Association of COVID-19 Vaccination and Facial Nerve Palsy

Abstract

IMPORTANCE Peripheral facial nerve (Bell) palsy has been reported and widely suggested as a possible adverse effect of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Israel is currently the leading country in vaccination rates per capita, exclusively using the BNT162b2 vaccine, and all residents of Israel are obligatory members of a national digital health registry system. These factors enable early analysis of adverse events.OBJECTIVE To examine whether the BNT162b2 vaccine is associated with an increased risk of acute-onset peripheral facial nerve palsy. DESIGN, SETTING, AND PARTICIPANTSThis case-control study was performed from January 1 to February 28, 2021, at the emergency department of a tertiary referral center in central Israel. Patients admitted for facial nerve palsy were matched by age, sex, and date of admission with control patients admitted for other reasons. EXPOSURES Recent vaccination with the BNT162b2 vaccine.MAIN OUTCOMES AND MEASURES Adjusted odds ratio for recent exposure to the BNT162b2 vaccine among patients with acute-onset peripheral facial nerve palsy. The proportion of patients with Bell palsy exposed to the BNT162b2 vaccine was compared between groups, and raw and adjusted odds ratios for exposure to the vaccine were calculated. A secondary comparison with the overall number of patients with facial nerve palsy in preceding years was performed.RESULTS Thirty-seven patients were admitted for facial nerve palsy during the study period, 22 (59.5%) of whom were male, and their mean (SD) age was 50.9 (20.2) years. Among recently vaccinated patients (21 [56.7%]), the mean (SD) time from vaccination to occurrence of palsy was 9.3 (4.2 [range, 3-14]) days from the first dose and 14.0 (12.6 [range, 1-23]) days from the second dose. Among 74 matched controls (2:1 ratio) with identical age, sex, and admittance date, a similar proportion were vaccinated recently (44 [59.5%]). The adjusted odds ratio for exposure was 0.84 (95% CI, 0.37-1.90; P = .67). Furthermore, analysis of the number of admissions for facial nerve palsy during the same period in preceding years (2015-2020) revealed a relatively stable trend (mean [SD], 26.8 [5.8]; median, 27.5 [range,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]). CONCLUSIONS AND RELEVANCEIn this case-control analysis, no association was found between recent vaccination with the BNT162b2 vaccine and risk of facial nerve palsy.

Ocular Adverse Events After COVID-19 Vaccination

“… A case report of possible uveitis post-vaccination BNT162b2 2 3 days Reduction in visual acuity, visual distortion n = 1 Shemer et al . 41 Association of COVID-19 Vaccination and Facial Nerve Palsy: A Case-Control Study A case-control study of association between facial nerve palsy between vaccinated and unvaccinated groups BNT162b2 1, 2 9–14 days n = 21 Vera-Lastra et al . 42 Two Cases of Graves’ Disease Following SARS-CoV-2 Vaccination: An Autoimmune/Inflammatory Syndrome Induced by Adjuvants.…”

“… 38 provided detailed expositions of the signs and symptoms that led to a diagnosis of Bell’s palsy in COVID-19 BNT162b2 vaccine recipients. An Israeli case-control study 41 found that 21 of 37 individuals (56.8%) with facial nerve palsy were recently vaccinated with the first or second dose of the BNT162b2 vaccine, compared with 44 of 74 (59.5%) in the control group. After adjustment for pre-existing immune- or inflammatory-related disorders, diabetes, and a previous episode of peripheral nerve palsy, odds ratio (OR) for exposure to the vaccine among cases was insignificant at 0.84 (95%CI 0.37–1.90, p -value = 0.67).…”

Spectrum of neurological complications following COVID-19 vaccination

“…Bell’s palsy developed within 2 weeks following first dose of COVID-19 vaccination. There was no difference in any of the clinical parameter between vaccinated or unvaccinated groups [ 97 ].…”

“Association between COVID-19 vaccination, infection, and risk of Guillain-Barre syndrome, Bell’s palsy, encephalomyelitis and transverse myelitis: a population-based cohort and self-controlled case series analysis”

“…They also compared the numbers of cases in January and February 2021 to the same period during 2015 to 2020, and found no meaningful increase in admission numbers due to facial nerve palsy. [57] Renoud et al conducted a disproportionality analysis using the World Health Organization’s pharmacovigilance database. They found no higher safety signal for facial palsy after mRNA Covid-19 vaccines when compared with all other viral vaccines or restricted to influenza vaccines.…”