Q: What are the different types of COVID-19 vaccines?

A: Globally, there are a number of different types of COVID-19 vaccines either in use or in development against the novel coronavirus (SARS-CoV-2) that causes COVID-19. They include messenger RNA (mRNA) vaccines and viral vector-based vaccines. None of these vaccines contain live virus, which means the vaccines cannot give you the virus or cause infection. For more information on types of vaccines, please find overview here.

Q: Which COVID-19 vaccines are approved for use in Canada?

A: The following four COVID-19 vaccines have been approved for use in Canada: PfizerBioNTech COVID19 mRNA vaccine, Moderna Therapeutics COVID-19 mRNA vaccine, AstraZeneca/COVISHIELD COVID-19 vaccine, Johnson & Johnson COVID-19 vaccine, Novavax COVID-19 vaccine, and Medicago COVID-19 vaccine.

To optimize safety for Canadians based on current evidence and recommendations, mRNA vaccines are being preferentially given in Canada (Pfizer and Moderna vaccines). NACI recommends that an authorized recombinant protein subunit COVID-19 vaccine (Novavax) or recombinant VLP COVID-19 vaccine (Medicago) may be offered to individuals in the authorized age group without contraindications to the vaccine who are not able or willing to receive an mRNA COVID-19 vaccine.

Q: How do I learn more about COVID-19 vaccines and MS

A: The MS Society of Canada held an educational session with Dr. Jodie Burton from the University of Calgary on February 8, 2021. Find a link to the webinar here - Hear From the Experts: COVID-19 vaccines and MS. Future educational sessions will be provided with more updates.

Q: Do MS DMTs reduce the effectiveness of the COVID-19 vaccines?

A: People with MS taking certain DMTs (ocrelizumab, rituximab, ofatumumab, fingolimod, siponimod, ozanimod and ponesimod) may have a blunted vaccine response (i.e., reduction in the amount of vaccine-induced antibodies). However, even if your antibodies are undetectable or low, you could still be relatively protected from COVID-19 as other components of the immune system are activated by the vaccine that could contribute to your protection. Research is underway to explore these other components of the immune response to the vaccine and how they play a role in protection against COVID-19. Read here for more information about DMTs and COVID-19 vaccines.

The best protection remains to follow public health recommendations. For example, washing hands frequently, wearing a mask indoors when other people (i.e., people outside of your immediate household, those who are unvaccinated, and/or have an unknown vaccination status) are present, and wearing a mask outdoors when physical distancing cannot be respected.

Q: Will the COVID-19 vaccines cause MS or trigger a relapse?

A: None of the available vaccines contain live virus and the vaccines will not cause COVID-19. There is nothing to indicate that the vaccines will cause MS. For most people, the vaccines are not likely to trigger an MS relapse or have any impact on long-term disease progression. The risk of getting COVID-19 far outweighs any risk of having an MS relapse from the vaccine. Like other vaccines, COVID-19 vaccines can cause side effects, including a fever. A fever can make your MS symptoms worsen temporarily, but they should return to prior levels after the fever is gone or with acetaminophen. Even if you have side effects, it’s important to get the second dose of the vaccine for it to be effective.

Q: Are the vaccines interchangeable (mixing different vaccines for first, second and additional doses)?

A: NACI recommendations:

• Experts state that it is thought to be just as safe and effective to take one vaccine product for the first dose, then to take either the same vaccine product or a different vaccine product for the second and additional doses.

• When the first dose in a COVID-19 vaccine series is the AstraZeneca/COVISHIELD vaccine, an mRNA vaccine product is preferred as a subsequent dose based on emerging evidence.

An authorized mRNA COVID-19 vaccine, Pfizer-BioNTech and Moderna vaccines can be used for third doses and boosters in individuals 18 years of age and older. This is the recommendation whether you received AstraZeneca/ COVISHEILD or an mRNA vaccine previously. A booster dose of an authorized viral vector vaccine should only be considered when other authorized COVID-19 vaccines are contraindicated or inaccessible. Despite the paucity of studies on the interchangeability of COVID-19 mRNA vaccines, there is no reason to believe that mRNA vaccine series completion with a different authorized mRNA vaccine product will result in any additional safety issues or deficiency in protection.

