ABSTRACT
Background: Vaccination against SARS-CoV-2 is recommended for all persons with multiple sclerosis (pwMS) to prevent severe COVID infections and death. However, it is unknown how many pwMS are fully vaccinated or have received a booster dose and whether vaccination patterns differ across patient subgroups. In addition, there is limited research evaluating COVID outcomes by vaccination status among pwMS despite concerns that pwMS receiving immunosuppressive therapies might have an impaired immune response that could impact vaccine effectiveness. Objective(s): To describe COVID vaccination patterns and COVID outcomes among pwMS in the FlywheelMS cohort and in subgroups of pwMS, including by disease-modifying therapy (DMT) status. Method(s): All pwMS included in the FlywheelMS cohort, a patient-centred study that digitises all health records for US-based pwMS across all US sites of care, were asked to complete a questionnaire on their COVID vaccination history (completed 2 July-4 May 2022). COVID diagnoses and outcomes were identified in health records. Vaccination rates were calculated for all pwMS overall and in subgroups, including by index DMT (i.e. the most recent DMT in the 6 months prior to vaccination). Breakthrough infections >14 days after the last dose of the primary vaccine series and COVID-related outcomes (i.e. hospitalisation, severe hospitalisation, death) were evaluated overall and in subgroups of pwMS, including by DMT status. Result(s): A total of 1041 pwMS (20% response rate) completed the survey and were included in the study: 182 (17%) were unvaccinated, 11 (1%) were partially vaccinated and 848 (81%) were fully vaccinated. Among the fully vaccinated, 595 (70%) received 1 and 47 (6%) received >=2 booster/additional doses. Fully vaccinated pwMS were more likely to be older (mean age, 50 vs 49 years), male (22% vs 13%) and treated with any DMT (76% vs 63%) compared with unvaccinated pwMS. Among all fully vaccinated pwMS, 48 (6%) had a documented breakthrough infection after vaccination. Vaccination rates and outcomes following breakthrough infections (i.e. hospitalisation, severe hospitalisation, death) for subgroups will be presented in the full poster. Conclusion(s): Rates of full vaccination and boosters were higher among pwMS compared with all adults in the US. The documented breakthrough rate among fully vaccinated pwMS was low and similar to that in the general population, suggesting vaccination against SARS-CoV-2 provides benefits among pwMS.
ABSTRACT
Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) has shown to be beneficial for the treatment of severe COVID-19. Barriers to mobilization include acuity, devices, personal protective equipment, negative pressure rooms, and healthcare worker safety. We report our experience with progressive mobility in this complex patient population. Methods: A retrospective review of adult patients requiring VV ECMO for COVID-19 was performed at a single institution from April to July 2020. A multidisciplinary team collaborated daily to determine readiness for progressive mobility. Therapy interventions followed a five-stage protocol and were evaluated using three standardized functional mobility tools (Table 1). Scores were recorded at baseline, highest during ECMO run, and at discharge. Results: Seventeen of 28 COVID-19 patients received protocolized progressive mobility during their extracorporeal support period. The mean scores of the three mobility tools demonstrated an improvement over the course of hospitalization (Table 1). At the time of data analysis, one patient had expired and four patients were still on ECMO support. Twelve (71%) were weaned from ECMO and all were alive at discharge. Of the 12 discharged patients, 6 (50%) were discharged home or inpatient rehab, 4 (33%) to long-term acute care facility and 2 (17%) to their referring hospitals. There were no adverse events or circuit complications. No health care worker infection occurred. Discussion: Early and progressive mobility with a multidisciplinary team is safe and feasible in patients with COVID-19 supported by VV ECMO and may contribute to a high rate of weaning from extracorporeal support and survival to discharge.