Attitudes toward vaccination in patients with multiple sclerosis: A report from Iran

Evaluation of willingness to obtain of Covid 19 vaccine in patients with multiple sclerosis

INTRODUCTION

Assessing vaccine willingness and understanding sources of vaccine hesitancy in individuals with multiple sclerosis (MS) helps healthcare providers approach patients more effectively while respecting their autonomy to encourage coronavirus disease 2019 (COVID-19) vaccination.

MATERIALS AND METHODS

A descriptive-analytical cross-sectional study using a researcher-made checklist was conducted on MS patients referred to Neshat Clinic of Hamadan during the years 2020-2021. The checklist contained questions about demographic information, MS phenotype, duration of illness, expanded disability status scale (EDSS) score, and COVID-19 vaccination status. The expanded disability status scale (EDSS) is the most commonly used instrument for measuring disability in patients with multiple sclerosis (MS). The EDSS scale ranges from 0 to 10 in increments of 0.5 units, denoting advanced points of disability.

RESULTS

Based on the results, 20 individuals (10%) were in the vaccine non-acceptance group, while 181 individuals (90%) were in the vaccine acceptance group. A significant number of relapsing and remitting (RR) type MS patients (90.7%) and all primary progressive (PP) type MS patients (100%) accepted the vaccine. In comparison, vaccine non-acceptance in the secondary progressive (SP) group was relatively higher (20.7%) compared to other types of MS, and this difference was significant (P < 0.05). Additionally, there was a statistically significant relationship between the history of COVID-19 and vaccine acceptance (P < 0.05).

CONCLUSION

The study results demonstrated a high rate of COVID-19 vaccine acceptance among MS patients. MS phenotype, previous infection experiences, and other influences allow for COVID-19 vaccine acceptance among MS patients. This information can improve health programs and communication strategies for COVID-19 and future possible infectious disease vaccination in individuals with MS.

Assessment of COVID-19 vaccine attitude in people with multiple sclerosis, its correlation with demographic factors, and fear of coronavirus: A cross-sectional survey

Background: Despite special global considerations which have been made to prioritize vaccination of people with multiple sclerosis (MS), some are reluctant to get vaccinated. This study was aimed to evaluate the attitude toward coronavirus disease-2019 (COVID-19) vaccine and its probable correlations. Methods: Considering the study objectives, two valid questionnaires including Fear of COVID-19 Scale (FCV-19S) and attitude questionnaires were administered pre and post COVID-19 vaccination among people with MS. Results: The questionnaires were administered among 349 people with MS pre and post vaccination. The mean age of participants was 38.78 ± 8.68 (range: 19 to 64) years. They all received the first dose of COVID-19 vaccine (Sinopharm). Although about 90% of participants felt satisfied after getting vaccinated and respected the preventive actions like social distancing and wearing face mask after vaccination, about 40% of them did not recommend vaccination to other patients. None of the demographic data was predictor of attitude score in COVID-19 vaccine and the only effective factor regarding fear of COVID-19 among people with MS was gender (P = 0.001). It was found that the more a patient's fear score was, the more he/she felt satisfied after vaccination. Those patients who had got the influenza vaccine last year felt more satisfied with the vaccine and accepted the COVID-19 vaccine easier than others. Conclusion: This study revealed that there was an inverse correlation between fear of coronavirus and less trust in the vaccine in patients with MS. However, it should be mentioned that the patients felt more satisfied after COVID-19 vaccination.

The perspective of Iranian patients with multiple sclerosis on the third dose of COVID-19 vaccine

