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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(11): 1049-1061
DOI: 10.1590/0004-282X-ANP-2021-0162
Brazilian Academy of Neurology

Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system

Recomendações do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia (DCNI/ABN) e do Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla e Doenças Neuroimunológicas (BCTRIMS) sobre vacinação em geral e contra a SARS-CoV-2 para pacientes com doenças desmielinizantes do sistema nervoso central
Jefferson Becker 
1   Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil.
,
Lis Campos Ferreira 
2   Universidade Federal de Sergipe, Aracaju SE, Brazil.
3   Universidade Tiradentes, Aracaju SE, Brazil.
,
Alfredo Damasceno 
4   Universidade de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
,
Denis Bernardi Bichuetti 
5   Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil.
,
Paulo Pereira Christo 
6   Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.
,
Dagoberto Callegaro 
7   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Marco Aurélio Lana Peixoto 
6   Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.
,
Nise Alessandra De Carvalho Sousa 
8   Universidade Federal do Amazonas, Manaus AM, Brazil.
,
Sérgio Monteiro De Almeida 
9   Universidade Federal do Paraná, Curitiba PR, Brazil.
,
Tarso Adoni 
10   Hospital Sírio Libanês, São Paulo SP, Brazil.
,
Juliana Santiago-Amaral 
6   Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.
,
Thiago Junqueira 
11   Escola Bahiana de Medicina e Saúde Pública, Salvador BA, Brazil.
,
Samira Luisa Apóstolos Pereira 
7   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Ana Beatriz Ayroza Galvão Ribeiro Gomes 
7   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Milena Pitombeira 
12   Hospital Geral de Fortaleza, Fortaleza CE, Brazil.
,
Renata Barbosa Paolilo 
7   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Anderson Kuntz Grzesiuk 
13   Clínica Nossa Senhora das Graças, Cuiabá MS, Brazil.
,
Ana Claudia Piccolo 
14   Hospital Santa Marcelina, São Paulo SP, Brazil.
,
José Arthur Costa D´Almeida 
12   Hospital Geral de Fortaleza, Fortaleza CE, Brazil.
,
Antonio Pereira Gomes  Neto
15   Santa Casa, Belo Horizonte MG, Brazil.
,
Augusto Cesar Penalva De Oliveira 
16   Instituto de Infectologia Emílio Ribas, São Paulo SP, Brazil.
,
Bianca Santos De Oliveira 
17   Fundação Centro Integrado de Apoio ao Portador de Deficiência, João Pessoa PB, Brazil.
,
Carlos Bernardo Tauil 
18   Secretaria de Estado da Saúde, Brasília DF, Brazil.
,
Claudia Ferreira Vasconcelos 
19   Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.
,
Damacio Kaimen-Maciel 
20   Santa Casa, Londrina PR, Brazil.
,
Daniel Varela 
21   Hospital de Clínicas de Passo Fundo, Passo Fundo RS, Brazil.
,
Denise Sisterolli Diniz 
22   Universidade Federal de Goiás, Goiânia GO, Brazil.
,
Enedina Maria Lobato De Oliveira 
5   Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil.
,
Fabiola Rachid Malfetano 
23   Universidade Estácio de Sá, Rio de Janeiro RJ, Brazil.
,
Fernando Elias Borges 
24   Private Service, Goiânia GO, Brazil.
,
Fernando Faria Andrade Figueira 
25   Hospital São Francisco na Providência de Deus, Rio de Janeiro RJ, Brazil.
,
Francisco De Assis Aquino Gondim 
26   Universidade Federal do Ceará, Fortaleza CE, Brazil.
,
Giordani Rodrigues Dos Passos 
1   Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil.
,
Guilherme Diogo Silva 
7   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Guilherme Sciascia Do Olival 
27   Associação Brasileira de Esclerose Múltipla, São Paulo SP, Brazil.
28   Santa Casa, São Paulo SP, Brazil.
,
Gutemberg Augusto Cruz Dos Santos 
23   Universidade Estácio de Sá, Rio de Janeiro RJ, Brazil.
29   Universidade Federal Fluminense, Niterói RJ, Brazil.
,
Heloisa Helena Ruocco 
29   Universidade Federal Fluminense, Niterói RJ, Brazil.
30   Pontifícia Universidade Católica, Campina SP, Brazil.
,
Henry Koiti Sato 
31   Instituto de Neurologia de Curitiba, Curitiba PR, Brazil.
,
Herval Ribeiro Soares  Neto
32   IAMSPE, São Paulo SP, Brazil.
,
Leandro Cortoni Calia 
33   Private Service, São Paulo SP, Brazil.
,
Marcus Vinícius Magno Gonçalves 
34   Universidade da Região de Joinville, Joinville SC, Brazil.
,
Maria Cecilia Aragón De Vecino 
35   Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
,
Maria Lucia Vellutini Pimentel 
36   Santa Casa, Rio de Janeiro RJ, Brazil.
,
Marlise De Castro Ribeiro 
37   Universidade Federal Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil.
,
Mateus Boaventura 
7   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Mônica Koncke Fiuza Parolin 
38   Private Service, Curitiba PR, Brazil.
,
Renata Brant De Souza Melo 
15   Santa Casa, Belo Horizonte MG, Brazil.
,
Robson Lázaro 
39   Faculdade de Medicina de Jundiaí, Jundiaí SP, Brazil.
,
Rodrigo Barbosa Thomaz 
40   Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
,
Rodrigo Kleinpaul 
6   Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.
,
Ronaldo Maciel Dias 
41   Hospital de Base do Distrito Federal, Brasília DF, Brazil.
,
Sidney Gomes 
42   Hospital Beneficiência Portuguesa, São Paulo SP, Brazil.
,
Simone Abrante Lucatto 
43   Hospital Regional de Vilhena, Vilhena RO, Brazil.
,
Soniza Vieira Alves-Leon 
44   Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro RJ, Brazil.
,
Thiago Fukuda 
45   Hospital Universitário Prof. Edgar Santos, Salvador BA, Brazil.
,
Taysa Alexandrino Gonsalves Jubé Ribeiro 
22   Universidade Federal de Goiás, Goiânia GO, Brazil.
,
Thereza Cristina D'ávila Winckler 
38   Private Service, Curitiba PR, Brazil.
,
Yara Dadalti Fragoso 
46   Universidade Metropolitana de Santos, Santos SP, Brazil.
,
Osvaldo José Moreira Do Nascimento 
23   Universidade Estácio de Sá, Rio de Janeiro RJ, Brazil.
29   Universidade Federal Fluminense, Niterói RJ, Brazil.
,
Maria Lucia Brito Ferreira 
47   Hospital da Restauração, Recife PE, Brazil.
,
Maria Fernanda Mendes 
28   Santa Casa, São Paulo SP, Brazil.
,
Doralina Guimarães Brum 
48   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil.
,
Felipe Von Glehn 
4   Universidade de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
49   Universidade de Brasília, Faculdade de Medicina, Brasília DF, Brazil.
,
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ABSTRACT

