Based on existing evidence, neurologists should recommend COVID-19 vaccination to their patients, a newly released American Academy of Neurology (AAN) paper said.
“Barring the rare circumstance of an absolute contraindication to available vaccine formulations, it is the American Academy of Neurology’s formal position that eligible patients should be offered the COVID-19 vaccine,” wrote Elisabeth Marsh, MD, of Johns Hopkins University School of Medicine in Baltimore, and members of the AAN Quality Committee, in Neurology.
“Though limited, the currently available data report low rates of neurologic complications post-vaccination, particularly when weighed against the severity of morbidity and mortality resulting from the infection in populations of people with neurological illness,” the committee members stated.
Special consideration about vaccination timing should be given to people with multiple sclerosis (MS) or myasthenia gravis on immunotherapies, they pointed out. In addition, “patients treated with immunotherapies known or suspected to attenuate vaccine response must be counseled about the ongoing potential for SARS-CoV-2 infection, an issue of increasing relevance as state and local safety mandates are lifted,” they wrote.
“With the uncertainty within the community surrounding vaccination for COVID-19, we really wanted to follow the evidence,” Marsh told MedPage Today.
“In this manuscript, we tried to provide a resource for clinicians, reviewing the frequency and severity of potential adverse events associated with vaccination, while also focusing on how that compares to the scope of adverse events caused by the virus itself. Importantly, we also wanted to highlight how potential side effects may impact patients with neurological disease, particularly those who are immunosuppressed,” she said.
“I think it is critical to acknowledge that while potential side effects have been reported and require continued monitoring, the overall rate of these complications is extremely low and the benefit of vaccination — considering side effects associated with viral infection itself — far outweighs the risk for the majority of patients,” Marsh added.
Of the three COVID vaccines approved by the FDA for emergency use, the Johnson & Johnson vaccine, which uses an adenovirus-based mechanism, has been linked with rare reports of blood clots after vaccination and cases of Guillain-Barré syndrome.
In addition, neurologic complications of the vaccines now are being reported in “the most comprehensive registry, the Vaccine Adverse Events Reporting System (VAERS) database,” AAN committee members added. “These complications are rare when compared to the large number of vaccinated individuals; however, it is too early to know the true incidence and risk factors for these complications. They are thought to be immune mediated and early recognition and treatment with immunomodulatory therapies might be warranted,” they wrote.
“Unfortunately, there are little to no data regarding the safety or efficacy of the COVID-19 vaccines in patients with pre-existing neurological conditions and/or patients receiving immunomodulatory therapies,” Marsh and colleagues acknowledged.
“Based on COVID-19 vaccine data from the general population and extrapolations from other vaccines studied in patients with neurological disease, statements from the American Academy of Neuromuscular and Electrodiagnostic Medicine and the National Multiple Sclerosis Society support vaccination,” they wrote.
Other national societies, including the Alzheimer’s Association, American Heart Association, and the Epilepsy Foundation, also have issued statements about COVID-19 vaccines.
Between 30% and 60% of people infected with SARS-CoV-2 have experienced neurologic complications which tend to fall into three main categories — ones caused acutely by systemic effects on the body, ones stemming from direct invasion of the nervous system, or long-term sequelae after patients have recovered from acute illness — the committee members noted.
“While there is no clear evidence at this time that those with pre-existing neurological illness are at higher risk of infection or neurologic complications, the question of whether individuals with neuromuscular or bulbar weakness may be more vulnerable to either infection or neurologic sequelae will require careful study,” they wrote.
“Viral illnesses can be a predisposing factor for delirium in patients with dementia or mild cognitive impairment, leading to poor prognosis. In addition, those on immunomodulating therapy are at risk for more severe, recurrent and persistent infection,” they added. Some studies have shown that in MS patients, anti-CD20 therapies may be linked with a more severe COVID course.
“Clearly, there is evidence that SARS-CoV-2 infection poses risk to patients with neurological disease,” the AAN Quality Committee members stated.”Fortunately, vaccination presents an opportunity to decrease transmission and reduce severity of infection within vulnerable populations.”
Disclosures
The authors reported no targeted funding for this paper and no conflicts of interest related to this work.