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

Abstract

Background and purpose Information on Guillain–Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS‐CoV‐2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti‐SARS‐CoV‐2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. Methods Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA‐based (mRNA‐1273 and BNT162b2), adenovirus‐vectored (ChAdOx1 nCov‐19, rAd26‐rAd5, Ad5‐nCoV, and Ad26.COV2‐S), and inactivated whole‐virion‐vectored (CoronaVac) vaccines. Results We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33–60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97–1.45), with incidence higher among Ad26.COV2‐S (3.86/1,000,000 doses, 95% CI 1.50–9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36–2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3–17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID‐19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy‐five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. Conclusions Guillain–Barré syndrome was an extremely infrequent AEFI against SARS‐CoV‐2. The protection provided by these vaccines outweighs the risk of developing GBS.

SARS-CoV-2 Vaccination as a Trigger for Perinuclear Antineutrophil Cytoplasmic Antibodies (p-ANCA) Associated With Rapidly Progressive Glomerulonephritis

“…Based on this, they concluded that the presence of viral RNA in influenza vaccines was capable of activating the immune system, providing evidence for a possible role as a trigger for autoimmune diseases [ 10 ]. The temporal association to RNA or viral vector vaccines suggests the vaccine as a trigger in predisposed individuals as is the case for some neurological adverse effects such as optic neuritis and transverse myelitis [ 11 , 12 ].…”

Real-World Data on the Incidence and Risk of Guillain-Barre Syndrome Following SARS-CoV-2 Vaccination: A Prospective Surveillance Study

“…Nevertheless, the total incidence of GBS after SARS-CoV-2 vaccination in our study is comparable to the numbers reported by García-Grimshaw and colleagues, where they observed an incidence of 1.19/1,000,000 doses. 41 Finally, we did not account for the differences between homologous and heterologous vaccination and the different immunogenicity and reactogenicity conveyed by each method. 42,43 In our study, only one case of GBS following SARS-CoV-2 vaccination presented after heterologous vaccination (received ChAdOx1-S/nCoV-19 for the rst dose and BNT162b2 for the second dose).…”

Guillain–Barré syndrome following different COVID-19 vaccines: a case series

“…The current report confirms the favorable response of post-COVID-19 immunization to plasmapheresis, rather than IV methylprednisolone. Recent studies reported more frequent use of IVIG, with less frequent use of plasmapheresis and rare use of steroids [ 16 , 17 ]. Similar to thesis reports, plasmaphereses showed favorable outcome [ 16 , 17 ].…”

“…Recent studies reported more frequent use of IVIG, with less frequent use of plasmapheresis and rare use of steroids [ 16 , 17 ]. Similar to thesis reports, plasmaphereses showed favorable outcome [ 16 , 17 ]. Plasmapheresis was used as it is more affordable and available.…”