A Single-Health System Case Series of New-Onset CNS Inflammatory Disorders Temporally Associated With mRNA-Based SARS-CoV-2 Vaccines

Abstract

BackgroundSince 2020, over 250 million doses of mRNA-based SARS-CoV-2 vaccines have been administered in the United States and hundreds of millions worldwide between the Pfizer-BioNTech and Moderna SARS-CoV-2 vaccines. To date, there have been rare reports associating mRNA-based SARS-CoV-2 vaccines with episodes of inflammatory and autoimmune CNS disorders. We report a case series of five patients with new-onset neurological disorders of inflammatory or immunological origin temporally associated with these vaccines.MethodsA case-series of five patients within a single 23-hospital health system who developed new-onset CNS inflammatory disease within 2 weeks of receiving a dose of an mRNA-based SARS-CoV-2 vaccine.ResultsFive cases of post-vaccination CNS disorders of immune origin (fatal ADEM; n = 1, new-onset NMOSD; n = 2, new-clinical onset MS-like syndrome but with preexisting clinically silent mild demyelination; n = 1, meningoencephalitis; n = 1) observed within 2 weeks of inoculation with either the first or second dose of mRNA-based SARS-CoV-2 vaccines (Moderna = 3, Pfizer = 2).DiscussionTo our knowledge, these are among the emerging cases of CNS adverse events of immunological or inflammatory origin. These findings should be interpreted with great caution as they neither prove a mechanistic link nor imply a potential long-term increased risk in post-vaccination CNS autoimmunity. Larger prospective studies assessing the potential association between mRNA-based vaccination and the development of neurological adverse events of suspected immune origin, particularly among those with underlying CNS or systemic autoimmune disorders, are needed. The use of mRNA-based SARS-CoV-2 vaccines should continue to be strongly encouraged given their high efficacy in overcoming this pandemic.

Acute disseminated encephalomyelitis (ADEM) following COVID-19 vaccination: A systematic review

“…Next, 88 studies were excluded via title and abstract evaluation. Finally, after the full-text screening, 20 studies with a total of 54 cases were entered into our systematic review [ [6] , [18] , [20] , [21] , [22] , [23] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ].

Fig.

…”

A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against Covid-19

“…A study reviewing case reports and case series reported the occurrence of variable central and peripheral nervous system complications in patients receiving gene-based vaccines including transverse myelitis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis (Sriwastava et al, 2022). It was noticed that post-mRNA-based SARS-CoV-2 vaccines, either the first or the second dose, were complicated by new-onset neuroimmunological disorders like acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, and multiple sclerosis (Ballout et al, 2022).…”

Electroencephalographic findings post‐COVID‐19 vaccination: A systematic review of case reports and case series

“…Another 11 records were identified from citation ( n = 1) or Google Scholar searches ( n = 10) and were also included. Finally, 31 articles met the eligibility criteria 15,24–53 and were included in the present systematic review (Figure 1).…”