Background: Now that the majority of the population has been immunized with two-dose vaccines, debates over the third booster dose have been raised. We studied the viewpoint of cases with multiple sclerosis (MS) on this matter. Methods: In a cross-sectional study, a google form containing questions about participants' characteristics, the history of coronavirus disease 2019 (COVID-19) infection and vaccination, and opinions on the third dose was designed. Results: Of 1067 responders, only 16 (1.5%) were not vaccinated at all. The most used vaccine type was Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) (n = 1002, 93.9%). Generally, 58 (5.4%) cases were hospitalized due to COVID-19. Of those with full vaccination, 134 (13.3%) got COVID-19 infection after the second dose. Only 13 participants (1%) did not agree with the third dose, while 564 (53.0%) believed that a booster dose was needed. Of all, 488 (45.7%) declared that they did not have a final idea and would follow the instructions by the experts. A significant association was found between not receiving the first two doses and not believing in the third dose (P = 0.001). 692 patients declared their reasoning for the importance of the third dose. All the cases who thought the administered vaccine was not efficient enough had received Sinopharm BBIBP-CorV. Those who got infected after full vaccination were more uncertain about the efficacy of the vaccine [odds ratio (OR): 2.6, 95% confidence interval (CI): 1.6-4.2]. Conclusion: It seems that the majority of the Iranian patients with MS expect the authorities to administer a third booster dose, especially if scientifically validated.

COVID-19 vaccines and patients with multiple sclerosis: willingness, unwillingness and hesitancy: a systematic review and meta-analysis

Objective

The purpose of this study was to determine the pooled prevalence of vaccination willingness, unwillingness, and hesitancy among patients with multiple sclerosis.

Methods

Databases including PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were searched. by two expert researchers, as well as references in the included studies, which were published before October 2021.

Results

Three hundred eighty articles were found in four data bases. One hundred eighty-two studies remained following deleting duplicates. Finally, ten studies remained for the meta-analysis. Totally, 5983 patients with MS were assessed. The pooled prevalence of willingness to vaccination among patients with MS was 76% (95% CI: 67–85%) (I² = 98.4%, p < 0.001). Unwillingness pooled prevalence to vaccination among patients with MS was 2% (95% CI: 2–3%) (I² = 97.9%, p < 0.001). Hesitancy pooled prevalence to vaccination among patients with MS was 0% (I² = 98%, p < 0.001).

Conclusion

According to the findings of this systematic review and meta-analysis, more than two-thirds of patients with MS were willing to obtain COVID-19 vaccines.

Implementing education: Personal communication with a healthcare professional is a critical step to address vaccine hesitancy for people with multiple sclerosis

Background

People with Multiple Sclerosis (PwMS) were first able to access COVID-19 vaccines in Australia from March 2021, when vaccine hesitancy in the general population was high (14–43%). High uptake of vaccination is important globally and critical to protect this vulnerable population. We conducted an on-line survey to examine factors influencing COVID-19 vaccination willingness among PwMS in Australia.

Methods

149 PwMS living in Australia completed the on-line survey (April-September 2021) examining demographic, environmental and clinical factors with respect to vaccine willingness, including attitudes towards COVID-19 illness and vaccines. Additional items explored the influence of different information sources on vaccination decisions. Continuous and ordinal data were compared using the Mann-Whitney U test. All tests were two-tailed, with alpha set at 0.5.

Results

A majority of the respondents were female (87.2%) with relapsing-remitting MS (77.5%) treated by a neurologist (94.0%). A majority were on high efficacy disease-modifying therapies (DMTs) (64.9%), while 19.9% were on no DMTs. About one third of respondents (32.9%) had had two doses, 20.8% had received their first dose, and 22.1% were unvaccinated, while 24.2% of responses were missing. When asked about vaccine intentions, 60.6% of the unvaccinated indicated they were likely to extremely likely to get vaccinated, while 15.2% were very unlikely or extremely unlikely to do so and 24.2% were undecided. Unvaccinated people were significantly more concerned about vaccine side effects (mean 5.3 versus 3.1/10; p < .001). Only 53.3% of people on DMTs were vaccinated, compared to 75% of those who were not. People on ocrelizumab therapy (n = 35) had a lower vaccination rate (39%) than those on other medications (n = 86, 59%). Vaccine willingness in the unvaccinated was most highly correlated with knowledge regarding the vaccine (r_s²=.709), agreement with the statement that COVID-19 vaccination is “too new for me to be confident about getting vaccinated” (r_s²= -.709), anticipation of regret due to side effects of vaccination (r_s²= -.642), and lack of knowledge regarding interactions between COVID-19 vaccines and DMTs (r_s²= -.570).

