Objective This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID‐19) in people with multiple sclerosis (PwMS). Methods We retrospectively collected data of PwMS with suspected or confirmed COVID‐19. All the patients had complete follow‐up to death or recovery. Severe COVID‐19 was defined by a 3‐level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID‐19 by multivariate and propensity score (PS)‐weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID‐19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty‐eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti‐CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18–4.74, p = 0.015) with increased risk of severe COVID‐19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20–12.53, p = 0.001). Results were confirmed by the PS‐weighted analysis and by all the sensitivity analyses. Interpretation This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID‐19 pandemic persists. ANN NEUROL 2021;89:780–789

We evaluated the effect of DMTs on Covid‐19 severity in patients with MS, with a pooled‐analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid‐19 severity was assessed by multivariate ordinal‐logistic models and pooled by a fixed‐effect meta‐analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti‐CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid‐19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled‐analysis confirms an increased risk of severe Covid‐19 in patients on anti‐CD20 therapies and supports the protective role of interferon.

This cross-sectional study, conducted in Naples (Italy) between 16 November and 6 December 2021, explored the willingness to receive the booster dose of the COVID-19 vaccine among a random sample selected from the list of those who had completed a primary vaccination series at the immunization center of a teaching hospital in Naples and the associated factors. Females had a significantly higher perceived risk of getting the SARS-CoV-2 infection, whereas those not-having a cohabitant were less worried. 85.7% were willing to receive the booster dose. Those older respondents who perceived a better health status after the primary vaccination series, who have friends/family members who were diagnosed with COVID-19, who had received information from official government organizations, and those who did not need information would be willing to get the booster dose. 24.7% was hesitant with a Vaccine Hesitancy Scale (VHS) score ≥ 25. Respondents who self-rated a lower health status after the primary vaccination series, who did not have friends/family members who were diagnosed with COVID-19, who had not received information from official government organizations, and who needed information were hesitant. Information and communication regarding the benefits and efficacy of the booster dose are needed in order to control the pandemic.

COVID-19 vaccination has been extended to include children aged 5–11 years. This cross-sectional survey evaluated parental COVID-19 vaccine willingness and hesitancy, and associated factors, for their children aged 5–11 years with chronic conditions. A telephone survey was conducted from 14 December 2021 to 4 January 2022. The questionnaire assessed participants’ socio-demographic and health-related information, attitudes towards COVID-19 infection, hesitancy, by using the PACV-5 (Parent Attitudes About Childhood Vaccines Survey Tool), and sources of information. A total of 430 answers were collected anonymously. Respondents with no cohabitant who had been infected by SARS-CoV-2 and having been vaccinated against COVID-19 had a higher concern about the severity of COVID-19. The parents’ perceived risk that the child could be infected by SARS-CoV-2 was higher in those more concerned about the severity of COVID-19, with an older child, and who had at least one cohabitant positive for COVID-19. Only 38.8% parents were willing to vaccinate their children against COVID-19. Parents who did not need additional information, those with higher education, those who have been vaccinated against COVID-19, those whose child was older, who had received information on this vaccination from physicians, with higher self-reported concern about the severity of COVID-19, and who had a higher perceived risk that their child could be infected by SARS-CoV-2, expressed a greater willingness to vaccinate their child. Overall, 26.3% were high-hesitant, with a PACV-5 score ≥ 7. Respondents who did not get the COVID-19 vaccine, were less educated, with a lower concern about severity of COVID-19, and with a lower perceived risk that their child could be infected by SARS-CoV-2, were more likely to be high-hesitant. New policies and educational programs regarding COVID-19 vaccination for children with chronic conditions are needed to reduce hesitancy and increase vaccination uptake.

Background: The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. Objective: To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. Methods: We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. Results: Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). Conclusion: Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination.

