Guillain-Barré syndrome following SARS-CoV-2 vaccination in the UK: a prospective surveillance study

Abstract

ObjectiveTo investigate features of Guillain-Barré syndrome (GBS) following SARS-CoV-2 vaccines and evaluate for a causal link between the two.MethodsWe captured cases of GBS after SARS-CoV-2 vaccination through a national, open-access, online surveillance system. For each case, the certainty of GBS was graded using the Brighton criteria, and the relationship to the vaccine was examined using modified WHO Causality Assessment criteria. We compared age distribution of cases with that of prepandemic GBS cases and clinical features with the International GBS Outcome Study (IGOS).ResultsBetween 1 January and 30 June 2021, we received 67 reports of GBS following the ChAdOx1 vaccine (65 first doses) and three reports following the BNT162b2 vaccine (all first doses). The causal association with the vaccine was classified as probable for 56 (80%, all ChAdOx1), possible for 12 (17%, 10 ChAdOx1) and unlikely for two (3%, 1 ChAdOx1). A greater proportion of cases occurred in the 50–59 age group in comparison with prepandemic GBS. Most common clinical variants were sensorimotor GBS (n=55; 79%) and facial diplegia with paraesthesias (n=10; 14%). 10% (n=7/69) of patients reported an antecedent infection, compared with 77% (n=502/652) of the IGOS cohort (p<0.00001). Facial weakness (63% (n=44/70) vs 36% (n=220/620); p<0.00001) and sensory dysfunction (93% (n=63/68) vs 69% (n=408/588); p=0.00005) were more common but disease severity and outcomes were similar to the IGOS study.InterpretationMost reports of GBS followed the first dose of ChAdOx1 vaccine. While our study cannot confirm or refute causation, this observation, together with the absence of alternative aetiologies, different than expected age distribution and the presence of unusual clinical features support a causal link. Clinicians and surveillance bodies should remain vigilant to the possibility of this very rare adverse event and its atypical variants.

Acute polyradiculoneuropathy with SARS‐CoV2 vaccines: Reply

“…The second point raised, regarding the number of cases we observed specifically after the AstraZeneca vaccine, appears, as mentioned by Galassi et al, in keeping with Keh et al's subsequent report, which also demonstrated an increased risk with this vaccine. 3 Similarly, Patone et al 4 and, more recently, Tamborska et al, reporting for the UK Covid vaccine GBS Study Group, 5 both described an excess risk with the AstraZeneca vaccine in UK-wide studies, in keeping with our regional findings. Keh et al reported an increased risk comparable with that of the 1976 swineflu vaccine, 3 which itself is a notable finding that should be made known to the medical community and patients.…”

“…cohorts from Europe and America. 5 We disagree with Galassi et al about the statistical methods that we used, as also used in other studies, 3,5 which compared proportions of subjects with specific features between two groups, and which we consider both adequate and appropriate.…”

“…However, the study by Tamborska et al showed more frequent facial weakness in controls in International Guillain‐Barré Syndrome Outcome Study cohorts from Europe and America 5 . We disagree with Galassi et al about the statistical methods that we used, as also used in other studies, 3,5 which compared proportions of subjects with specific features between two groups, and which we consider both adequate and appropriate.…”

“…Since our report, the nationwide study by Keh et al, as cited by Galassi et al, showed no specific characteristics of post‐AstraZeneca SARS‐CoV2 vaccination polyradiculoneuropathy compared with cases in the post‐surveillance period. However, the study by Tamborska et al showed more frequent facial weakness in controls in International Guillain‐Barré Syndrome Outcome Study cohorts from Europe and America 5 . We disagree with Galassi et al about the statistical methods that we used, as also used in other studies, 3,5 which compared proportions of subjects with specific features between two groups, and which we consider both adequate and appropriate.…”

Miller-Fisher syndrome and Guillain–Barre syndrome overlap syndrome following inactivated COVID-19 vaccine: Case report and scope review

“…Regarding other types of COVID-19 vaccines, seven cases of GBS were reported following BNT162b2 mRNA vaccine among approximately 4 million recipients, and a recent report issued by the UK Health Security Agency concluded that the risk of developing GBS after ChAdOx1vaccine adds 5.6 extra cases of GBS per million doses. 10 , 11 Hence, for detailed description and comparison of the clinical and prognosis information regarding the association between COVID-19 vaccines and MFS, we systematically searched in “PubMed,” “Web of Science,” and “Cochrane” using the keywords“COVID-19” or “SARS-CoV-2,” “vaccination” or “vaccine,” “Miller Fisher syndrome” or “MFS” or “acute ataxic neuropathy” or “acute ophthalmoparesis” from 1 January 2020 to 30 July 2022. The flow diagram of publication identification is listed in Figure 1 .…”