Q: Should I get an antibody test to determine immunity or protection against COVID-19?

A: While antibody tests are helpful to determine if someone may have been exposed to the SARS-CoV-2 virus (the virus that causes COVID-19) and may have developed an immune response, they should not be used to determine immunity or protection against COVID-19, especially after a person has received a COVID-19 vaccination. Learn more from the FDA.

Q: I am fully vaccinated; do I need to continue to take precautions against COVID-19?

A: Even though the current COVID-19 vaccines are highly effective, some people can still become infected with the virus that causes COVID-19 and give it to others. While research on the immune response to the vaccines in MS is underway, the safest approach is to ensure those closest to you are vaccinated. When in settings where you are unsure of the vaccination status of those around you, continue to wear a mask, practice physical distancing, wash your hands frequently and follow local rules about getting tested for COVID-19 when necessary.

Q: Do I need a booster (third dose) or additional dose of the vaccine?

A: NACI recommends a booster dose of an authorized mRNA COVID-19 vaccine should be offered to all individuals 18 years and older to complete the primary COVID-19 vaccine series. Recent evidence suggests vaccine effectiveness against COVID-19 infection is decreasing over time following completion of the primary series. A booster dose could help restore protection against infection that may have decreased over time.

Adults who are immunocompromised including those on anti-CD20 disease modifying therapies such as rituximab, ocrelizumab and ofatumumab as well as residents in high-risk congregate settings, including long-term care homes who received a three dose primary series may receive a booster dose (fourth dose). Please consult your public health authority to determine when you are eligible to receive an additional dose or booster as dosing intervals differ across the country.

An additional dose of the mRNA vaccines produces more robust immune responses against the virus that causes COVID-19. These responses can include an increase in antibodies (produced by B cells) as well as an increase in the immune cellular responses (T cells)—both of which offer protection from serious illness due to COVID-19.

People who lack B cells, such as those on B cell depleting therapies, may have reduced or even absent antibody responses to the additional dose as well, though other aspects of their vaccine response (T cells) are likely to be present. Recent studies of people with MS who had a reduced or absent antibody response to the COVID-19 vaccine showed good T cell responses. This finding shows the importance of vaccination for all people with MS regardless of the anticipated antibody response. Please speak with your health care provider about the optimal timing of your vaccine with your DMT.

Q: What is the difference between an additional dose and a booster?

An additional dose is intended to improve the response to the first and second dose of the vaccine. A booster dose is given when the immune response to the first and second dose is likely to have waned over time. People who are immunocompromised who received an mRNA vaccine (Pfizer or Moderna) as their primary series (two doses) may receive a total of four COVID-19 vaccine doses (an additional primary dose and booster). Please speak with your health care provider about the optimal timing of your vaccine with your DMT.

Q: What are newly approved COVID-19 treatments?

Several medications have been authorized by Health Canada to treat COVID-19. Most of the treatments are indicated for people with symptoms and with a laboratory confirmed COVID-19 positive test who are not hospitalized. These treatments are generally given to individuals at high risk of being hospitalized or dying due to COVID-19, because of their age or medical condition(s). Because of how these medications work, they must be administered soon after a positive COVID-19 laboratory test result is confirmed, ranging from five to seven days of symptom onset, depending on the treatment. Please see here for a list of the Health Canada approved COVID-19 medications.

Health Canada has approved Evusheld, a monoclonal antibody used for the prevention of COVID-19 in people who have not previously been exposed or infected with the virus. This medication is only administered to individuals who are not expected to have an adequate immune response to the vaccine or who have a severe allergy to the vaccines. Evusheld helps fight off infection by attacking the natural spike protein on the surface of the COVID-19 virus. Individuals living with MS may qualify for treatment with Evusheld if they take one of the following DMTs: ocrelizumab, rituximab, ofatumumab, fingolimod, siponimod, ozanimod and ponesimod. 
**Availability and eligibility of Evusheld varies across the country. Please speak with your health care provider. 

Q: Are children and adolescents at risk of severe illness from COVID-19?