The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.

RESUMO

O DC de Neuroimunologia da ABN e o BCTRIMS trazem, nesse documento, as recomendações sobre vacinação da população com doenças desmielinizantes do sistema nervoso central (SNC) contra infecções em geral e contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), causador da COVID-19. Destaca-se a gravidade do atual momento frente ao avanço da COVID-19 em nosso País, o que torna mais evidente e importante a criação de guia de referência para orientação aos médicos, pacientes e autoridades de saúde pública quanto à vacinação, meio efetivo e seguro no controle de determinadas doenças infecciosa. O DCNI/ABN e o BCTRIMS recomendam que os pacientes com doenças desmielinizantes do SNC (ex., EM e NMOSD) sejam constantemente monitorados, quanto a atualização do seu calendário vacinal, especialmente, no início ou antes da mudança do tratamento com uma droga modificadora de doença (DMD). É importante também salientar que as vacinas são seguras e os médicos devem estimular o seu uso em todos os pacientes. Evidentemente, deve ser dada especial atenção às vacinas com vírus vivos atenuados. Por fim, é importante que os médicos verifiquem qual DMD o paciente está em uso e quando foi feita a sua última dose, pois cada fármaco pode interagir de forma diferente com a indução da resposta imune.

Keywords:

Demyelinating Autoimmune Diseases, CNS - Multiple Sclerosis - Neuromyelitis Optica - Vaccination - COVID-19 - SARS-CoV-2

Palavras-chave:

Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central - Esclerose Múltipla - Neuromielite Óptica - Vacinação - COVID-19 - SARS-CoV-2

Author’s contributions:

JB, LCF, AD, DBB, PC, DG, MALP, NACS, SMA, TA, JSA, TJ, SLAP, ABAGRG, MP, RP: conceptualization, writing of original draft, methodology; JB, FG: project administration and supervision; JB, LCF, AD, DBB, PC, DG, MALP, NACS, SMA, TA, JSA, TJ, SLAP, ABAGRG, MP, RP: writing, review & editing; AKG, ACP, JAA, APGN, ACPO, BSO, CBT, CFV, DKM, DV, DS, EMLO, FRM, FEB, FFAF, FAAG, GRP, GDS, GSO, GACS, HHR, HKS, HRSN, LCC, MVMG, MCAV, MLVP, MCR, MB, MKFP, RBSM, RL, RBT, RK, RMD, SG, SAL, SAL, TF, TAGJR, TCAW, YF, OJMN, MLBF, MFM, DGB, FG: final approval by all participants of the Neuroimmunology Brazilian Study Group.


