J Neurol Res
Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc
Journal website https://www.neurores.org

Editorial

Volume 11, Number 1-2, April 2021, pages 1-4


COVID-19 Vaccine Priority for People With Neurologic and Rare Diseases

Gerald Pfeffera, b, d, Sarah Jacoba, Jeffrey Prestonc

aHotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
bAlberta Child Health Research Institute, Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
cDisability Studies, King’s University College, Western University, London, ON, Canada
dCorresponding Author: Gerald Pfeffer, Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, HMRB 155, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada

Manuscript submitted April 12, 2021, accepted April 15, 2021, published online April 20, 2024
Short title: COVID-19 Vaccine Prioritization
doi: https://doi.org/10.14740/jnr665

As vaccination programmes against coronavirus disease 2019 (COVID-19) are expanded, substantial variation in the prioritisation of different groups is apparent both between countries but also interprovincially within Canada. In this editorial, we bring attention to the need to prioritize individuals with neurologic and rare disorders for vaccination.

Neurologic Complications From COVID-19▴Top 

The pandemic illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the identification of numerous common neurologic complications, which may result directly or indirectly from infection [1]. The most well-known neurologic symptom is anosmia/dysgeusia (loss of sense of smell/taste) [2] whose uniqueness to SARS-CoV-2 has been debated [3]; involvement of skeletal muscles is also very common and fortunately mild in most cases (predominantly myalgias), although myositis and rhabdomyolysis are described [4, 5]. Rarely, more significant neurologic complications arise [6]. In the central nervous system, some of the described phenotypes include encephalopathy [7], neuroimmunological syndromes [8], and myoclonus/ataxia [9]. Ischemic stroke appears to have a more severe outcome in COVID-19 patients but was not more common in a recent large series [10]. Peripheral nervous system complications mainly relate to above-mentioned complications of skeletal muscle, as well as variants of Guillain-Barré syndrome [11-13]. Mononeuritis multiplex has been described with high prevalence in a series of critically ill patients with COVID-19 [14], which is a group of patients in whom neurologic impairments may be difficult to identify and may be misattributed to critical illness neuro/myopathy. When present, neurologic syndromes have been associated with increased mortality in COVID-19 patients [15].

SARS-CoV-2 infects cells via angiotensin-converting enzyme 2 (ACE2), a protein found abundantly among numerous cell types including neurones of the central and peripheral nervous systems, and muscle [16-18]. Therefore, neurologic complications may occur as a direct consequence of viral infection, in addition to neurologic damage resulting from hypoxia, the inflammatory cascade, and other end-organ injuries. As a result, there is concern that patients with pre-existing neurological disorders may be at greater risk of neurological complications, or more severe outcomes in general from COVID-19 [19].

Persons With Pre-Existing Neurological Conditions and Rare Diseases, and COVID-19 Risk▴Top 

Recent evidence indicates more severe outcomes may occur in patients with common pre-existing neurological disorders [20]. It is more challenging to study the impact of COVID-19 on rare diseases (a large group of individually rare, but collectively common disorders, approximately one-third of which are neurologic) [21]. The available evidence certainly demonstrates a major impact of the pandemic on patients with rare disease in numerous domains [22, 23], including mental health, physical health, and access to care among others. Shifts in healthcare resources to address pandemic needs have directly impacted the care of patients with chronic neurologic conditions [24]. For some specific rare disorders there is evidence for an increased risk of poor outcomes. For example, in trisomy 21 (Down syndrome), the mortality risk is markedly increased compared with the general population [25]. Preliminary evidence from a myasthenia gravis registry suggests severe outcomes may be frequent [26]. Expert opinions agree that many neuromuscular conditions are likely to be associated with increased risk from SARS-CoV-2 infection [27]. This is a highly rational conclusion because patients with neuromuscular disorders are at high risk from pulmonary infections in general [28], and can have compromised respiratory muscle strength at various stages of disease [29]. While there is otherwise limited evidence for specific rare disorders, there is evidence that broader groups of patients, such as those with intellectual and developmental disability, may have more severe outcomes [30].

