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First manifestation of multiple sclerosis after immunization with the Pfizer-BioNTech COVID-19 vaccine.

J Neurol. 2021 Jun 11:1–4. doi: 10.1007/s00415-021-10648-w. Epub ahead of print. PMID: 34115170; PMCID: PMC8193159.

Authors/Editors: Havla J, Schultz Y, Zimmermann H, Hohlfeld R, Danek A, Kümpfel T.
Publication Date: 2021


Dear Sirs,

Vaccination against SARS-CoV-2 is critical to control the pandemic. Although there are not yet sufficient data regarding the COVID-19 risk of patients with multiple sclerosis (MS), it is likely that especially older MS patients with higher levels of disability and relevant comorbidities have a higher risk of complications from COVID-19 infection [1]. Therefore, vaccination against the SARS-CoV-2 virus is generally recommended in MS, as is vaccination against other infectious agents [2]. It is thought that vaccine-induced protection from infection by far outweighs the risk of autoimmune exacerbation. Regarding vaccination against SARS-CoV-2 virus, three cases of reactivation or new-onset demyelinating disease were reported after vaccination with Oxford-AstraZeneca COVID-19 recombinant adenovirus (ChAdOx1 nCoV-19; AstraZeneca) [3]. Professional societies and physicians are currently addressing vaccination concerns with an awareness campaign to promote high vaccination rates in the MS community who generally tends to be more skeptical about vaccination [4]. The vaccination campaign is supported by initial safety data in MS: a very recently published study in approximately 500 MS patients showed that the relapse rate after vaccination with the Pfizer-BioNTech COVID-19 vaccine was similar (approximately 2%) to the relapse rate in a comparative time period without vaccination [5]. Here we report on a vaccinated patient who experienced the initial clinical manifestation of MS on a background of previously unknown, but likely pre-existing subclinical inflammatory CNS disease.


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