Q&A: AAN issues guidance on COVID-19 vaccine

The American Academy of Neurology has issued what it described as a formal position that, barring an “absolute contraindication” to available vaccine formulations, eligible patients should be offered the COVID-19 vaccine.

Researchers published the position within the context of a larger paper in Neurology on COVID-19 and vaccination in the setting of neurologic disease. That paper evaluated the risks associated with COVID-19 among adults with neurological disorders and the possible risks related to vaccination, all based on data from current COVID-19 vaccination trials and previous research about responses to vaccines for other diseases. Researchers also offered guidance about the “optimal timing” of vaccination for individuals on immunotherapies and recommendations for those with specific neurological disorders, including neuromuscular disease, dementia and epilepsy, among others.

Healio Neurology spoke with Elisabeth B. Marsh, MD, FAHA, associate professor of neurology at Johns Hopkins University School of Medicine, director of Bayview Comprehensive Stroke Center and associate program director of the Johns Hopkins Hospital neurology residency program, to learn more about the research and its relevance for providers.

Healio Neurology: What prompted this research?

Marsh: There is so much uncertainty right now regarding COVID-19 and vaccination, particularly in patients with neurological disease. We wanted to follow the data to help determine the most appropriate recommendations for our patients.

Healio Neurology: What are the primary issues with COVID-19 among patients who have an underlying neurological illness?

Marsh: Certainly, patients with neurological disease have the same risks as others from infection with COVID-19. Fortunately, there is not currently evidence to suggest that infection puts our patients at higher risk for neurological complications, but we do know that having a condition where you already have significant functional disability, such as a stroke or weakness in the muscles you use to breathe or swallow due to myasthenia gravis, may put you at higher risk for poorer outcomes with infection. This is why vaccination is so important for these patients.

Healio Neurology: What do we know about COVID-19 vaccination among these patients?

Marsh: Fortunately, we have not seen greater risks for neurological adverse events post-vaccination in patients with neurological disease.

Healio Neurology: What can neurologists do to reassure their patients about getting the COVID-19 vaccine?

Marsh: It is important to put things in perspective. We are continuing to monitor reports of adverse events related to the vaccine. While they are concerning, the numbers are very small, particularly in comparison to the risks for adverse events after infection with the virus.

Healio Neurology: What specific issues should they address?

Marsh: Patients with neurological disease who are currently on immunosuppression also benefit from vaccination. However, providers might consider the timing of vaccination with respect to their treatment regimen. They can also look for evidence of decreased immunity following vaccination when counseling these patients, particularly as we begin to relax social distancing and mask mandates.

Healio Neurology: What are the most important strategies we have for increasing vaccine uptake in these patients?

Marsh: As always, it is important to listen to patients and build trust. Patients are trying to make the best decisions they can for themselves and their families. As physicians, it is our job to help them to understand the risks and benefits associated with vaccination. For most patients with neurological disease, the benefits of the COVID-19 vaccine far outweigh any potential risk.

Reference:

Marsh EB, et al. Neurology. 2021;doi:10.1212/WNL.0000000000012578.