Acute‐onset polyradiculoneuropathy after SARS‐CoV2 vaccine in the West and North Midlands, United Kingdom

Abstract

Introduction/Aims: We aimed to determine whether specific severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines may be associated with acute-onset polyradiculoneuropathy and if they may result in particular clinical presentations. Methods: We retrospectively reviewed records of all persons presenting with acuteonset polyradiculoneuropathy from January 1, 2021, to June 30, 2021, admitted to two Neuroscience centers, of the West and North Midlands, United Kingdom. We compared subjects with previous SARS-CoV2 vaccine exposure with a local cohort of persons with acute-onset polyradiculoneuropathy admitted between 2005 and 2019 and compared admission numbers for the studied time frame with that of the previous 3 years.Results: Of 24 persons with acute-onset polyradiculoneuropathy, 16 (66.7%) presented within 4 weeks after first SARS-CoV2 vaccine. Fourteen had received the AstraZeneca vaccine and one each, the Pfizer and Moderna vaccines. The final diagnosis was Guillain-Barré syndrome (GBS) in 12 and acute-onset chronic inflammatory demyelinating polyneuropathy in 4. Among AstraZeneca vaccine recipients, facial weakness in nine persons (64.3%), bulbar weakness in seven (50%), and the bifacial weakness and distal paresthesias GBS variant in three (21.4%), were more common than in historical controls (P = .01; P = .004, and P = .002, respectively). A 2.6-fold (95% confidence interval: 1.98-3.51) increase in admissions for acute-onset polyradiculoneuropathy was noted during the studied time frame, compared to the same period in the previous 3 years.Discussion: Despite a low risk, smaller than that of SARS-CoV2 infection and its complications, exposure to the first dose of AstraZeneca SARS-CoV2 vaccine may be a risk factor for acute-onset polyradiculoneuropathy, characterized by more common cranial nerve involvement.

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

“…The authors found a 2.6‐fold increase in number of admissions for GBS during the study period, compared to the same period in the previous 3 years 237 . Patients presenting with GBS after AstraZeneca vaccine had more frequent facial and bulbar involvement than the historical cases, and more commonly they had the bifacial weakness and distal paresthesia GBS variant, similar to the above‐mentioned reports 237‐239 …”

“…226 A cohort study conducted from 1 January 2021 to 30 June 2021 at the Birmingham University Hospital, United Kingdom, compared 16 cases of GBS presenting within 4 weeks after the first COVID-19 vaccine (14 had received the AstraZeneca vaccine and the remaining two the Pfizer and Moderna vaccines) to a historical cohort of 114 consecutive GBS patients diagnosed between 2005 and 2019. 237 The authors found a 2.6-fold increase in number of admissions for GBS during the study period, compared to the same period in the previous 3 years. 237 Patients presenting with GBS after AstraZeneca vaccine had more frequent facial and bulbar involvement than the historical cases, and more commonly they had the bifacial weakness and distal paresthesia GBS variant, similar to the above-mentioned reports.…”

“…Overall, these data are preliminary and should be taken cautiously, without leaping to costly conclusions 246 . The only cohort study so far on GBS and COVID‐19 vaccines is retrospective, included four cases out of 16 that later were diagnosed has having acute onset CIDP, was small and could have been affected by random clustering bias 237 . Surveillance programs have so far been limited to relatively short periods of time (weeks or months).…”

Inflammatory demyelinating polyneuropathy after the ChAdOx1 nCoV-19 vaccine may follow a chronic course

“…Fourteen of these had received the AZ vaccine, at a mean of 14.4 days prior to onset of symptoms. Four (25%) had a subsequent clinical course and electrophysiology meeting criteria for aCIDP, re-treated with IVIg, plasma exchange or corticosteroids [ 34 ]. These findings were supported by a recent review of the English National Immunisation Database of COVID-19 vaccination, which found an increased risk of hospital admission or death due to GBS 15–28 days following the first dose of the AZ vaccine, as well an increased risk of facial palsy in the same period.…”

Case Report: Guillain-Barré Syndrome as Primary Presentation of Systemic Lupus Erythematosus (SLE-GBS) in a Teenage Girl

“…Although lupus was not suspected initially, an antinuclear antibody panel and complement 3 and 4 concentrations were requested early after patient transfer to screen for an underlying etiology, particularly in view her family history with cases of SLE and (autoimmune) thyroid disease, respectively ( Table 1 ). Recent infection or vaccination, including COVID-19, a newly recognized trigger of GBS or GBS spectrum ( 23 – 25 ), were ruled out (SARS-CoV-2 vaccines were not yet available at the time).…”