Risque de poussée après le vaccin COVID-19 chez les patients atteints de sclérose en plaques en France : étude nationale de type « self-controlled case series »

Introduction Les patients ayant une sclérose en plaques (SEP) ont parfois des réticences concernant la vaccination, notamment en raison d'idées fausses qui ont été largement diffusées concernant la vaccination de l'hépatite B. Objectifs Étudier l'association entre la vaccination COVID-19 et le risque de survenue de poussées de SEP. Méthodes Les données du Système national des données de santé (SNDS, 68 millions de Français couverts) ont été utilisées pour identifier tous les patients présentant une SEP, et un algorithme a permis d'identifier toutes les poussées ayant nécessité un traitement par corticoïdes à fortes doses. Une méthode de type « self-controlled case series » a été utilisée pour comparer les périodes exposées à la vaccination à celles non exposées, globalement et dans des sous-groupes d'intérêt. Résultats Au total, 124 545 patients SEP ont été identifiés, dont plus de 80 % ont reçu au moins une dose vaccinale. Les patients ne présentaient aucune majoration du risque de poussée, que la période d'analyse porte sur les 6 ou les 12 semaines après la vaccination. Ces données étaient les mêmes après la deuxième dose vaccinale. Il existait même une légère diminution du risque de poussée pendant quelques semaines, dans les suites de chaque vaccination. Discussion Cette étude de grande ampleur, portant sur la France entière, et utilisant une méthodologie adaptée autocontrôlée (chaque patient étant son propre témoin), ne montre pas d'augmentation du risque de poussée de SEP après une vaccination contre le COVID, là où de nombreuses séries de cas de petit effectif avaient montré l'existence de poussées inflammatoires dans les suites de la vaccination. Conclusion Ces données très rassurantes permettent de poursuivre l'incitation vaccinale chez nos patients SEP, en particulier chez ceux ayant des facteurs de risque d'infection grave (âge, handicap, obésité, traitement par anti-CD20…).

Post-vaccine COVID-19 in patients with multiple sclerosis or neuromyelitis optica.

INTRODUCTION: Recent studies suggested that anti-CD20 and fingolimod may be associated with lower anti-spike protein-based immunoglobulin-G response following COVID-19 vaccination. We evaluated if COVID-19 occurred despite vaccination among patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), using the COVISEP registry. CASE SERIES: We report 18 cases of COVID-19 after two doses of BNT162b2-vaccination, 13 of which treated with anti-CD20 and four with fingolimod. COVID-19 severity was mild. DISCUSSION: These results reinforce the recommendation for a third COVID-19 vaccine dose among anti-CD20 treated patients and stress the need for a prospective clinical and biological study on COVID-19 vaccine efficacy among MS and NMO patients.

Nasopharyngeal swab-induced pain for SARS-CoV-2 screening: A randomised controlled trial of conventional and self-swabbing.

BACKGROUND: Massive screening campaigns for SARS-CoV-2 are currently carried out throughout the world, relying on reverse-transcriptase-polymerase chain reaction (RT-PCR) following nasopharyngeal swabbing performed by a healthcare professional. Yet, due to the apprehension of pain induced by nasopharyngeal probing, poor adhesion to those screening campaigns can be observed. To enhance voluntary participation and to avoid unnecessary exposition to SARS-CoV-2, self-swabbing could be proposed. To date, no data have been published concerning pain induced by conventional- or self-swabbing. Thus, the primary objective of the present study was to evaluate pain induced with the conventional swabbing method and compare it to self-swabbing. Secondary objectives focused on swabbing-induced discomfort and acceptability of the two methods. METHODS: The study was conducted in Clermont-Ferrand medical school (France). Overall, 190 students were randomised into two groups and experienced either self- or conventional-swabbing. Each subject had to rate pain, discomfort and acceptability of such swabbing on a 0-10 numeric rating scale. RESULTS: No significant difference was found between the two methods. The mean pain level was 2.5 ± 1.9, 28% rating pain as ≥4/10. Discomfort was 4.8 ± 2.2, 66% indicating significant (≥4/10) discomfort. Higher pain and discomfort were associated with female sex. Acceptability was ≥8/10 for 89.0% of the subjects and all would have accepted to undergo a new test with the same technique if necessary. CONCLUSION: Both conventional and self-swabbing induce low levels of pain for most young healthy volunteers whereas discomfort is very frequent. Nonetheless, both methods are indifferently well-accepted in medical students. Future studies amongst symptomatic subjects are awaited. SIGNIFICANCE: Using the thinnest available swabs, procedural pain induced by nasopharyngeal swabbing for SARS-CoV-2 screening is very low for most subjects and should not limit voluntary participation in screening campaigns. Self-swabbing does not lead to more pain or discomfort compared to conventional swabbing, is well-accepted, and could be proposed to optimize screening campaigns, at least in healthcare professionals.

High Prevalence of Headaches During Covid-19 Infection: A Retrospective Cohort Study.

OBJECTIVES: To document the prevalence of new headaches in patients with Covid-19 infection and the potential association with other neuro-sensorial symptoms (anosmia and ageusia). The persistence of these symptoms 1 month after recovery was also documented. BACKGROUND: Headaches are a very common symptom of viral infections. Surprisingly, early Chinese studies reported a relatively low prevalence (12-15%) of headaches associated with Covid-19. METHODS: All the patients with laboratory-confirmed or chest-CT-confirmed Covid-19 infection, diagnosed between February 27th and April 15th , 2020 in the dedicated laboratory of Clermont-Ferrand University Hospital were followed for 1 month after recovery. RESULTS: A total of 139 consecutive patients (mean [SD] age, 48.5 [15.3] years; 87 women [62.6%]) were interviewed 1 month after disappearance of fever and dyspnea (semi-structured phone interview). Overall, 59.0% (82/139) of people with Covid-19 had mild disease, 36.7% (51/139) had severe disease, and 4.3% (6/139) had critical illness. Eighty-two (59.0%; 95% CI: 50.3 to 67.3) reported new headaches during the acute phase and 3.6% (5/139) had persistent headaches 1 month after fever and dyspnea remission. Anosmia and ageusia were also very common, occurring in 60.4% (84/139) and 58.3% (81/139) of the patients, respectively. These 2 symptoms persisted in 14.4% (20/139) and 11.5% (16/139) of Covid-19 patients 1 month after recovery. Headaches were neither clearly associated with anosmia, nor with ageusia, and were not associated with disease severity (ie, requiring hospitalization or intensive care unit). CONCLUSION: This specific study highlights the high prevalence of new headaches during Covid-19 infection in French patients. Further studies are needed to refine the characterization of patients with Covid-19-associated headaches.