Humoral and T- cell response to multiple COVID-19 booster vaccinations in people with MS

Introduction: People with multiple sclerosis (PwMS) treated with anti-CD20 therapies and fingolimod are less likely to successfully produce a humoral response to COVID-19 vaccines 1 and 2. Objective(s): To measure the humoral and/or cellular response to COVID-19 booster vaccinations in a cohort of PwMS who were previously seronegative after their initial COVID vaccine course. Aim(s): To determine whether there is a benefit of COVID-19 booster vaccinations for people with MS who are known to have had an attenuated response to initial vaccines. Method(s): We studied a cohort of PwMS all of whom were seronegative for anti-SARS-CoV-2 spike protein IgG after the 1st and 2nd COVID-19 vaccines, including PwMS treated with ocrelizumab (n=53), fingolimod (n=15), other DMTs (n=9) and no DMT (n=2). Dried blood spot +/- whole blood samples were obtained from participants at 2-8 weeks after their 3rd (n=79) and 4th (n=40) COVID-19 vaccines. Samples were used to measure anti-SARS-CoV-2 spike protein IgG (ELISA) and T-cell response (IFN-g release assay measured on whole blood). Result(s): Overall 27/79 (34%) who were seronegative after COVID vaccine 2 seroconverted after vaccine 3. Seroconversion rates were 17% for PwMS treated with ocrelizumab, 47% for fingolimod and 100% for other DMTs. A further 2/30 (7%) of those who remained seronegative after vaccine 3 seroconverted after vaccine 4. Anti-SARS-CoV-2 T-cell responses were measurable in 26/40 (65%) after vaccine 3 and 13/19 (68%) after vaccine 4 but were conspicuously absent in people treated with fingolimod. Overall, 75% of participants showed either humoral or cellular response after receiving 4 COVID vaccinations. PwMS with laboratory evidence of prior COVID-19 infection had higher measurable T-cell responses. Conclusion(s): Booster vaccinations for COVID-19 are associated with incremental benefits in measurable immunity in those with attenuated responses to the initial vaccine course. Overall, three quarters of those who were seronegative after COVID vaccines 1 & 2 had a measurable immune response after COVID vaccine 4. This data supports the use of booster vaccinations in pwMS at risk of attenuated vaccine response.

Group counselling consultations: the way forward?

Introduction: Virtual patient consultations have become increasingly common following the COVID-19 pandemic. In our region, we have utilised virtual group meetings of up to 30 patients to deliver education sessions regarding drug therapy for multiple sclerosis. Counselling sessions using Microsoft Teams provided information for either Siponimod, Fampridine, or Ocrelizumab and Ofatumumab, with opportunity following the presentation for questions. Patients were subsequently offered an individual Consultant review for a personalised discussion. Objective(s): All individuals who attend a virtual session during February 2021 - March 2022 will be sent an online questionnaire to complete. Aim(s): To determine the effectiveness of online group counselling consultations in providing information on medication. Method(s): Patients attending a virtual session during February 2021 - March 2022 were contacted to complete an online questionnaire. Result(s): More than half (42/80) of patients who responded had no previous experience of using MS Teams. Sessions were considered easy to access (average rating 8.8/10) and technical issues with sound or connection were only reported by 9/80. Average knowledge of the drug prior to the session was 3.8/10 and following the session this improved to 7.9/10. A virtual group session allowed the opportunity to hear the questions of other patients and this was felt to be beneficial (average rating 8.9/10). The vast majority (78/80) had no concerns regarding their confidentiality. Preference for this session to be delivered virtually rather than in person, favoured virtual delivery (7.6/10). Final comments highlighted the time and travel savings, with no significant concerns raised. Conclusion(s): Virtual group counselling sessions provide clear advantages to both patients and clinicians, saving time for the clinicians, but also giving patients group support around medication decisions. This review confirms that the majority of patients report group sessions are an effective, convenient and safe method of discussing medication. As treatment options for patients with MS expand and demand on services increases, this group counselling platform will allow greater flexibility to deliver information to patients.

YULETIDE TREMOR, TWITCHES AND TUNES

A 53 year old fit and well female was admitted to hospital with rapidly evolving progressive generalised stimulus sensitive myoclonus, axial rigidity and encephomyelitis over five days, two weeks after confirmed diagnosis of SARS-COV-2 infection. On admission to hospital she had generalised myoclonus involving face, voice, trunk, proximal and distal limbs augmented with tactile and auditory stimulus and voluntary movements. A few days later she developed significant axial rigidity, ocular bobbing and encephalitis as well as a myoclonic storm requiring intubation and ventilation. MRI Brain with contrast and CSF exami-nation were unremarkable and an EEG showed no epileptiform discharges. She was started on high dose intravenous steroids followed by 5 courses of plasma exchange. Her COVID serology was positive and other investigations including Glycine, GAD, amphiphysin and DPPX antibodies were negative. She demonstrated significant improvement and was discharged home a week after plasma exchange with the view to wean off steroids over six weeks. This case demonstrates a patient presenting with a rapidly evolving stimulus sensitive myoclonic storm with rigidity and encephalomyelitis two weeks after SARS-COV2 infection, which responded well to prompt immunomodulatory treatment.

AN ANALYSIS AND COMPARISON OF OBJECTIONS TO BRITISH SPACEPORTS

In the early days of astronautics, when only governments engaged in spaceflight, launch facilities could be sited by of ficial decision, with varying degrees of attention being paid to public opinion. Furthermore, in countries with large stretches of ocean or plains for discarded lower stages in which to land, or for debris to fall, a freer approach can be taken with range safety than in Britain. However, with the necessity for placing spaceports in out-of -the-way locations, and the small size of the British Isles, many who live near proposed spaceports are concerned at the effects upon their locality. Unless objections are dealt with in a fashion satisfying public concern, spaceports will not be built or utilised to their full capability, hindering the ability of the British launch industry to play the role that it should in the post-COVID-19 recovery. Each of the seven proposed spaceports in Britain will be examined, with objections, and possible methods of refuting or mitigating same. Finally, ways in which a unified approach to problems common to spaceports in Great Britain may be taken by the Spaceports Alliance will be proposed as a basis for future discussion. © 2021 British Interplanetary Society. All rights reserved.

COVID-19 in Multiple Sclerosis: Clinically reported outcomes from the UK Multiple Sclerosis Register.

BACKGROUND: In March 2020, the United Kingdom Multiple Sclerosis Register (UKMSR) established an electronic case return form, designed collaboratively by MS neurologists, to record data about COVID-19 infections in people with MS (pwMS). OBJECTIVES: Examine how hospital admission and mortality are affected by disability, age and disease modifying treatments (DMTs) in people with Multiple Sclerosis with COVID-19. METHODS: Anonymised data were submitted by clinical teams. Regression models were tested for predictors of hospitalisation and mortality outcomes. Separate analyzes compared the first and second 'waves' of the pandemic. RESULTS: Univariable analysis found hospitalisation and mortality were associated with increasing age, male gender, comorbidities, severe disability, and progressive MS; severe disability showed the highest magnitude of association. Being on a DMT was associated with a small, lower risk. Multivariable analysis found only age and male gender were significant. Post hoc analysis demonstrated that factors were significant for hospitalisation but not mortality. In the second wave, hospitalisation and mortality were lower. Separate models of the first and second wave using age and gender found they had a more important role in the second wave. CONCLUSIONS: Features associated with poor outcome in COVID-19 are similar to other populations and being on a DMT was not found to be associated with adverse outcomes, consistent with smaller studies. Once in hospital, no factors were predictive of mortality. Reassuringly, mortality appears lower in the second wave.