Supplementary material



Publikationsverlauf

Eingereicht: 24. April 2021

Angenommen: 30. Mai 2021

Artikel online veröffentlicht:
04. Juli 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Faria NR, Mellan TA, Whittaker C, Claro IM, Candido D da S, Mishra S, et al. Genomics and epidemiology of the P.1 SARS-CoV-2 lineage in Manaus, Brazil. Science. 2021 May 21;372(6544):815-21. https://doi.org/10.1126/science.abh2644
  • 2 Hussein IH, Chams N, Chams S, El Sayegh S, Badran R, Raad M, et al. Vaccines through centuries: major cornerstones of global health. Front Public Health. 2015 Nov 26;3:269. https://doi.org/10.3389/fpubh.2015.00269
  • 3 Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008 Feb;86(2):140-6. https://doi.org/10.2471/blt.07.040089
  • 4 Murphy K, Weaver C. Janeway’s Immunobiology. 9th edition. New York (NY): Garland Science; 2017. 887p.
  • 5 Brasil, Ministério da Saúde. Instrução normativa referente ao Calendário de Vacinação 2020 [Internet]. 2020 [cited 2021 Mar 2];2:1-28. Available from: https://www.saude.gov.br/images/pdf/2020/marco/04/Instru----o-Normativa-Calend--rio-Vacinal-2020.pdf
  • 6 Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tombly M, et al. Executive summary: 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014 Feb 1;58:309-18. https://doi.org/10.1093/cid/cit816
  • 7 Montassier HJ. Vacinas e imunoterapia [Internet]. 2015 [cited 2021 Jan 10]. Available from: https://www.fcav.unesp.br/Home/departamentos/patologia/HELIOJOSEMONTASSIER/aula-12--vacinas-e-imunoterapia.pdf
  • 8 Ciotti JR, Valtcheva MV, Cross AH. Effects of MS disease-modifying therapies on responses to vaccinations: a review. Mult Scler Relat Disord. 2020 Oct 1;45:102439. https://doi.org/10.1016/j.msard.2020.102439
  • 9 Miller ER, Moro PL, Cano M, Shimabukuro TT. Deaths following vaccination: What does the evidence show? Vaccine. 2015 Jun 26;33(29):3288-92. https://doi.org/10.1016/j.vaccine.2015.05.023
  • 10 Reyes S, Ramsay M, Ladhani S, Amirthalingam G, Singh N, Cores C, et al. Protecting people with multiple sclerosis through vaccination. Pract Neurol. 2020 Dec;20(6):435-45. https://doi.org/10.1136/practneurol-2020-002527
  • 11 Farez MF, Correale J, Armstrong MJ, Rae-Grant A, Gloss D, Donley D, et al. Practice guideline update summary: vaccine-preventable infections and immunization in multiple sclerosis: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Neurology. 2019 Sep 24;93(13):584-94. https://doi.org/10.1212/WNL.2021016220210162815
  • 12 Brasil, Ministério da Saúde. Manual dos centros de referência para imunobiológicos especiais [Internet]. 5th ed. Brasília: Ministério da Saúde; 2019 [cited 2021 Mar 10]. 174p. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/manual_centros_imunobiologicos_%0Aespeciais_5ed.pdf
  • 13 Lebrun C, Vukusic S. Immunization and multiple sclerosis: recommendations from the French Multiple Sclerosis Society. Rev Neurol (Paris). 2019 Jun;175(6):341-57. https://doi.org/10.1016/j.neurol.2019.04.001
  • 14 Mokhtarian F, Shirazian D, Morgante L, Miller A, Grob D, Lichstein E. Influenza virus vaccination of patients with multiple sclerosis. Mult Scler J. 1997 Aug 1;3(4):243-7. https://doi.org/10.1177/135245859700300405
  • 15 Zrzavy T, Kollaritsch H, Rommer PS, Boxberger N, Loebermann M, Wimmer I, et al. Vaccination in multiple sclerosis: Friend or foe? Front Immunol. 2019 Aug 7;10:1883. https://doi.org/10.3389/fimmu.2019.01883
  • 16 Bar-Or A, Freedman MS, Kremenchutzky M, Menguy-Vacheron F, Bauer D, Jodl S, et al. Teriflunomide effect on immune response to influenza vaccine in patients with multiple sclerosis. Neurology. 2013 Aug 6;81(6):552-8. https://doi.org/10.1212/WNL.0b013e31829e6fbf