Almost two thirds had read MS-specific information about COVID-19 vaccinations and found it easy to understand (67.6%) and applicable to their situation (53.6%). However, less than half (47.8%) reported the information helped them make a personal vaccination decision. Over two-thirds (64.9%) had discussed vaccinations with their healthcare professional and 31.1% had not. Those who had not, were significantly more uninformed about the interactions of the vaccine with MS medications (mean 3.9 versus 2.9/10; p = .044) and significantly lower intention of vaccine uptake than those who had (mean 5.8 versus 7.9/10; p = .009).

Conclusion

Our study highlights that vaccination efforts should be delivered by healthcare professionals, focus on educating those who are managed with DMTs, and include individual recommendations related to specific DMTs, how the vaccines work, expectations regarding potential side-effects, potential exacerbation of MS symptoms, likelihood of recovery from any exacerbation, and the relative risks of side effects versus COVID-19 infection. Specific recommendations are provided.

Highlight of potential impact of new viral genotypes of SARS-CoV-2 on vaccines and anti-viral therapeutics

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of the coronavirus disease (COVID-19) pandemic, has infected millions of people globally. Genetic variation and selective pressures lead to the accumulation of single nucleotide polymorphism (SNP) within the viral genome that may affect virulence, transmission rate, viral recognition and the efficacy of prophylactic and interventional measures. To address these concerns at the genomic level, we assessed the phylogeny and SNPs of the SARS-CoV-2 mutant population collected to date in Iran in relation to globally reported variants. Phylogenetic analysis of mutant strains revealed the occurrence of the variants known as B.1.1.7 (Alpha), B.1.525 (Eta), and B.1.617 (Delta) that appear to have delineated independently in Iran. SNP analysis of the Iranian sequences revealed that the mutations were predominantly positioned within the S protein-coding region, with most SNPs localizing to the S1 subunit. Seventeen S1-localizing SNPs occurred in the RNA binding domain that interacts with ACE2 of the host cell. Importantly, many of these SNPs are predicted to influence the binding of antibodies and anti-viral therapeutics, indicating that the adaptive host response appears to be imposing a selective pressure that is driving the evolution of the virus in this closed population through enhancing virulence. The SNPs detected within these mutant cohorts are addressed with respect to current prophylactic measures and therapeutic interventions.

The study of COVID-19 infection following vaccination in patients with multiple sclerosis

Background

At this time vaccination against SARS-CoV2 is a global priority. Cases with multiple sclerosis (MS) were among the first vaccinated populations in Iran. We evaluated the change in the frequency of COVID-19 after vaccination and the associated factors with severe COVID-19 infection before and after full vaccination.

Methods

A questionnaire was validated to investigate the basic characteristics (age, gender, education, body mass index, smoking status, and comorbidities), MS disease and treatment status (MS type, MS duration, The Expanded Disability Status Scale (EDSS), disease modifying treatments) and the information about COVID-19 infection and severity.

Results

692 (91.9%) of participants have received both doses of vaccines, of which Sinopharm appeared to be the most common type. Significant difference of COVID-19 infection prevalence was seen before vaccination and after full vaccination (difference: 0.16, 95% CI: 0.12–0.20) (p value < 0.001). The difference was not significant for severe cases (those who were admitted in the ward or ICU) relative to the COVID-19 cases or the whole participants. Of all the basic and disease factors, only EDSS showed a significant association with severe COVID-19 before vaccination. Severe COVID-19 in fully vaccinated cases did not show any significant relation to any of basic or disease characteristics except with prior history of severe allergic reactions (OR: 17.1, p value: 0.001).

Discussion

The decreased frequency of infection with SARS-CoV2 was predictable but the insignificant difference in cases with the severe forms of the disease raise concern. The only significant predictor was found to be severe allergic reactions. As there are debates on antiCD20 s association with severe COVID-19 and vaccine efficacy, we could not find such significant relation. The other noticeable point about the found relation of EDSS and critical COVID-19 before vaccination is the absence of such relation after full vaccination.