COVID-19 Vaccine for Patients with Brain and Nervous System Diseases

Since the outbreak of the COVID-19 virus in 2020 until now, it has been found that there are no less than 118 million infected people worldwide. In Thailand alone, more than 50,000 cases have been reported. As vaccination has begun in Thailand, several issues regarding indications and precautions for patients with brain and neurological diseases have been identified, which can be summarized as follows:

Guidelines for COVID-19 Vaccination for Patients with Brain and Neurological Diseases in Each Disease Group

• Stroke

Since this group of patients is considered high risk for severe symptoms if infected, they are prioritized to receive the vaccine before other groups.

Stroke is not a contraindication for vaccination, except for patients whose condition is still unstable. In cases where patients are taking anticoagulants such as warfarin, the blood coagulation level must be less than 3. For new oral anticoagulants such as Dabigatran, Rivaroxaban, Apixaban, and Edoxaban, as well as antiplatelet drugs like Aspirin, Clopidogrel, and Cilostazol, vaccination is allowed. However, a small needle should be used, and intramuscular massage after vaccination should be avoided. The injection site should be pressed longer than usual after vaccination until it is certain that there is no abnormal bleeding.

• Epilepsy

This disease is not a contraindication for vaccination, and there have been no reports that vaccination worsens epilepsy. Patients with epilepsy can receive the vaccine if there are no other contraindications. However, fever after vaccination may trigger seizures.

• Immune-mediated Neurological Diseases

For patients previously diagnosed with immune-mediated neurological diseases such as autoimmune encephalitis, central demyelinating diseases including Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO), myelitis, acute polyneuropathy (Guillain-Barre Syndrome), chronic polyneuropathy (CIDP), myositis, Bell’s palsy, or cranial neuritis, vaccination is not contraindicated.

Currently, there are two types of vaccines available in Thailand: inactivated virus type (Sinovac) and viral vector type (AstraZeneca). The viral vector vaccine uses a live virus that cannot replicate.

According to international data, it is recommended for use in patients on immunosuppressive drugs, but some experts advise caution because long-term safety data is not yet clear. Patients in this group need to consult their doctors before vaccination to understand the disease and vaccination, including whether the disease is in a stable phase. Additionally, immunosuppressive therapy may reduce the immune response to the vaccine compared to healthy individuals.

• Other Neurological Diseases

Other neurological diseases such as Parkinson’s disease, dementia, and motor neuron disease are not contraindications for vaccination.

This information is referenced from the Neurological Institute, Department of Medical Services, the Neurological Society of Thailand, and the University Hospital Network of Thailand (UHosNet).