Vaccine Priority for People With Neurological and Rare Diseases▴Top 

Persons with neurologic disabilities may have increased risk of contracting SARS-CoV-2 (due to carers entering the home) [31], have reduced access to public health information and health services [32], and have additional challenges during hospitalization if visits from family and other supports are restricted [33]. There is also a bioethical concern that forthcoming intensive care unit (ICU) rationing guidelines [34] could deprioritize the care of those with neurological disorders hospitalized with COVID-19 [35]. The impetus to deprioritized care must be considered in light of regular lack of synchronicity between patient and practitioners’ definitions and assumptions of what constitutes “quality of life” with a disability [36-39]. Bureaucratic barriers, such as a focus on recipients of chronic home care as opposed to diagnosis-based priority for phase 1 inoculation, leaves those living with and receiving care from family off priority lists in some municipalities. These decisions are often driven by studies regarding the impact of COVID-19 on persons with disabilities that may be limited due to systemic problems with how data in these populations are collected [40]. Within these communities, individuals have been advised to exercise heightened levels of precaution and vigilance [41], which may result in lower infection numbers and misleading conclusions that patients with neurologic and rare disorders are not at high risk.

There have been calls to prioritize COVID-19 vaccination in persons with intellectual and developmental disabilities [42]. We here suggest that persons with other neurological disorders and rare diseases should also be considered a priority group for vaccination. Neurologic and rare disorders are not considered one of the major risk factors for severe outcomes from SARS-CoV-2 infection; nonetheless the evidence clearly shows these patients are vulnerable to direct complications of the virus in addition to elevated risks of exposure due to home care needs and the potential for deprioritized care should they become infected during surging ICU admissions. The impact of SARS-CoV-2 variants of concern, which are more transmissible [43] and virulent [44], adds to the immediacy of this issue. For all these reasons, there is an urgent need to prioritize protecting those with neurologic and rare disorders from contracting COVID-19.

Acknowledgments

None to declare.

Financial Disclosure

None to declare.

Conflict of Interest

None to declare.

Author Contributions

GP and JP authored the manuscript. SJ edited the work for intellectual content and aided in literature review.

Data Availability

The authors declare that data supporting the findings of this study are available within the article.


