NAA issues official position statement on COVID-19 vaccine

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Based on the existing evidence, neurologists should recommend COVID-19 vaccination to their patients, according to a recently published American Academy of Neurology (AAN) article.

“Except in the rare circumstances of an absolute contraindication to available vaccine formulations, it is the formal position of the American Academy of Neurology that eligible patients should be offered the COVID-19 vaccine,” Elisabeth wrote. Marsh, MD, of Johns Hopkins University School of Medicine in Baltimore, and members of the AAN Quality Committee, in Neurology.

“Although limited, the data currently available point to low rates of neurological complications after vaccination, especially when compared to the severity of morbidity and mortality resulting from infection in populations of people with neurological diseases, ”the committee members said.

Particular attention at the time of vaccination should be given to people with multiple sclerosis (MS) or myasthenia gravis on immunotherapy, they stressed. In addition, “patients treated with immunotherapies known or suspected of attenuating the vaccine response should be made aware of the continued potential for SARS-CoV-2 infection, an issue increasingly relevant as security mandates state and local are lifted, ”they wrote.

“With the uncertainty within the community surrounding the COVID-19 vaccination, we really wanted to follow the evidence,” Marsh said. MedPage today.

“In this manuscript, we have attempted to provide a resource for clinicians, examining the frequency and severity of potential adverse events associated with vaccination, while also focusing on comparing with the extent of adverse events caused by the virus. himself. Importantly, we also wanted to highlight how potential side effects can impact patients with neurological diseases, especially those who are immunosuppressed, ”she said.

“I think it is essential to recognize that even though potential side effects have been reported and require continued monitoring, the overall rate of these complications is extremely low and the benefit of vaccination – given the side effects associated with it. ‘viral infection itself – far exceeds the risk for the majority of patients,’ added Marsh.

Of the three COVID vaccines approved by the FDA for emergency use, the Johnson & Johnson vaccine, which uses an adenovirus-based mechanism, has been associated with rare cases of blood clots after vaccination and with cases of Guillain-Barré syndrome.

In addition, neurological complications from vaccines are now reported in “the most comprehensive registry, the Vaccine Adverse Events Reporting System (VAERS) database,” added the AAN committee members. “These complications are rare compared to the large number of people vaccinated; however, it is too early to know the true incidence and risk factors for these complications. justified, ”they wrote.

“Unfortunately, there is little or no data regarding the safety or effectiveness of COVID-19 vaccines in patients with pre-existing neurological conditions and / or patients receiving immunomodulatory therapies,” acknowledged Marsh and colleagues.

“Based on data from the COVID-19 vaccine 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, the American Heart Association, and the Epilepsy Foundation, have also released statements on COVID-19 vaccines.

Between 30% and 60% of people infected with SARS-CoV-2 have experienced neurological complications which tend to fall into three main categories – those caused acutely by systemic effects on the body, those resulting from direct invasion of the nervous system, or long-term sequelae after patients have recovered from acute illness – the committee members noted.

“Although there is no clear evidence at this time that people with pre-existing neurological disease are at a higher risk of infection or neurological complications, the question of whether people with weakness neuromuscular or bulbar may be more vulnerable to infection or neurological sequelae will require further study, ”they wrote.

“Viral diseases may be a predisposing factor to delirium in patients with dementia or mild cognitive impairment, resulting in a poor prognosis. In addition, those who take immunomodulatory therapy are at risk for more serious, recurrent and persistent infection.” , they added. Some studies have shown that in patients with MS, anti-CD20 therapies may be linked to a more severe COVID course.

“Clearly, there is evidence that infection with SARS-CoV-2 poses a risk to patients with neurological disease,” said members of the AAN quality committee. Fortunately, vaccination offers an opportunity to decrease transmission and reduce the severity of infection in vulnerable populations.

  • Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s disease, dementia, MS, rare diseases, epilepsy, autism, headaches , stroke, Parkinson’s disease, ALS, concussions, CTE, sleep, pain and more. To pursue

Disclosures

The authors did not report any targeted funding for this article and no conflicts of interest related to this work.



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