By now most people with MS have had, or have at least been offered, their first dose of the Covid-19 vaccine. Here at the MS Trust we've seen an increasing amount of questions regarding possible side effects and also how to prepare for the second dose.
To get some answers to these questions, we have once again spoken to neurologist Alasdair Coles from Addenbroke’s hospital in Cambridge.
Hi Alasdair! The first question is related to the AstraZeneca vaccine. There's been a lot of press coverage about this vaccine and recent government guidance is to offer an alternative option for the under 30s. Can you offer reassurance that this vaccine is safe for people, particularly people who are not so mobile?
I can understand everyone's concern about this because the headlines state that the AstraZeneca vaccine is associated with people having blood clots in the brain and that some of those people have died. This is really very worrying for people. Clearly this is a very serious potential side effect, so I think the important thing to bear in mind is just how rare this is. In the UK something like 79 cases have been described and of these 19 have died. This is out of a total of 20 million people who've received the vaccine, so if you do the sums, it comes to roughly one in a hundred thousand chance of having this side effect. So to put that in perspective, your chance of having a blood clot after the AstraZeneca vaccine are about the same as dying from a general anaesthetic and about the same as dying if you drive every day on the roads in England for a year. Those are the sort of risks we're talking about. It’s clearly a very worrying side effect and very unpleasant if you get it, but it’s extremely rare.
If you've had the first dose of the AstraZeneca vaccine and you're now worried about the second, can you take the second dose with a different vaccine or should you still stick to AstraZeneca?
I would encourage you to stick with the AstraZeneca vaccine. I think the benefits are likely to be greater than if you try another vaccine. However, if your anxiety is overwhelming and it would really be a big burden on you to take another dose of the AstraZeneca vaccine you could talk to your doctors or your GP or vaccine provider about it.
With regards to the Moderna vaccine, we had a question from someone who says they are allergic to contrast which is in the Moderna vaccine. They were scheduled to have this one, so what should they do?
Each vaccine comes with a list of things that the vaccine contains, which might be simple chemicals used to glue everything together in the vaccine shot that you're given. If you are potentially allergic, you should check that list. I looked up the Moderna ingredients and I didn't actually see contrast in there. So I think that it's a good question to ask and it's well worth clarifying before making any decisions.
This question is for all the different versions of the vaccine. If you reacted badly after the first jab, would you expect that to happen with the second? Should you still have the second jab if you had a bad reaction?
We've heard some people feel really rotten after the first time. People close to me have had a really bad experience of both the Pfizer and AstraZeneca vaccines, in terms of those general flu-like symptoms that you can get. Experience from both these vaccines and from other vaccines that we've used in the past, is that the second dose will be the same or slightly less in terms of the severity of side effects.
Is there anything that can be done before or after the vaccination to try and prevent some of these side effects? Like for instance taking paracetamol?
The side effects that are most common after vaccines make you feel like you've got the flu, so headaches, a fever, chills and shakes are all due to cytokines in the bloodstream. These are released in response to the vaccine or in response to a virus if you've got the flu, so it's the same sort of mechanism. Resting, drinking lots, keeping your temperature down if you can and taking paracetamol or aspirin to reduce your temperature will work. In the same spirit, taking paracetamol before you have the vaccine may also help to reduce these side effects.
How many people have had side effects after their first jab? Have any of them caused longer lasting MS symptoms or relapses?
The most common side effect is pain at the injection site, which 90% of people report. 70% of people have reported a headache or feeling a bit lousy. Something like 50% of people report muscle ache and people have documented a fever or high temperature in about 15% of all cases. So that's the normal rate. People with MS will experience all of those things, and may also experience a worsening of their neurological symptoms. Very commonly people might experience their legs going stiffer and weaker and their bladder becoming less reliable. This usually lasts for several days and, in all the cases that I'm aware of, resolves completely, with people returning to where they were before the vaccine within a week.