References▴Top 
  1. Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021; 8(5):416-427.
    doi
  2. Zayet S, Klopfenstein T, Mercier J, Kadiane-Oussou NJ, Lan Cheong Wah L, Royer PY, Toko L, et al. Contribution of anosmia and dysgeusia for diagnostic of COVID-19 in outpatients. Infection. 2021;49(2):361-365.
    doi pubmed
  3. Carrillo-Larco RM, Altez-Fernandez C. Anosmia and dysgeusia in COVID-19: A systematic review. Wellcome Open Res. 2020;5:94.
    doi pubmed
  4. Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci. 2020;41(11):3039-3056.
    doi pubmed
  5. Pitscheider L, Karolyi M, Burkert FR, Helbok R, Wanschitz JV, Horlings C, Pawelka E, et al. Muscle involvement in SARS-CoV-2 infection. Eur J Neurol. 2020, Sep 30;10.1111/ene.14564. Online ahead of print.
    doi pubmed
  6. Jardim Vaz de Mello L, Guimaraes Silva E, Oliveira Correa Rabelo G, et al. Neurologic compromise in COVID-19: a literature review. J Neurol Res. 2020;10(5):164-172.
    doi
  7. Reming K, Sivakumar K, Moheb N, Nizam A, Yacoub HA. Late-onset encephalopathy associated with SARS-CoV-2 infection. J Neurol Res. 2020;10(6):237-239.
    doi
  8. Zanin L, Saraceno G, Panciani PP, Renisi G, Signorini L, Migliorati K, Fontanella MM. SARS-CoV-2 can induce brain and spine demyelinating lesions. Acta Neurochir (Wien). 2020;162(7):1491-1494.
    doi pubmed
  9. Chan JL, Murphy KA, Sarna JR. Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review. J Neurol. 2021, Feb 22;1-32. Online ahead of print.
    doi pubmed
  10. Qureshi AI, Baskett WI, Huang W, Shyu D, Myers D, Raju M, Lobanova I, et al. Acute Ischemic Stroke and COVID-19: An Analysis of 27 676 Patients. Stroke. 2021;52(3):905-912.
    doi pubmed
  11. Chan JL, Ebadi H, Sarna JR. Guillain-Barre Syndrome with facial diplegia related to SARS-CoV-2 infection. Can J Neurol Sci. 2020;47(6):852-854.
    doi pubmed
  12. Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barre syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021;268(4):1133-1170.
    doi pubmed
  13. Judge C, Moheb N, Castro Apolo R, Dupont JL, Gessner ML, Yacoub HA. Facial diplegia as a rare late neurologic manifestation of SARS-CoV-2 infection. J Neurol Res. 2020;10(6):235-236.
    doi
  14. Needham E, Newcombe V, Michell A, Thornton R, Grainger A, Anwar F, Warburton E, et al. Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19. J Neurol. 2020, Nov 26;1-5. Online ahead of print.
    doi pubmed
  15. Eskandar EN, Altschul DJ, de la Garza Ramos R, Cezayirli P, Unda SR, Benton J, Dardick J, et al. Neurologic syndromes predict higher in-hospital mortality in COVID-19. Neurology. 2021;96(11):e1527-e1538.
    doi pubmed
  16. Xu J, Lazartigues E. Expression of ACE2 in human neurons supports the neuro-invasive potential of COVID-19 virus. Cell Mol Neurobiol. 2020, Jul 4;1-5. Online ahead of print.
    doi
  17. Fenrich M, Mrdenovic S, Balog M, Tomic S, Zjalic M, Roncevic A, Mandic D, et al. SARS-CoV-2 dissemination through peripheral nerves explains multiple organ injury. Front Cell Neurosci. 2020;14:229.
    doi pubmed
  18. Yamamoto K, Takeshita H, Rakugi H. ACE2, angiotensin 1-7 and skeletal muscle: review in the era of COVID-19. Clin Sci (Lond). 2020;134(22):3047-3062.
    doi pubmed
  19. Manji H, Carr AS, Brownlee WJ, Lunn MP. Neurology in the time of COVID-19. J Neurol Neurosurg Psychiatry. 2020;91(6):568-570.
    doi pubmed
  20. Gao Y, Chen Y, Liu M, Niu M, Song Z, Yan M, Tian J. Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis. Epidemiol Infect. 2021;149:e66.
    doi pubmed
  21. National Institute of Neurological Disorders. Rare Disease Research at NINDS. 2016. https://www.ninds.nih.gov/News-Events/Directors-Messages/All-Directors-Messages/Rare-Disease-Research-NINDS. Accessed April 8 2021.
  22. Chung CC, Wong WH, Fung JL, Hong Kong RD, Chung BH. Impact of COVID-19 pandemic on patients with rare disease in Hong Kong. Eur J Med Genet. 2020;63(12):104062.
    doi pubmed
  23. Sanchez-Garcia JC, Cortes-Martin J, Rodriguez-Blanque R, Marin-Jimenez AE, Montiel-Troya M, Diaz-Rodriguez L. Depression and anxiety in patients with rare diseases during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(6).
    doi pubmed
  24. Bersano A, Pantoni L. On being a neurologist in Italy at the time of the COVID-19 outbreak. Neurology. 2020;94(21):905-906.
    doi pubmed
  25. Huls A, Costa ACS, Dierssen M, Baksh RA, Bargagna S, Baumer NT, Brandao AC, et al. Medical vulnerability of individuals with Down syndrome to severe COVID-19-data from the Trisomy 21 Research Society and the UK ISARIC4C survey. EClinicalMedicine. 2021;33:100769.