A: Cases of COVID-19 infection are rising in children and adolescents. While most COVID-19 infections in children and adolescents are mild, some infections are severe or even fatal. In addition to health risks due to COVID-19 infection, children and adolescents are at risk for paediatric multisystem inflammatory syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C) two to six weeks after infection with COVID-19. PIMS/MIS-C is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. PIMS/MIS-C is serious, even deadly, although with prompt and often intensive care most youth with PIMS/MIS-C in Canada survive. The risks of COVID-19 and PIMS/MIS-C outweigh any potential risks from the vaccine. For more information about PIMS/MIS-C please visit the Canadian Pediatric Society.

Q: Should youth aged 5-17 with MS be vaccinated against COVID-19?

A: NACI recommends that a complete series with the Pfizer-BioNTech COVID-19 vaccine (10 mcg) may be offered to children 5-11 years of age without contraindications to the vaccine, with a dosing interval of at least 8 weeks between first and second dose. Children and adolescents aged 12 years and older are recommended to receive a complete series with one of the mRNA vaccines (Pfizer-BioNTech or Moderna COVID-19 vaccines).

Children 5 to 11 years of age who are moderately to severely immunocompromised who have previously received two doses of the PfizerBioNTech Comirnaty vaccine (10 mcg), should be offered a third dose of the Pfizer-BioNTech Comirnaty vaccine (10 mcg) 4 to 8 weeks after the second dose.

The COVID-19 vaccine advice for youth with MS is the same as the advice for adults with MS. Vaccination of youth aged 5-17 brings us one step closer to ending this pandemic and is an additional layer of protection for the most vulnerable among us. While there is no evidence to date that youth with MS experience more severe COVID-19 infection, nor that they are at higher risk for paediatric multisystem inflammatory syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C) compared to youth who do not have MS, vaccination is strongly encouraged.

Q: Will the COVID-19 vaccines cause MS or trigger an MS relapse in youth?

A: None of the available vaccines contain live virus and the vaccines will not cause COVID-19. There is nothing to indicate that the vaccines will cause MS. For youth with MS, the vaccines are not likely to trigger an MS relapse or have any impact on long-term disease progression. The risk of getting COVID-19 far outweighs any risk of having an MS relapse from the vaccine. Like other vaccines, COVID-19 vaccines can cause side effects, including a fever. A fever can make your MS symptoms worsen temporarily, but they should return to prior levels after the fever is gone or with acetaminophen. Even if you have side effects, it’s important to get the second dose of the vaccine for it to be effective.

Q: Can COVID-19 vaccines affect fertility?

A: There is no reason to expect any COVID-19 vaccine would affect fertility. According to the Society of Obstetricians and Gynaecologists of Canada recent studies have shown that COVID-19 vaccines do not impact fertility. Please see here for more information.

Q: How old does a child need to be to receive a COVID-19 vaccine?

A: The Pfizer-BioNTech COVID-19 vaccine has been tested in children aged 5-11 years and older and at this time can only be administered in children in this age group. Both Pfizer-BioNTech and Moderna COVID-19 vaccines have been tested in children aged 12 years and older and at this time can only be administered in children in this age group.

Q: Should children who have had a single episode of neuroinflammation in the past get a COVID-19 vaccine?

A: Yes, all the recommendations for people with MS apply to those who have had a single episode of neuroinflammation. There are no known special considerations for vaccination for people who have had a single episode of neuroinflammation in the past and who are not currently taking immunosuppressive medicine.

Q: Should children living with an allied condition such as Autoimmune Encephalitis, NMOSD or a MOG-related disorder and are taking immunosuppressive medications get vaccinated?

A: It is recommended that children living with an allied condition follow the MS Society guidelines in consultation with their healthcare provider with regards to timing of vaccination in relation to the specific treatments they are receiving.

Q: Does vaccination and its potential complications outweigh the risks of COVID-19 infection?

A: Studies have found more complications, like myocarditis, paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and demyelinating events, after children and adolescents have COVID-19 infection than following COVID-19 vaccination. The benefits of vaccination outweigh any potential risks.

Q: Should parents and siblings of children living with MS or allied condition get vaccinated?

A: It is recommended that all members of the same household receive a vaccine. Vaccination of an entire household reduces risk for COVID-19 transmission to persons in close contact with each other.