  • 17 Olberg HK, Eide GE, Cox RJ, Jul-Larsen Å, Lartey SL, Vedeler CA, et al. Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy. Eur J Neurol. 2018 Mar;25(3):527-34. https://doi.org/10.1111/ene.13537
  • 18 Bar-Or A, Wiendl H, Miller B, Benamor M, Truffinet P, Church M, et al. Randomized study of teriflunomide effects on immune responses to neoantigen and recall antigens. Neurol Neuroimmunol Neuroinflammation. 2015 Feb 12;2(2):e70. https://doi.org/10.1212/NXI.20210162202101620070
  • 19 Von Hehn C, Howard J, Liu S, Meka V, Pultz J, Mehta D, et al. Immune response to vaccines is maintained in patients treated with dimethyl fumarate. Neurol Neuroimmunol Neuroinflammation. 2017 Nov 15;5(1):e409. https://doi.org/10.1212/NXI.20210162202101620409
  • 20 Kappos L, Mehling M, Arroyo R, Izquierdo G, Selmaj K, Curovic-Perisic V, et al. Randomized trial of vaccination in fingolimod-treated patients with multiple sclerosis. Neurology. 2015 Mar 3;84(9):872-9. https://doi.org/10.1212/WNL.20210162202101621302
  • 21 Metze C, Winkelmann A, Loebermann M, Hecker M, Schweiger B, Reisinger EC, et al. Immunogenicity and predictors of response to a single dose trivalent seasonal influenza vaccine in multiple sclerosis patients receiving disease-modifying therapies. CNS Neurosci Ther. 2019 Feb;25(2):245-54. https://doi.org/10.1111/cns.13034
  • 22 Mehling M, Hilbert P, Fritz S, Durovic B, Eichin D, Gasser O, et al. Antigen-specific adaptive immune responses in fingolimod-treated multiple sclerosis patients. Ann Neurol. 2011 Feb;69(2):408-13. https://doi.org/10.1002/ana.22352
  • 23 Signoriello E, Bonavita S, Sinisi L, Russo CV, Maniscalco GT, Casertano S, et al. Is antibody titer useful to verify the immunization after VZV vaccine in MS patients treated with fingolimod? A case series. Mult Scler Relat Disord. 2020 May;40:101963. https://doi.org/10.1016/j.msard.2020.101963
  • 24 Kaufman M, Pardo G, Rossman H, Sweetser MT, Forrestal F, Duda P. Natalizumab treatment shows no clinically meaningful effects on immunization responses in patients with relapsing-remitting multiple sclerosis. J Neurol Sci. 2014 Jun 15;341(1-2):P22-7. https://doi.org/10.1016/j.jns.2014.03.035
  • 25 Olberg HK, Cox RJ, Nostbakken JK, Aarseth JH, Vedeler CA, Myhr KM. Immunotherapies influence the influenza vaccination response in multiple sclerosis patients: an explorative study. Mult Scler. 2014 Jul 1;20(8):1074-80. https://doi.org/10.1177/1352458513513970
  • 26 Bar-Or A, Calkwood JC, Chognot C, Evershed J, Fox EJ, Herman A, et al. Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: the VELOCE study. Neurology. 2020 Oct;95(14):e1999-2008. https://doi.org/10.1212/WNL.202101620000010380
  • 27 McCarthy CL, Tuohy O, Compston DAS, Kumararatne DS, Coles AJ, Jones JL. Immune competence after alemtuzumab treatment of multiple sclerosis. Neurology. 2013 Sep 3;81(10):872-6. https://doi.org/10.1212/WNL.0b013e3182a35215
  • 28 Roy S, Boschert U. P059 - Analysis of influenza and varicella zoster virus vaccine antibody titers in patients with relapsing multiple sclerosis treated with cladribine tablets [Internet]. ACTRIMS Forum Virtual. 2021 [cited 2021 May 15]. Available from: https://www.abstractsonline.com/pp8/#!/9245/presentation/160
  • 29 Bingham CO, Looney RJ, Deodhar A, Halsey N, Greenwald M, Codding C, et al. Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial. Arthritis Rheum. 2010 Jan;62(1):64-74. https://doi.org/10.1002/art.2503
  • 30 van Assen S, Holvast A, Benne CA, Posthumus MD, van Leeuwen MA, Voskuyl AE, et al. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum. 2010 Jan;62(1):75-81. https://doi.org/10.1002/art.25033
