There are a number of case-control studies for inactivated vaccines, which include the vaccines against COVID19. A causal relationship between vaccination and disease activity could never be found in these studies (1). “On the contrary,” says Prof. Mathias Mäurer, spokesman for the specialist committee on care structures and therapeutics at the KKNMS and member of the medical advisory board of the DMSG Federal Association, “it is more likely to be found evidence a lower disease activity, because vaccinations have been proven to protect against infections or weaken them and thus offer “indirect” protection MS– Disease activity frequently observed in connection with wild-type infections “.
A study from Israel on the COVID19 vaccination of over 500 patients with MS found that 2.1 percent of people vaccinated with the first vaccination with the vaccine from Biontech / Pfizer MS a thrust Suffered after the second vaccination were 1.6 percent of the cohort MS– Documented thrusts. This percentage corresponds to the expected number of attacks in the comparison period from 2017 to 2020, i.e. before the availability of the COVID19 vaccination. The numbers thus confirm a coincidence of attacks and vaccination and make a causal relationship unlikely (2).
Another vaccination study from Italy confirms this observation. Two months after the COVID19 vaccination of 324 people with MS with the vaccines from Biontech / Pfizer and Moderna, 2.2 percent of the cohort was one MS thrust documented, two months before vaccination, 1.9 percent of the cohort suffered one MS thrust. These data also show that vaccination does not lead to changes in disease activity and not as causal for the occurrence of MS Relapses can be viewed.
What is feared again and again in connection with the COVID19 vaccination Acute Transverse Myelitis (ATM, an acute inflammation of the spinal cord), it must first be made clear that most cases with this complication were caused by an infection with SARS CoV2 (n = 43), only 3 cases were described in connection with a COVID19 vaccination, and only with the vector vaccine from AstraZeneca, which is currently of minor importance for the vaccination campaign in Germany. It cannot be ruled out in principle that the three cases are an immunological cross-reaction, but these few cases currently have no effect on the basic risk-benefit assessment of the COVID19 vaccination. This is also confirmed by the current safety report from the Paul Ehrlich Institute (PEI), which systematically lists the myelitis cases that have occurred in Germany in connection with vaccination (5).
Of course, there are also individual case reports in the literature of severe relapses that occurred in connection with the COVID19 vaccination (6). This should also correspond to the individual experiences of neurologists and patients in recent months. But you have to realize that at a time when thousands of people are vaccinated every day, a temporal connection between the vaccinations and different medical events can naturally be observed without a direct causal connection being assumed. It must be remembered again that individual narratives are unable to answer an overall question – this can only be achieved through controlled studies.
In view of this situation, the disease-related competence network see themselves MS (KKNMS) and the German MS Gesellschaft (DMSG), Bundesverband eV to issue the following statement, which according to Prof. Dr. med. Frauke Zipp (on the board of the KKNMS, the medical advisory board of the DMSG, and on the steering committee of the advisory board of the MS International Federation MSIF and for vaccination recommendations ) corresponds to the international vaccination recommendations:
- There is currently no scientific evidence that vaccination against COVID19 leads to an increase in activity or an increase in relapses in MS.
- The MS is therefore not an obstacle to vaccination against COVID19, the individual benefit of the vaccination outweighs the individual risk of an MS patient.
- Nevertheless, there may be (rare) individual constellations in which vaccination has to be suspended or delayed in MS patients. However, this decision should be made in consultation with an experienced MS practitioner on the basis of the individual medical history. General practitioners and neurologists with little experience in MS treatment should not issue blanket certificates against vaccination if the sole reason is the MS diagnosis.
- The use of MS immunotherapy – of whatever kind – does not represent a contraindication to the COVID19 vaccination the advantages mentioned above should also be used. The only problem in these cases is that the vaccination response may be impaired, which is why booster vaccinations can be considered. (see KKNMS statement of August 6, 2021 (8)
Corona vaccination and MS: A high level of participation in the vaccination observation study by the Dt. MS-Registers of Germans Multiple Sclerosis Gesellschaft, Bundesverband eV can help, among other things, to better understand the issues of side effects or relapse events in the temporal context of the vaccination.
 Zrzavy T, Kollaritsch H, Rommer PS, Boxberger N, Loebermann M, Wimmer I, Winkelmann A, Zettl UK. Vaccination in Multiple Sclerosis: Friend or Foe? Front Immunol. 2019 Aug 7;10:1883. doi: 10.3389/fimmu.2019.01883. PMID: 31440255; PMCID: PMC6693409.
 Anat Achiron, Mark Dolev, Shay Menascu, Daniela-Noa Zohar, Sapir Dreyer-Alster, Shmuel Miron, Emanuel Shirbint, David Magalashvili, Shlomo Flechter, Uri Givon, Diana Guber, Yael Stern, Michael Polliack, Rina Falb, Michael Gurevich Mult Scler . 2021 May; 27 (6): 864–870. Published online 2021 Apr 15. doi: 10.1177 / 135245852110034
 Di Filippo M, Cordioli C, Malucchi S, et al mRNA COVID-19 vaccines do not increase the short-term risk of clinical relapses in multiple sclerosis Journal of Neu-rology, Neurosurgery & Psychiatry Published Online First: 18 August 2021. doi: 10.1136/jnnp-2021-327200
 Gustavo C. Román, Fernando Gracia, Antonio Torres, Alexis Palacios, Karla Gracia, Diógenes Harris. Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021; 12: 653786. Published online 2021 Apr 26. doi: 10.3389/fimmu.2021.653786
(5) www.pei.de/DE/newsroom/dossier/coronavirus/coronavirus- inhalt.html? Cms_pos = 6)
(6) Maniscalco GT, Manzo V, Di Battista ME, Salvatore S, Moreggia O, Scavone C, Capuano A. Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report)
 www.msif.org/wp-content/uploads/2021/06/June-2021-MSIF-Global- advice-on-COVID-19-for-people-with-MS-FINAL.pdf
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