS-CoV-2 antibody response via a virology laboratory. Please note it has to be a specific request for anti-spike and not just anti-SARS-CoV-2 antibodies. Most antibody tests for the latter are looking for anti-nucleocapsid antibodies, which are not induced by the vaccine.
Prof - I actually caught covid despite being double jabbed but I am on ocrelizumab so it wasn't a big surprise. I've since had another round of ocrelizumab (possibly a mistake but I was worried about the virus kicking off a relapse) Does my infection effectively act as a booster jab? I probably had no bcells at the time and almost certainly won't now. Does this leave me as vulnerable to reinfection? Reinfection rates appear fairly low generally but for the anti CD20 users, are we just constantly vulnerable to the virus?
Yes, wild-type infection is a booster and maybe better than the vaccine. Anti-CD20 therapy is likely to blunt vaccine responses to wild-type infections as well, but not CD8+ T-cell responses that you need to recover from infections.
Thank you. This is what i thought....my t-cells have been given a boost. However, are they likely to prevent reinfection? my understanding was that it was the antibody response that performed this role. So in theory, i have no protection from infection but i am ready to fight it
These are giving me a lot to think about. I’m 61 and have been using DMTs since1997, (I’m in the UK) I had a 5 year break from 2005-2010, not my choice! (Postcode lottery) Much better care from neurology department in Sheffield meant I could try them again after a major relapse in 2010. I’ve had Avonex, Copaxone, Gilenya and then in late 2019 started Orcrevus infusions. I’m due to go for my 4th round of treatment in September. I’ve decided to put that on hold. Because of ‘immunosenescense’ (a new word for me, hope I’ve spelt it right) I think it’s time for me to stop taking DMTs (I’m going to talk this through with consultant). I’m going to try and offer a one off payment to offer some support
When I get some time I will do a specific post on immunosenescence to explain it to you in detail. In summary, as you get older your immune system is less responsive to vaccines and infections and is one of the reasons why older people are so susceptible to COVID-19 (severe infection and death).
That would be great. I'd also love to hear your thoughts on what this all means for those of us on anti-CD20, especially now with COVID. Should we view anti-CD20 as an inherently time-limited treatment, and have an exit strategy in mind from the beginning?
I think for the older person (>50) with MS definitely.
I understand that other therapies like Natalizumab work differently but will I be likely to need a covid booster too? I am double vaccinated with Astrazeneca vaccine. I do have my annual flu vaccine today - never been offered a Pneumonia jab though.
On the BBC news this morning they said that both the Pfizer and the Oxford offer the same protection against delta as the original variant which is not what you are saying
The Pfizer and AZ vaccines protect against severe infection if you have had both doses. What it doesn't do is protect you from getting infected and possibly spreading the virus.
What the BBC did not mention is what is happening in Israel, i.e. older people who were vaccinated 6+ months ago are now getting reinfected and are getting severe COVID-19. This is not good news and is likely to happen in the UK. Israel is ahead of us by a few months; so this is likely to repeat itself in the UK in the next few months.
But if those in Israel have a booster should this help? Many thanks for your reply
Yes, it should as their antibody levels are waning. But unlikely to help if they are B-cell depleted or on an S1P modulator.
I suspect as the delta variant evolves we may also need to adapt the vaccine to include the new emerging strains. This is the advantage of the mRNA vaccines, they are relatively easy to adapt, update and produce a new vaccine. I hope the regulators license the technology and allow safety studies to be done on the fly as the vaccine is being rolled out.
Are you saying that being on Gilenya the Booster won't help me? I just took it
It may help, but it won't be as good and as predictable as people who are not on fingolimod or a related drug. You have done the right thing. Coming off fingolimod for a vaccine is not really feasible.
I paused my Kesimpta (ofatumumab) injections for almost 4 months. During that pause I got my two Pfizer doses after 4 and 3 weeks. Three weeks later I tested my B-cell (4 cells/microliter) and antibody counts (9.5 U/mL), and found that both were measurable but low. Six weeks later I got a booster shot of the Pfizer vaccine, and three weeks after than retested. My B-cell count was higher but still low (17 cells/microliter), but my antibody count was high (> 250 U/mL). I resumed my Kesimpta shots a week later, but I plan to instead take them every 3 months, not every one month, admittedly in part due to some of the concerns you've voiced about the long term risks of the therapy.
So clearly, taking a break helped my immune response.
Note: I didn't wait for FDA and CDC approval, as I was already on a pause of my ofatumumab injections, so got my booster shot a couple of months sooner that I would have if I had waited for what seemed like an eventuality, and, to me, frustrating bureaucratic delays.
Well done for doing this. Who helped you with the counts etc.? Your neurologist? Your family doctor?
My MS doctor of 15 years has been ordering the labs. B-cell tests are not cheap and my share after insurance is ~$90. The antibody tests are being contested, so I'm not sure what those will cost me yet. As the booster was not yet approved I had to pretend I was getting my first dose again.
Speak to your HCP.
B-cells counts have to be done by an immunology laboratory and the anti-SARS-CoV-2 antibody response via a virology laboratory. Please note it has to be a specific request for anti-spike and not just anti-SARS-CoV-2 antibodies. Most antibody tests for the latter are looking for anti-nucleocapsid antibodies, which are not induced by the vaccine.