COVID-19 infection after SARS-CoV-2 mRNA vaccination in Multiple Sclerosis, AQP4-antibody NMOSD and MOGAD during the Omicron BA.1/2 wave in Singapore
Kevin Tan1, Janis Tye1, Xuejuan Peng1, Daniel Wong1, Tianrong Yeo1
1National Neuroscience Institute
Objective:
To determine the factors associated with breakthrough COVID-19 infection despite at least two SARS-CoV-2 mRNA vaccines in multiple sclerosis (MS), aquaporin-4 neuromyelitis optica spectrum disorder (AQP4-Ab NMOSD) and myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD) patients during the Omicron BA.1/2 wave in Singapore.
Background:
While SARS-CoV-2 Omicron variant appears to cause mild disease, its high transmissibility remains a concern amongst people with neuroimmunological diseases, especially those on disease-modifying therapies (DMTs).
Design/Methods:
We performed a prospective study at the National Neuroscience Institute (NNI), Singapore during the Omicron BA.1/2 wave from January to April 2022. Data (demographics, disease history, DMTs, vaccination records and COVID-19 infection status) was collected via clinic and/or teleconsultation from January to August 2022.
Results:
Two hundred and one patients were included – 125 MS, 65 AQP4-Ab NMOSD, and 11 MOGAD. Forty-seven had COVID-19 infection of whom 14 were on anti-CD20 therapies and 4 on fingolimod. Two infections were of moderate severity while the rest were mild. Anti-CD20 therapies and fingolimod were associated with COVID-19 infection (p=0.039) while the other DMTs were not. On survival analysis, time to infection after 3 vaccinations was shorter in anti-CD20 therapies and fingolimod (as a group) compared to other DMTs (HR 2.96, p=0.006) and to no DMTs (HR 2.74, p=0.025). Receipt of a third dose of vaccine was associated with fewer infections (33/176, 18.8%; crude rate of 11.3 infections per 1000 person-years) compared to 2 doses only (14/25, 56.0%; crude rate of 21.8 infections per 1000 person-years) (p<0.0001).
Conclusions:
Patients on anti-CD20 therapies and fingolimod are still at increased risk of COVID-19 infection after SARS-CoV-2 mRNA vaccinations although the majority of infections are mild. Receipt of a third dose confers additional protection, supporting the vaccination strategy in this group of patients.