COVID-19 Vaccines Well-Tolerated by NMOSD Patients, Survey Finds

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by Forest Ray PhD |

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COVID-19 vaccines are safe and well-tolerated by people with the rare neurological disorders neuromyelitis optica spectrum disorder (NMOSD), MOG-antibody disease (MOGAD), and transverse myelitis in the U.S., according to a recent study.

Patients surveyed about their vaccine experiences reported a rate of side effects similar to that of the general population, and infrequent new or worsening neurological symptoms.

The study, “Patient-reported safety and tolerability of the COVID-19 vaccines in persons with rare neuroimmunological diseases,” was published in the journal Multiple Sclerosis and Related Disorders.

While people living with neurological and autoimmune diseases appear to contract COVID-19 at similar rates to the general population, at least one recent study suggested that those with NMOSD — particularly if older and severely disabled — face higher risks of hospitalization, including a need for intensive care, making vaccination all the more important for these individuals.

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Currently available vaccines have proven to be highly effective at limiting infection by the SARS‑CoV‑2 virus and preventing the worst outcomes of infection. Little data specific to NMOSD and the related disorders MOGAD and transverse myelitis is available, however.

Researchers at Harvard Medical School recruited patients within those populations via an NMO Facebook group, and sent them an anonymous survey that focused on their experiences with the COVID-19 vaccines.

They received 438 complete responses, from 242 individuals with NMOSD, 99 with MOGAD, and 79 with transverse myelitis.

Respondents’ median age was 51, most (83.7%) lived in the U.S., and were white (75.3%) and female (83.6%).

Over one-quarter of participants (27.4%) reported co-occurring conditions, which included diabetes, high blood pressure, and lung disease. Most respondents (354, or 80.1%) reported using immunotherapies, with 172 (48.6%) on rituximab.

The Pfizer/BioNTech and Moderna COVID-19 vaccines were most prevalent (given to 57.3% and 34.9% of respondents, respectively), followed by AstraZeneca (7.3%) and Johnson & Johnson (0.4%).

Overall, reactions to the vaccines were mild, and largely did not affect neurological symptoms.

Slightly under one-third of participants (31.5%), a majority of whom (67.4%) were younger than 55, reported experiencing early side effects.

Local reactions at the injection site, such as pain, redness, and swelling, were the most common side effects, reported by 155 participants (35.4%). Others included headaches, muscle pain, fatigue, fever, chills, and dizziness.

About one-fifth of respondents (16.7%) reported new or worsening neurological symptoms after vaccination. These included sensory effects, such as numbness, tingling, and itching, as well as increased pain, muscle weakness, gait instability, visual symptoms, and problems involving control of the sphincter, the ring-shaped muscle that relaxes or tightens passages or openings in the body.

Symptoms tended to occur within the first week after vaccination, and slightly over half (52.1%) resolved within three days without further treatment. Nine of the 73 people reporting new or worsening symptoms were given additional corticosteroids, three were treated with painkillers, and one received anti-nausea medications.

Although larger, controlled studies should be done to verify these findings, the survey “indicates an overall favorable safety and tolerability profile of the COVID-19 vaccines among persons with rare neuroimmunological diseases,” the investigators concluded.