Guillain-Barr� syndrome in Mexico: An updated review amid the coronavirus disease 2019 era

Abstract

Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis and if not diagnosed and treated timely, a significant cause of long-term disability. Incidence in Latin America ranges from 0.71 to 7.63 cases/100,000 person-years.Historically, GBS has been linked to infections (mainly gastrointestinal by Campylobacter jejuni) and vaccines (including those against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]); however, a trigger cannot be detected in most cases. Regarding SARS-CoV-2, epidemiological studies have found no association with its development. Acute motor axonal neuropathy is the most common electrophysiological variant in Mexico and Asian countries. Intravenous immunoglobulin or plasma exchanges are still the treatment cornerstones. Mortality in Mexico can be as high as 12%. Advances in understanding the drivers of nerve injury in GBS that may provide the basis for developing targeted therapies have been made during the past decade; despite them, accurate criteria for selecting patients requiring acute treatment, prognostic biomarkers, and novel therapies are still needed. The newly-developed vaccines against SARS-CoV-2 have raised concerns regarding the potential risk for developing GBS. In the midst of coronavirus disease 2019 and vaccination campaigns against SARS-CoV-2, this review discusses the epidemiology, clinical presentation, management, and outcomes of GBS in Mexico. (REV INVEST CLIN. 2022;74(3):121-30

Incidence of Guillain–Barré syndrome following SARS‐CoV‐2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines

“…The overall incidence that we observed of 1.19/1,000,000 doses (95% CI 0.97–1.45) was much lower than the incidence in 2019 (pre‐COVID‐19) officially reported by the Mexican ministry of health of 0.71 cases per 100,000 persons‐years (7.1 cases 1,000,000 persons‐years) [ 7 , 8 ]; however, as we did not have information on GBS occurring among unvaccinated persons or during 2020, our results should be interpreted with caution. Regarding mRNA‐based vaccines, previous reports suggest a lack of association between these vaccines and GBS [ 13 , 14 , 17 , 36 , 37 ].…”

“…According to the Mexican Health Ministry, in 2019 (i.e., pre‐COVID‐19), the nationwide reported GBS incidence was 0.71 cases per 100,000 person‐years [ 7 , 8 ]. Between December 2020 and September 2021, the Mexican Ministry of Health granted emergency approval for the use of seven different vaccines against SARS‐CoV‐2, using three different platforms: mRNA (mRNA‐1273 and BNT162b2), adenovirus (ChAdOx1 nCov‐19, rAd26‐rAd5, Ad5‐nCoV, and Ad26.COV2‐S), and inactivated whole‐virion (CoronaVac) [ 9 ], thus, it was in a unique position to evaluate the differences among several of the currently available anti‐SARS‐CoV‐2 vaccines and not only those commonly used in developed nations, for which ample safety information has already been reported.…”

Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization in Mexico: A nation-wide registry of seven COVID-19 vaccines

“…[4][5][6] According to the Mexican General Board of Epidemiology, in 2019 (i.e., pre-COVID-19), Mexico reported a GBS incidence of 0•71 cases per 100,000 personyears. 7,8 We previously reported a preliminary incidence of GBS ranging from 0•18-0•43 cases per 100,000 doses administered among 3•9 million first-dose recipients of BNT162b2-the only vaccine in use at the time of those reports-which fell within the expected (pre-COVID-19 and pre-SARS-CoV-2 vaccine) incidence. 9,10 However, as nationwide immunization efforts incorporated more vaccines, epidemiological data from the United States and the United Kingdom suggested epidemiological associations between two adenovirus-vectored vaccines (Ad26.COV2.S [1 case per 100,000 doses administered], and ChAdOx1 nCov-19 (0•87 per 100,000 first-doses administered]) and GBS.…”

“…The overall incidence observed in this study increased 1.67-fold in comparison to the expected (pre-COVID-19) incidence in Mexico. 7,8 Regarding mRNA-based vaccines, previous reports suggest a lack of association between these vaccines and GBS. 9,10,[35][36][37] The unadjusted GBS incidence we observed for mRNA-based vaccines is similar to a previous report including recipients of 13,952,901 doses of either mRNA-1273 and BNT162b2.…”

Authors' reply to SARS-COV-2 and anti-covid vaccines trigger Guillain-Barr� syndrome

“…We greatly appreciate the comments and observations on our review article by Dr. Finsterer 1 . Concerning the epidemiological differences in electrophysiological variants of Guillain-Barré syndrome (GBS), we are aware that in Caucasians (persons from Europe and North America), acute inflammatory demyelinating neuropathy is the predominant variant, an epidemiological observation mentioned in our article 1 . Nonetheless, as we stated in the title of our article, we aimed to discuss mainly GBS epidemiology in Mexico, where acute motor axonal neuropathy is the prevailing electrophysiological variant 2 .…”