Emerging Infection, Vaccination, and Guillain–Barré Syndrome: A Review

Abstract

Guillain–Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system that typically develops within 4 weeks after infection. In addition to conventional infectious diseases with which we are familiar, emerging infectious diseases, such as Zika virus infection and coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have also been suggested to be associated with GBS. GBS is mainly categorized into a demyelinating subtype known as acute inflammatory demyelinating polyneuropathy (AIDP) and an axonal subtype known as acute motor axonal neuropathy (AMAN). Most patients who develop GBS after Zika virus infection or COVID-19 have AIDP. The concept of molecular mimicry between pathogens and human peripheral nerve components was established through studies of AMAN with anti-ganglioside GM1 antibodies occurring after Campylobacter jejuni infection. Although such mimicry between specific pathogens and myelin or Schwann cell components has not been clearly demonstrated in AIDP, a similarity of Zika virus and SARS-CoV-2 proteins to human proteins has been suggested. With the development of global commerce and travel, emerging infectious diseases will continue to threaten public health. From this viewpoint, the development of vaccines and antiviral drugs is important to prepare for and control emerging infectious diseases. Although a decrease in the number of patients after the 2015–2016 Zika epidemic increased the difficulty in conducting phase 3 trials for Zika virus vaccines, the efficacy and safety of new vaccines have recently been demonstrated for COVID-19. In general, vaccines can decrease the risk of infectious disease by stimulating the immune system, and discussions regarding an increased risk of autoimmune disorders, such as GBS, have been ongoing for many years. However, the risk of GBS is not considered a legitimate reason to limit the administration of currently available vaccines, as only a trivial association or no association with GBS has been demonstrated.

Guillain-​Barré Syndrome Associated with COVID-19 Vaccination

“…Similar to previous reviews on GBS associated with COVID-19, we found that both COVID-19 and COVID-19 vaccination mostly cause the classic form of GBS (under the clinical diagnosis classification) and the acute inflammatory demyelinating polyneuropathy subtype (based on electrodiagnostic features) within 2 weeks of infection or vaccination ( 6 – 8 ). However, the bilateral facial palsy with paresthesia variant and initial onset symptoms of facial diplegia were more frequently found in GBS case-patients after COVID-19 vaccination.…”

Guillain–Barrè syndrome following COVID-19 vaccine mRNA-1273: a case report

“…With this respect, we can speculate that a late autoimmunity reaction might have occurred with a molecular mimicry mechanism [5], probably after seroconversion. Accordingly, in our patient, SARS-CoV-2 IgG antibodies were detected in the serum, feasibly responsible of the onset of the molecular mimicry process [5], although antiganglioside antibodies were not found. However, this hypothesis cannot be confirmed due to the nature of this case report.…”

“…Despite the controversial link between this neurologic pathology and SARS-CoV-2 vaccination [5], the risk-benefit ratio clearly recommends the vaccination due to its efficacy in reducing the morbidity and mortality for COVID-19 [1]. The first report on the possible association between GBS and vaccination was in 1976 during the mass vaccination campaign against Swine Influenza in the USA, with an eightfold rise in the incidence of GBS in those vaccinated (4.9-5.9/1,000,000) [5]. However, further studies trying to assess this relation in other type of vaccines revealed inconsistent results.…”

“…However, further studies trying to assess this relation in other type of vaccines revealed inconsistent results. In addition, it must be considered that the risk of having GBS is higher when contracting COVID-19 than after vaccination, as it is for influenza [5].…”

Guillain–Barré syndrome following Covid-19 immunization: a report of two cases

“…GBS has also been extensively reported after Covid-19 infection: AIDP is the most common form, but acute motor axonal neuropathy and AMSAN variants have also been described; the suspected pathogenetic mechanism is para-infectious, anti-ganglioside antibodies (including anti-GM1, GM2, GD1a and GQ1b) have been detected and clinical features include a more severe weakness and more frequent need of intensive care unit admission when compared to GBS not related to Covid-19 [ 7 ].…”