BackgroundPregnant women, especially those with comorbidities, compared to those non-pregnant, have higher risk of developing a severe form of COVID-19. However, COVID-19 vaccine uptake is very low among them.MethodsAn anonymous questionnaire was administered to randomly selected women 18 years of age that were currently pregnant or had just given birth between September 2021 and May 2022 in the geographic area of Naples. Vaccine hesitancy was assessed using the vaccine hesitancy scale (VHS).ResultsA total of 385 women participated. Women who had not been infected by SARS-CoV-2 and who needed information about vaccination against COVID-19 had a higher perceived risk of being infected with SARS-CoV-2. More than half (54.3%) of the women were very afraid of the potential side effects of the COVID-19 vaccination on the fetus. There was higher concern of the side effects of the vaccine on the fetus among those who did not have a graduate degree, those with high-risk pregnancy, those who had not been infected by SARS-CoV-2, those who were more concerned that they could be infected by SARS-CoV-2, those who did not know that this vaccination was recommended for them, and those trusting mass media/internet/social networks for information. Only 21.3% were vaccinated when pregnant, mostly women with a university degree, those who had been infected by SARS-CoV-2 before pregnancy, those who did not need information, and those who acquired information about the vaccination from gynecologists. Almost three-quarters (71.9%) were willing to receive the vaccination and those more likely were those with a university degree, those who have had at least one relative/cohabitant partner/friend who had been infected by SARS-CoV-2, those who were more concerned that they could be infected by SARS-CoV-2, and those who were not extremely concerned of the side effects of the vaccine on the fetus. A total of 86.4% were highly hesitant. Highly hesitant were respondents who did not get a graduate degree, those less concerned that they could be infected by SARS-CoV-2, and those trusting mass media/internet/social networks for information.ConclusionPublic health efforts and education campaigns for pregnant women are needed for changing their perception patterns and for supporting gynecologists in promoting the uptake of this vaccination.

The objectives of the survey were to explore any changes in the adherence to the three main COVID-19 preventive measures (social distancing, washing hands, wearing face-masks) among 795 individuals who received the COVID-19 vaccine booster dose in Italy and to identify the predictors associated. The concern of contracting COVID-19 before the vaccination, after the primary COVID-19 vaccine series, and after the booster dose resulted with a mean value of 7.7, 4.6, and 4.2, respectively. Females, those who had a lower mean self-perceived health status, who perceived COVID-19 as a very serious health problem, who decided to receive the booster dose because they perceived to be at risk of getting COVID-19, and who expressed interest in acquiring more information regarding the COVID-19 vaccine booster dose were more likely to report a higher concern of contracting COVID-19 after the booster dose. Over two-thirds were willing to respect the three main COVID-19 preventive measures following the booster dose. The multinomial logistic regression analysis showed that those who had used all three main preventive measures before and after the second or single dose were less likely to perceive COVID-19 as a serious illness. Those who had used them irregularly were less likely to have used official government organizations and scientific journals as sources of information. This survey provided an understanding regarding the adherence to COVID-19 preventive measures that may help to target policy interventions needed to reduce the spread of SARS-CoV-2.

ObjectivesThe aims of this cross-sectional study were to investigate why parents decide to vaccinate, as well as the determinants, their children aged 5–11 years against COVID-19 in Italy.MethodsThe survey was conducted from January through May 2022. All parents/guardians who came in randomly selected days to immunization centers for the administration of the first dose of the COVID-19 vaccine to their child were asked to complete a questionnaire about socio-demographic characteristics, attitudes toward COVID-19 infection and vaccination, reason(s) regarding their decision to vaccinate their child, and source(s) of information.ResultsA total of 358 questionnaires were collected. Parent's perception that COVID-19 is a severe illness for the child, assessed using a 10-point Likert scale, was 7.5. The overall mean scores of the risk perception for their child of having the COVID-19 before and after the vaccination were 8.1 and 6.3. A significantly higher parents' level of risk perception for their child of having the COVID-19 after the vaccination has been observed among those not having a university degree, those with the child having at least one chronic medical condition, and those who perceived that COVID-19 is a severe illness for the child. The mean value of respondent trust in the information provided by the pediatricians on a 10-point scale Likert type was 7.6. Female, not having a university degree, higher perception that COVID-19 is a severe disease, not having received information about the vaccination from pediatricians, and needing information had a significantly higher concern of side effects after the vaccination. The most common reasons for vaccinating their children included wanting to protect the child against COVID-19, to attend the school with less risk, to prevent the transmission to family members, and to practice sport and other activities with less risks. Participants with a university degree were more likely to have vaccinated their child for attending the school and practicing sport and other activities with less risks.ConclusionsMore publicity should be promoted among parents of children aged 5–11 years which would increase the coverage rates and thus lower the transmission of SARS-CoV-2 and reduce the occurrence of COVID-19.