Facial paralysis and vaccinations: a vaccine adverse event reporting system review

Abstract

Background Vaccinations are a cornerstone of preventative medicine in the USA. However, growing concerns regarding facial nerve palsy following vaccination exist. Objective This study aims to assess the occurrence of facial palsy as reported by the Vaccine Adverse Event Reporting System (VAERS) database. Methods A retrospective analysis of the VAERS database was performed for cases of ‘Facial Palsy’, ‘Bell’s Palsy’, ‘Facial Paralysis’ and ‘Ramsay Hunt Syndrome’ between 2009 and 2018. Subgroup analysis was performed to determine gender, age, history of facial palsy, type of vaccine used, number of days until onset of symptoms and overall facial palsy rate. Results Nine hundred and forty-four entries met our inclusion criteria with 961 vaccine administrations resulting in facial paralysis. Facial palsy following vaccinations was evenly distributed across all age cohorts with two peaks between 60 and 74 years old and between 0 and 14 years old. Most patients were female (N = 526, 55.7%) without a reported history of facial palsy (N = 923, 97.8%). In 2009, reported incidence rate was 0.53%, as compared with 0.23% in 2018. The influenza vaccine had the greatest number of cases (N = 166, 17.3%), followed by the varicella (N = 87, 9.1%) and human papillomavirus vaccines (N = 47, 4.9%). Conclusions With the SARS-CoV-2 pandemic and recent approvals of the vaccinations, there is growing concern of facial palsy following vaccination. Although it is a known adverse event following vaccination, the likelihood of facial palsy following vaccination is low, with only 0.26% of overall reported cases over a 10-year span.

Risk of peripheral facial palsy following parenteral inactivated influenza vaccination in the elderly Chinese population

“…Although controversial in the scientific literature (22), our study provides evidence from China to support that influenza vaccination does not significantly increase the risk of PFP. The possibility of vaccine-induced immune-mediated adverse effects has raised concerns about a link between vaccines and peripheral facial paralysis (15). However, our data did not identify a significant association between vaccination and PFP, which is consistent with the findings of other studies also designed for SCCS (6)(7)(8)(9).…”

“…The possibility of vaccine-induced immune-mediated adverse effects has raised concerns about a link between vaccines and peripheral facial paralysis ( 15 ). However, our data did not identify a significant association between vaccination and PFP, which is consistent with the findings of other studies also designed for SCCS ( 6 – 9 ).…”

“…In the past 2 years, the case reports of facial paralysis after the 2019-nCoV vaccination have aroused the issue of vaccination and facial paralysis again ( 10 – 14 ). To our knowledge, so far, the association between influenza vaccination and PFP remains inconclusive, and further evidence is urgently needed ( 15 ). In addition, little is known about the risk of PFP following influenza vaccination in elderly Chinese.…”

Bilateral Vocal Fold Paralysis After COVID-19 mRNA Vaccination: A Case Report

“…However, not in case reports but in review articles, facial palsy is rare and its relationship with vaccination is not clear. 2 7 Similarly, VFP has also been reported and there are 2 studies about VFP associated with COVID-19 vaccination. 8 9 Lehrer et al 9 have reported 2 cases of unilateral VFP after BNT162b2 vaccination.…”

Bell’s Palsy and COVID-19 Vaccines: A Systematic Review and Meta-Analysis

“…In addition, it is worth mentioning that the influenza vaccine has been previously linked to an increased incidence of Bell’s palsy. The mechanism of this was also thought to be the reactivation of latent HSV-1 in the geniculate ganglion of the facial nerve, which in turn caused inflammation of the nerve [ 16 , 44 ]. Based on several hypotheses, the interaction between elements of the vaccine and specific human proteins’ immune cross-reactivity consequences in autoimmune disease, which may cause Bell’s palsy [ 45 ].…”