The explanation for this is very simple. People think "Oh my goodness, I'm having a relapse of my MS, this is a disaster" but actually I don't think it is that. It is the same explanation as when people’s symptoms get worse from an ordinary infection or if they get hot for some other reason. It’s due to the unreliability of nerves that have been damaged by MS in the past when the body gets hot. So symptoms from the past reappear or symptoms in the present will get worse because nerves are not very good at working and the body is hot. After a few days it should all settle down, I'm not aware of anyone having long lasting harm from those MS symptoms induced by the vaccine.
You mentioned bladder control, that somebody said that they lost bladder control the day after the vaccine. Is it likely that would happen again with the second dose?
Yes. I think all of these symptoms that people have experienced in the first day after your first dose might reoccur with the second dose. Just like with all potential side effects they could be the same or possibly slightly less severe with the second dose. But I'd encourage people not to let that put them off.
We've also heard a few people who said that they've had issues with their legs and mobility following the first dose. Is it still okay for them to take a second dose?
Yes. Naturally the worry that people might have is that they're causing themselves permanent harm by having these vaccines. Their walking or their bladder control will never be the same again and I can understand that. But I want to reassure people that that isn't the case, that these symptoms will resolve and people will get back to where they were before their first vaccine. We’ve spoken about taking paracetamol to help with side effects and I know some MS nurses have said that you should take it easy after you’ve had the vaccine.
I think people who haven't yet had their first vaccine, if there are any left, should expect to not feel great for a few days and should not plan difficult work things or social events, so they're not putting themselves under unnecessary strain at a time that they may not be feeling 100%.
A question that's not all completely MS related. Can the vaccine have an impact on fertility or future pregnancies?
I've heard concerns about this. It would be very worrying to think that taking a vaccine now might impair your chances of having a family in the future. I really don't understand this concern, I don't know where it's come from and it doesn't make sense to me scientifically. I've not seen any information on that. Clearly it would be very early days but I’m not aware of any vaccine that has an impact on fertility.
Does having the vaccine now mean that you can relax your guard and life can sort of return to normal? Or should we still be following social distancing?
Yes I mean it is a natural reaction, when you've had that second vaccination to think all the risks are over now. Unfortunately that isn't the case. I know this well because my poor son had mumps, when he was 11 years old despite the fact he'd had all the appropriate MMR vaccinations. Good reminder to me and it's a good reminder for everyone that vaccines aren't 100% effective at the individual level. Really what vaccines are intended to do is to give population immunity, that phrase herd immunity that we've heard a lot about. Your best chance of not getting Covid-19 is if the people around you are vaccinated, and if the people around them are vaccinated and if the whole nation is vaccinated and if we're all vaccinated. But at the level of the individual, if you've been vaccinated and you go into an area where there's a high Covid-19 rate, you may well still get Covid-19. The symptoms are likely to be less and the chance of severe disease is much likely to be less if you've been vaccinated. But it is certainly not a fool proof defence against personally getting Covid-19.
I think the first thing to do is to be honest about your own risk of severe Covid-19 disease. If you're a young, fit and healthy person with MS and you've been vaccinated, that risk is low. If you're older, if you're overweight with high blood pressure and diabetes, you know your risks of severe Covid-19 disease remain high. So firstly make a calculation about your own individual risk. Then think "well what risks am I willing to take in terms of my exposure to Covid-19?". Going to a crowded town centre is not a great idea if you're trying to avoid Covid-19 and that is still the case.
And my last question, is there any evidence about how severely people are affected who have been vaccinated and still caught Covid-19?
The evidence generally speaking, this isn't just for people with MS, but particularly older folk who've been vaccinated may well still get Covid-19 infection. But it's quite clear that the vaccination will protect them from the more severe forms of the illness. That's really good news. Of course the best bit of news is to remind everyone that we in the UK are doing fantastically well in terms of this Covid-19 vaccine rollout. I’d really encourage everyone to take part in that. Be good news to the people around you and get yourself vaccinated, if you haven't already done so! Just a reminder that if you are someone who is in a high risk category, then you should get vaccinated, but also those around you have a high priority for getting vaccinated now. If you're in a household with younger people who have not yet been offered the vaccine and yet you're in a high-risk group, then do talk to your local doctor or vaccine centre, because those in your household should be getting vaccinated soon as well.
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