b'MS Focus Activitiesvaccine be administered if possible. Cost of living with MSTiming of vaccine may also be important inThe National Multiple Sclerosis Society persons on these drugs with a recommendationpresented an eye-opening program on the of at least four or ve months after an infusionnancial burden of living with MS and treating being an optimal time to give the vaccine.MS. In the U.S., 6 percent of people with MS PersonsontheS1Pinhibitormedicationsare on Social Security, 26 percent on Social (Gilenya, Mayzent, and similar meds) maySecurity Disability Insurance and 22 percent not produce as high an antibody count afteron Long Term Disability Insurance. In 2004, vaccine as those on other medications, but itthe average copay for a DMT was $15 a month is felt that they may have sufficient responsewhile in 2016 it had risen to $309. No gures to the vaccine to protect from severe disease.have been released since, but it is estimated That said, the following recommendationsto currently be more than $1,000 for those on were made for those people with MS who areself-administered medication with Medicare. onS1PmodulatorsandBcelldepletion$6.5 billion dollars is spent annually on DMTs.disability income within the MS community.Wear a mask all the time indoors with personsEmphasis was placed on evaluating employment not a part of your household.status and potential change as early in theContinue to social distance, and wash andcourse of treatment as possible to enable sanitize hands frequently.persons to remain in the work force as longConsider virtual healthcare visits wheneveras feasible. possible to reduce the chance of infection.Relapse managementUniversity of Miami virologist Dr. KottilAs far as relapse management is concerned, Rammohan suggested that in light of the factitisstillrecommendedthatrelapsesbe that more than 15 million people have diedtreated with steroids or Acthar Gel to prevent from COVID-19 to date, and because of the lowprogressionofthedisease.Forthosewho overall vaccination rates and the increasingcannot take those medications, IVIg may be an laxness of mask use and distancing, we canalternative, or in severe cases, plasmapheresis.expect to see another surge in January orManagement of a relapse in the hospital February of 2022 that will be worse than any we have seen to date. He said the latestis recommended for those who lose the ability statistics that have come out of NARCOMSto walk with a relapse or those individuals this year show that approximately one thirdwho are diabetic, as treatment of relapses of all persons on DMTs for their MS are nowwith these medications can cause diabetes to on B cell depletion medications and may ortemporarily worsen and may need intense may not develop antibodies in response tomanagement during the course of treatment. the vaccine. Dr. Rammohan also noted thatExercise was stressed throughout this actual COVID-19 infection does not conveyconferenceasessentialtomaintaining immunity from the virus for more than aboutmobilityfromthemomentofdiagnosis three months on average so vaccines are aonward and even during a relapse once must.treatment has been started. msfocusmagazine.org 40'