Impact of COVID-19 infection and COVID vaccinations on the management of MS and related disorders in a low middle income country-real world experience from a demyelinating disease registry

Background and objective: The impact of COVID-19 infection and the effect of vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccinations in patients with MS and related disorders in order to develop management guidelines relevant to our patients. Method(s): A total of 621 patients (297 MS and 324 non MS disorders) from our registry were contacted. COVID-19 infection and vaccination status were queried. Patients who had infection were compared with noninfected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. Result(s): Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 13 patients were hospitalized, all of whom recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. Multivariate analysis of all patients with MS and related disorders showed that higher mean body mass index(BMI [p - 0.002, OR- 0.86,95% CI - 0.78-0.94]), presence of >= 1 comorbidity ( p-0.005, OR- 3.57,95% CI- 1.46- 8.7) and concurrent treatment with disease modifying therapy(p- 0.004, OR- 2.80, 95% CI- 1.39- 5.6)were significantly associated with risk of COVID-19 infection. Vaccination against COVID-19 infection was strongly protective (p- 0.0001, OR- 0.10, 95% CI- 0.05- 0.20). In the unvaccinated group, patients on treatment ( 61% were on nonspecific immunosuppressants) were significantly at risk of Covid-19 infection (p- 0.001, OR- 10.1, 95% CI- 4.59- 22.22) when compared to untreated patients. Conclusion(s): Frequency and severity of COVID-19 infection was low among our patient cohort.Higher rate of infection in the treated group was significant among unvaccinated patients. Our preliminary results suggests that in LMIC's, where off label therapies with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and protective against severe COVID-19 infection.

COVID-19 infection and vaccination against COVID-19: Impact on managing demyelinating CNS disorders in Southern India- experience from a demyelinating disease registry.

BACKGROUND AND OBJECTIVE: The impact of COVID-19 infection and the effect of COVID-19 vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccination in order to develop management guidelines relevant to our patients. METHODS: A total of 621 patients from our registry that included 297 MS and 324 non MS disorders (Aquaporin- 4 antibody positive [50], Myelin oligodendrocyte glycoprotein antibody positive [81], seronegative [162] and clinically isolated syndrome [31]) were contacted. COVID-19 infection and vaccination status were queried. Patients who self reported COVID-19 infection based on a positive RT PCR report were compared with non infected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. RESULTS: Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 81 patients had mild infection and remained quarantined at home. All 13 patients who needed hospitalization recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. In univariate analysis, presence of ≥1 comorbidity was significantly associated with COVID-19 infection in both MS (p value 0.01, OR-2.28, 95%CI- 1.18-4.4) and non MS patients (p- 0.001, OR-4.4, 95% CI-1.88-10.24). In the latter, BMI ≥ 30 (p-0.04, OR-3.27, 95% CI- 0.98-10.87) and EDSS score ≥ 3 (p-0.02, OR- 2.59,95% CI- 1.08-6.23) were other significant associations. History of prior COVID-19 vaccination was associated with reduced frequency of COVID-19 infection among MS (p- 0.001,OR- 0.24,95% CI- 0.13-0.43) and non MS patients (p- 0.0001,OR-0.14, 95% CI- 0.058-0.35). In multivariate analysis presence of comorbidities significantly increased and prior vaccination significantly reduced frequency of COVID-19 infection for both MS and related disorders. Concurrent disease modifying treatments showed a trend for association with infection. In the unvaccinated group, patients on disease modifying treatment were significantly at risk of infection, 81.5% unvaccinated and treated versus 18.5% who were unvaccinated and untreated (p- 0.0001, OR-10.1, 95% CI-0.56-2.11). CONCLUSION: Frequency and severity of COVID-19 infection was low among our patient cohort. Higher rate of infection in the treated group was significantly seen among unvaccinated patients. Our preliminary results suggests that in LMIC's, where "off label therapies" with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and effective against severe COVID-19 infection.

Risk Factors and Therapeutic Interventions Associated with Mortality in Veterans Diagnosed with SARS-CoV-2 Infection (or COVID-19) Admitted to a Large Academic Medical Center

Background. Patient and treatment-related factors have been used to stratify COVID-19 outcomes;however, studies in the general population and specifically veterans have yielded variable results. This study was designed to assess how baseline characteristics and interventions correlate with clinical outcomes in patients admitted with COVID-19 at a large academic Veterans Affairs hospital. Methods. Retrospective chart review was conducted on veterans admitted to the hospital with COVID-19 between March 1 to December 31, 2020. Veterans without respiratory symptoms attributed to COVID-19 or enrolled in a COVID-19 clinical trial were excluded. Primary outcome was in-hospital mortality up to 28 days. Secondary outcomes were 90-day mortality, discharge to higher level of care or remained in the hospital within 28 days, and discharge with new oxygen requirement within 28 days. Patient characteristics and therapeutic interventions were assessed for correlation with primary and secondary outcomes. Results. Of 497 hospitalized patients reviewed, 293 were included for analysis;94% were male;average age was 68 years with 64.9% of veterans greater than 65 years of age;43.7% were Black;17.4% were Hispanic. In-hospital mortality at 28-days and 90-day mortality were 18.1% and 21.5%, respectively. At discharge, 34.1% had a new oxygen requirement and 17.5% went to a higher level of care. Patients that died in-hospital were more likely to be greater than 65 years of age (p< 0.001), Hispanic (p=0.007), have chronic kidney disease (CKD) (p=0.005), be admitted to ICU (p< 0.001);receive dexamethasone (p< 0.001), convalescent plasma (p< 0.001), or antibiotics (p< 0.001);require mechanical ventilation (p< 0.001);or have new onset atrial fibrillation (p< 0.001). Veterans also had higher levels of inflammatory markers within 48 hours of hospital admission (see Table 2) and longer length of hospital stay (< 0.001). There was a trend for patients that died in the hospital within 28-days to be less likely to be Black (p=0.06). Conclusion. Patients were more likely to die in-hospital within 28-days if they were greater than 65 years of age, Hispanic and had CKD. Veterans that died in-hospital within 28-days had higher inflammatory marker levels and were more likely to receive COVID-19 treatments.