    doi pubmed
  26. Muppidi S, Guptill JT, Jacob S, Li Y, Farrugia ME, Guidon AC, Tavee JO, et al. COVID-19-associated risks and effects in myasthenia gravis (CARE-MG). Lancet Neurol. 2020;19(12):970-971.
    doi
  27. Association of British Neurologists Guidance on COVID-19 for people with neurological conditions, their doctors and carers. 2020. https://cdn.ymaws.com/www.theabn.org/resource/collection/65C334C7-30FA-45DB-93AA-74B3A3A20293/ABN_Neurology_COVID-19_Guidance_v5_26.3.20.pdf. Accessed April 10 2021.
  28. Benditt JO, Boitano LJ. Pulmonary issues in patients with chronic neuromuscular disease. Am J Respir Crit Care Med. 2013;187(10):1046-1055.
    doi pubmed
  29. Pfeffer G, Povitz M. Respiratory management of patients with neuromuscular disease: current perspectives. Degener Neurol Neuromuscul Dis. 2016;6:111-118.
    doi pubmed
  30. Turk MA, Landes SD, Formica MK, Goss KD. Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis. Disabil Health J. 2020;13(3):100942.
    doi pubmed
  31. Kuper H, Banks LM, Bright T, Davey C, Shakespeare T. Disability-inclusive COVID-19 response: What it is, why it is important and what we can learn from the United Kingdom's response. Wellcome Open Res. 2020;5:79.
    doi pubmed
  32. Armitage R, Nellums LB. The COVID-19 response must be disability inclusive. Lancet Public Health. 2020;5(5):e257.
    doi
  33. Preston J. Living with disability in the time of COVID. 2020. https://crhesi.uwo.ca/margins/considering-complex-lives-value-and-covid-19/. Accessed April 10 2021.
  34. Casey L. Plans for 'life-and-death' ICU triage decisions not finalized, Ont. health minister says. 2021. https://toronto.ctvnews.ca/plans-for-life-and-death-icu-triage-decisions-not-finalized-ont-health-minister-says-1.5378448. Accessed April 10 2021.
  35. Wilson C. Ontario patients to be ranked for life-saving care should ICUs become full, documents show. 2021. https://toronto.ctvnews.ca/ontario-patients-to-be-ranked-for-life-saving-care-should-icus-become-full-documents-show-1.5271774. Accessed April 10 2021.
  36. Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, Lagu T, et al. Physicians' perceptions of people with disability and their health care. Health Aff (Millwood). 2021;40(2):297-306.
    doi pubmed
  37. Shakespeare T, Iezzoni LI, Groce NE. Disability and the training of health professionals. Lancet. 2009;374(9704):1815-1816.
    doi
  38. Tervo RC, Azuma S, Palmer G, Redinius P. Medical students' attitudes toward persons with disability: a comparative study. Arch Phys Med Rehabil. 2002;83(11):1537-1542.
    doi pubmed
  39. Rousseau MC, Baumstarck K, Billette de Villemeur T, Auquier P. Evaluation of quality of life in individuals with severe chronic motor disability: A major challenge. Intractable Rare Dis Res. 2016;5(2):83-89.
    doi pubmed
  40. Reed NS, Meeks LM, Swenor BK. Disability and COVID-19: who counts depends on who is counted. Lancet Public Health. 2020;5(8):e423.
    doi
  41. Muscular Dystrophy Canada. What you need to know about COVID-19. 2020. https://muscle.ca/covid-19/what-you-need-to-know-about-covid-19/. Accessed April 10 2021.
  42. Hotez E, Hotez PJ, Rosenau KA, Kuo AA. Prioritizing COVID-19 vaccinations for individuals with intellectual and developmental disabilities. EClinicalMedicine. 2021;32:100749.
    doi pubmed
  43. Davies NG, Abbott S, Barnard RC, Jarvis CI, Kucharski AJ, Munday JD, Pearson CAB, et al. Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England. Science. 2021;372:6538).
    doi pubmed
  44. Adrielle Dos Santos L, Filho PGG, Silva AMF, Santos JVG, Santos DS, Aquino MM, de Jesus RM, et al. Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers. J Infect. 2021;82(3):399-406.
    doi pubmed


This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Journal of Neurology Research is published by Elmer Press Inc.

 

Browse  Journals  

 

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

 

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

 

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

 

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

 

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 
       
 

Journal of Neurology Research, bimonthly, ISSN 1923-2845 (print), 1923-2853 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.neurores.org   editorial contact: editor@neurores.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.