  • 31 Eisenberg RA, Jawad AF, Boyer J, Maurer K, McDonald K, Prak ETL, et al. Rituximab-treated patients have a poor response to influenza vaccination. J Clin Immunol. 2013 Feb;33(2):388-96. https://doi.org/10.1007/s10875-012-9813-x
  • 32 Kim W, Kim S-H, Huh S-Y, Kong S-Y, Choi YJ, Cheong HJ, et al. Reduced antibody formation after influenza vaccination in patients with neuromyelitis optica spectrum disorder treated with rituximab. Eur J Neurol. 2013 Jun;20(6):975-80. https://doi.org/10.1111/ene.12132
  • 33 Dotan I, Werner L, Vigodman S, Agarwal S, Pfeffer J, Horowitz N, et al. Normal response to vaccines in inflammatory bowel disease patients treated with thiopurines. Inflamm Bowel Dis. 2012 Feb 1;18(2):261-8. https://doi.org/10.1002/ibd.21688
  • 34 Andrade P, Santos-Antunes J, Rodrigues S, Lopes S, Macedo G. Treatment with infliximab or azathioprine negatively impact the efficacy of hepatitis B vaccine in inflammatory bowel disease patients. J Gastroenterol Hepatol. 2015 Nov;30(11):1591-5. https://doi.org/10.1111/jgh.13001
  • 35 McMahan ZH, Bingham CO 3rd. Effects of biological and non-biological immunomodulatory therapies on the immunogenicity of vaccines in patients with rheumatic diseases. Arthritis Res Ther. 2014 Dec 23;16(6):506. https://doi.org/10.1186/s13075-014-0506-0
  • 36 Kapetanovic MC, Roseman C, Jönsson G, Truedsson L, Saxne T, Geborek P. Antibody response is reduced following vaccination with 7-valent conjugate pneumococcal vaccine in adult methotrexate-treated patients with established arthritis, but not those treated with tumor necrosis factor inhibitors. Arthritis Rheum. 2011 Dec;63(12):3723-32. https://doi.org/10.1002/art.30580
  • 37 van Aalst M, Langedijk AC, Spijker R, de Bree GJ, Grobusch MP, Goorhuis A. The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: a systematic review and meta-analysis. Vaccine. 2018 Sep 18;36(39):5832-45. https://doi.org/10.1016/j.vaccine.2018.07.039
  • 38 Park JK, Lee YJ, Shin K, Ha Y-J, Lee EY, Song YW, et al. Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2018 Jun;77(6):898-904. http://doi.org/10.1136/annrheumdis-2018-213222
  • 39 WHO. Coronavirus (COVID-19) Dashboard [Internet]. World Health Organization; 2021 [cited 2021 May 15]. Available from: https://covid19.who.int/
  • 40 Brownlee W, Bourdette D, Broadley S, Killestein J, Ciccarelli O. Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic. Neurology. 2020 Jun 2;94(22):949-52. http://doi.org/10.1212/WNL.20210162202101629507
  • 41 Vetter V, Denizer G, Friedland LR, Krishnan J, Shapiro M. Understanding modern-day vaccines: what you need to know. Ann Med. 2018 Mar;50(2):110-20. https://doi.org/10.1080/07853890.2017.1407035
  • 42 van Riel D, de Wit E. Next-generation vaccine platforms for COVID-19. Nat Mater. 2020 Aug;19(8):810-2. https://doi.org/10.1038/s41563-020-0746-0
  • 43 REDONE.br - Neuroimmunology Brazilian Study Group Focused on COVID-19 and MS. Incidence and clinical outcome of Coronavirus disease 2019 in a cohort of 11,560 Brazilian patients with multiple sclerosis. Mult Scler J. 2021 Feb 2;1352458520978354. https://doi.org/10.1177/1352458520978354
  • 44 Shimabukuro T. COVID-19 vaccine safety update [Internet]. National Center for Immunization & Respiratory Diseases, Centers for Disease Control and Prevention; 2021 [cited 2021 May 20]. Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-01/06-covid-shimabukuro.pdf
  • 45 Agência Nacional de Vigilância Sanitária. Vacina COVID-19 (recombinante) [Internet]. FIOCRUZ; 2021 [cited 2021 May 20]. Available from: https://consultas.anvisa.gov.br/#/bulario/q/?nomeProduto=VACINA COVID-19
  • 46 Instituto Butantan. Vacina adsorvida COVID-19 (inativada) [Internet]. 2021 [cited 2021 May 20]. Available from: https://vacinacovid.butantan.gov.br/bulas