Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
Pediatr Neurol. 2023 Jun;143:19-25. doi: 10.1016/j.pediatrneurol.2023.02.017. Epub 2023 Mar 2.
Currently, there are no data available on SARS-CoV-2 vaccine responses in pediatric-onset multiple sclerosis (POMS), and little is known about the course of SARS-CoV-2 infection in this age group. We therefore investigated humoral immune responses after COVID-19 vaccination and/or infection in POMS.
We retrospectively analyzed seroconversion rates and SARS-CoV-2-specific antibody levels in 30 POMS and one pediatric CIS patient treated with no disease-modifying therapy (no DMT), immunomodulatory DMT (IM-DMT), or immunosuppressive DMT (IS-DMT) from two Austrian MS centers.
The median age at MS onset was 15.39 years (interquartile range [IQR]: 1.97). The median age at the first COVID-19 vaccination was 17.43 years (IQR: 2.76). After two vaccine doses, seroconversion (≥0.8 BAU/ml) was reached in 25 of 28 patients (89.3%). All patients with no DMT or IM-DMT generated robust immune responses to vaccination (seroconversion: no DMT: 6/6, IM-DMT: 7/7 [100%]; median titers: no DMT: 2075 BAU [IQR: 1268.50], IM-DMT: 2500 BAU [IQR: 0]). In the IS-DMT group, seroconversion was achieved in 12 of 14 patients (80%), and median titers were 50.8 BAU (IQR 254.63). Titers were significantly higher in no DMT versus IS-DMT (P = 0.012) and in IM-DMT versus IS-DMT (P = 0.001). Infection with SARS-CoV-2 occurred in 11 of 31 patients, and symptoms were mild in all cases. One relapse occurred after infection, but no relapses were documented after vaccination.
Generally, mRNA vaccinations were well tolerated in POMS patients with and without DMT. Immune response was significantly reduced in patients treated with IS-DMT. No unexpected adverse events or relapses related to vaccinations were observed.
目前，尚无关于儿童发病多发性硬化症（POMS）中 SARS-CoV-2 疫苗反应的数据，并且对于该年龄段 SARS-CoV-2 感染的过程知之甚少。因此，我们研究了 COVID-19 疫苗接种和/或感染后 POMS 中的体液免疫反应。
我们回顾性分析了来自奥地利两个 MS 中心的 30 名 POMS 患者和 1 名儿科 CIS 患者在未接受疾病修正治疗（no DMT）、免疫调节 DMT（IM-DMT）或免疫抑制 DMT（IS-DMT）治疗时的血清转化率和 SARS-CoV-2 特异性抗体水平。
MS 发病的中位年龄为 15.39 岁（四分位距 [IQR]：1.97）。首次 COVID-19 疫苗接种的中位年龄为 17.43 岁（IQR：2.76）。接种两剂疫苗后，28 名患者中有 25 名（89.3%）达到血清转化率（≥0.8 BAU/ml）。所有未接受 DMT 或 IM-DMT 治疗的患者均对疫苗产生了强大的免疫反应（血清转化率：无 DMT：6/6，IM-DMT：7/7 [100%]；中位数滴度：无 DMT：2075 BAU [IQR：1268.50]，IM-DMT：2500 BAU [IQR：0]）。在 IS-DMT 组中，14 名患者中有 12 名（80%）达到血清转化率，中位数滴度为 50.8 BAU（IQR 254.63）。无 DMT 组的滴度明显高于 IS-DMT 组（P=0.012），IM-DMT 组的滴度也明显高于 IS-DMT 组（P=0.001）。31 名患者中有 11 名感染了 SARS-CoV-2，所有患者的症状均较轻。感染后发生了 1 次复发，但接种疫苗后没有记录到复发。
一般来说，在接受 DMT 和未接受 DMT 的 POMS 患者中，mRNA 疫苗接种均耐受良好。接受 IS-DMT 治疗的患者免疫反应明显降低。未观察到与疫苗接种相关的意外不良事件或复发。
