How do you counsel B cell-depleted multiple sclerosis patients on the benefits of regular COVID-19 vaccinations?

The fact that B cell-depleted patients render a blunted antibody response is not unexpected, but antibodies do not protect from viral infections - cells do. To measure a proper vaccine response, one wants to test T cells from patients to see if they are able to kill viral infected cells. This is what was done by Bar-Or (Apostolidis et al., PMID 34522051) and others, showing that despite low antibody responses, there is adequate cellular immunity. That explains why in the paper cited from BMJ Ope...

I tell patients that they should stay current with recommended COVID-19 vaccinations. I counsel them that even though they may not have a robust humoral response to the vaccine, they still get some protection, as T cell responses are preserved. And the risk of the vaccine is minimal.

Same thoughts as below. We discuss that antibody response to the vaccine is likely reduced, but preserved cellular immunity helps to fill the gap.

While anti-CD20 drugs may not influence innate and CD8 T cell responses, the effect of prolonged suppression of the humoral responses following with a fixed dosing schedule needs to be revisited. No prospective study has compared a scheduled, fixed dosing regimen of anti-CD20 medications to a ‘test’ group whose dosing is based on following CD19 cell counts at periodic intervals to study if vaccine effectiveness and COVID 19 infection rates can be improved ( Does dosing frequency of anti-CD20 the...