Prevalence and factors associated with COVID-19 vaccination in people with multiple sclerosis compared to the general population in Croatia

Background: The aim of this study was to determine the pooled prevalence of COVID-19 vaccination among people with multiple sclerosis (pwMS) compared to the general population in Croatia. Method(s): Data from all pwMS entered in the MS Base register until24.03.2022 were extracted including age, sex, MS phenotype, disease-modifying therapy (DMT), COVID-19 vaccine, and date of vaccination (1st, 2ndand/or 3rddose). Data on the general population of Croatia were obtained from the vaccination register of the Croatian Institute of Public Health. Result(s): 464 pwMS (317 females, with a median age of 38.1 years, disease duration of 6.1 years, EDSS 1.5) were included in the analysis. 386 (83.2%) pwMS had relapsing-remitting, 26 (5.6%) primary progressive, 19 (4.1%) secondary progressive phenotypes, and 16 (3.4%) clinically isolated syndrome. Fifty-six (12.1%) pwMS were treatment naive, 21 (4.5%) were not on DMT at the moment of the last visit, 134 (28.9%) were on injectable DMTs, 84 (18.1%) on 1stline oral DMTs, and 169 (36.4%) were on high efficacy DMTs. 295 (63.6%) pwMS were fully COVID-19 vaccinated compared to 59.7% of the general population (p=0.089). However, in the age groups, 20-24 and 35-39 significantly more pwMS received 2 doses compared to the general population (p=0.001 and p=0.03, respectively). Vaccinated pwMS were older (40.5 vs 37.6 years, p=0.01), had higher EDSS (2.0 vs 1.0, p=0.025), and longer disease duration (6.39 vs 5.35 years, p=0.02), were more likely to have progressive disease course (p=0.049) and on high efficacy DMTs (p=0.045) compared to unvaccinated pwMS.In a multivariable logistic regression model, there were no predictors for COVID-19 vaccination in pwMS. Conclusion(s): There was a similar prevalence of vaccinated individuals in pwMS and the general population. However, in younger age groups significantly more pwMS were vaccinated when compared to the general population.

Use of Tocilizumab May Avoid the Need of Invasive Ventilation.

Coronavirus disease 2019 (COVID-19) is an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Increased pro-inflammatory cytokines including interleukin 6 (IL-6) are associated with severe forms of illnesses. The severe cases of COVID-19 require a high amount of oxygen supplementation and might even require endotracheal intubation with ventilator support. A blockade of inflammatory cascade with the use of tocilizumab has been shown to decrease the need for intubation and ventilator requirement.

Recurrent Pneumothorax in an Adult Male With Bilateral COVID-19 Pneumonia.

Pneumothorax is defined as the condition in which air is collected between the visceral and parietal pleura. Pneumothorax as a complication of coronavirus disease 2019 (COVID-19) infection has been reported in relatively few cases and recurrent pneumothorax is even rarer. We present a case of a 50-year-old critically ill patient who required mechanical ventilation for 55 days and developed recurrent bilateral pneumothorax. The patient initially presented with shortness of breath and cough. He was found to be COVID-19 positive on the polymerase chain reaction (PCR) test. Subsequently, his oxygen demand increased, and he ultimately needed mechanical ventilation. He developed four episodes of pneumothorax. The patient was managed in all four episodes with intercostal tube insertion. To prevent subsequent episodes, pleurodesis was performed after the fourth episode of pneumothorax.