Reports of Guillain-Barré Syndrome After COVID-19 Vaccination in the United States

Abara, Winston E.; Gee, Julianne; Marquez, Paige; Woo, Jared; Myers, Tanya R.; DeSantis, Allison; Baumblatt, Jane; Woo, Emily Jane; Thompson, Deborah; Nair, Narayan; Su, John R.; Shimabukuro, Tom T.; Shay, David K.

doi:10.1001/jamanetworkopen.2022.53845

Cited by 54 publications

(56 citation statements)

References 21 publications

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“…Furthermore, the early diagnosis of GBS in patients with COVID-19 is considered to be important, as the clinical course and progression correlate with the severity of disease and requirement of intensive care and mechanical ventilation [ 178 ]. A recent large-scale study also found that a replication-incompetent human adenovirus vector-based COVID-19 vaccine is associated with an increased risk of GBS [ 179 ]. The exact mechanism of action is poorly understood, but it is thought that the cell-surface antigen called as angiotensin-converting enzyme 2 (ACE2) and gangliosides are responsible for the interaction and uptake of SARS-CoV-2 [ 180 , 181 ].…”

Section: Guillain–barre Syndromementioning

confidence: 99%

Immune-Mediated Neuropathies: Pathophysiology and Management

Shastri

Aiyan

Kishore

et al. 2023

IJMS

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Dysfunction of the immune system can result in damage of the peripheral nervous system. The immunological mechanisms, which include macrophage infiltration, inflammation and proliferation of Schwann cells, result in variable degrees of demyelination and axonal degeneration. Aetiology is diverse and, in some cases, may be precipitated by infection. Various animal models have contributed and helped to elucidate the pathophysiological mechanisms in acute and chronic inflammatory polyradiculoneuropathies (Guillain–Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, respectively). The presence of specific anti-glycoconjugate antibodies indicates an underlying process of molecular mimicry and sometimes assists in the classification of these disorders, which often merely supports the clinical diagnosis. Now, the electrophysiological presence of conduction blocks is another important factor in characterizing another subgroup of treatable motor neuropathies (multifocal motor neuropathy with conduction block), which is distinct from Lewis–Sumner syndrome (multifocal acquired demyelinating sensory and motor neuropathy) in its response to treatment modalities as well as electrophysiological features. Furthermore, paraneoplastic neuropathies are also immune-mediated and are the result of an immune reaction to tumour cells that express onconeural antigens and mimic molecules expressed on the surface of neurons. The detection of specific paraneoplastic antibodies often assists the clinician in the investigation of an underlying, sometimes specific, malignancy. This review aims to discuss the immunological and pathophysiological mechanisms that are thought to be crucial in the aetiology of dysimmune neuropathies as well as their individual electrophysiological characteristics, their laboratory features and existing treatment options. Here, we aim to present a balance of discussion from these diverse angles that may be helpful in categorizing disease and establishing prognosis.

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Section: Guillain–barre Syndromementioning

confidence: 99%

Immune-Mediated Neuropathies: Pathophysiology and Management

Shastri

Aiyan

Kishore

et al. 2023

IJMS

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“…Moreover, although GBS cases were observed in individuals vaccinated with different COVID-19 vaccines, its increased risk was only found for adenoviral vector vaccines (19,21,22,58). Therefore, European Medicine Agency included a warning of GBS in the updated versions of package information of AZD1222 and Ad26.COV2.S vaccines (59,60), but not for other COVID-19 vaccines.…”

Section: Evaluating the Hypotheses 31 Guillain-barre ́Syndrome And Sp...mentioning

confidence: 99%

“…on mRNA vaccines (e.g., nearly 1 billion doses of mRNA vaccines vs. approximately 185 million doses of adenoviral vector vaccines were given in the European Economic Area by early February 2023)(61). Therefore, if the post-vaccination GBS was related to cross-reactive anti-spike antibodies generated after immunization, it should be predominantly observed after mRNA, not adenoviral vaccination, but the evidence points to the contrary(19,21, 58). Moreover, the varying risk of GBS observed for COVID-19 vaccines cannot be explained by the difference in the prefusion stability of full-length spike protein encoded by adenoviral, and mRNA vaccines, and present in subunit protein vaccines.…”

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confidence: 99%

Guillain-Barré syndrome and COVID-19 vaccines: focus on adenoviral vectors

Rzymski

2023

Front. Immunol.

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COVID-19 vaccination is a life-saving intervention. However, it does not come up without a risk of rare adverse events, which frequency varies between vaccines developed using different technological platforms. The increased risk of Guillain-Barré syndrome (GBS) has been reported for selected adenoviral vector vaccines but not for other vaccine types, including more widely used mRNA preparations. Therefore, it is unlikely that GBS results from the cross-reactivity of antibodies against the SARS-CoV-2 spike protein generated after the COVID-19 vaccination. This paper outlines two hypotheses according to which increased risk of GBS following adenoviral vaccination is due to (1) generation of anti-vector antibodies that may cross-react with proteins involved in biological processes related to myelin and axons, or (2) neuroinvasion of selected adenovirus vectors to the peripheral nervous system, infection of neurons and subsequent inflammation and neuropathies. The rationale behind these hypotheses is outlined, advocating further epidemiological and experimental research to verify them. This is particularly important given the ongoing interest in using adenoviruses in developing vaccines against various infectious diseases and cancer immunotherapeutics.

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“…The needed terms “increase” or “increased” were missing in descriptions of OE ratios and risk of Guillain-Barré syndrome for BNT162b2 and mRNA-1273 vaccines in the Abstract, Results, and Discussion. This article has been corrected …”

mentioning

confidence: 99%

“…In the Original Investigation titled “Reports of Guillain-Barré Syndrome After COVID-19 Vaccination in the United States,” 1 published February 1, 2023, there were errors in the Results in the number of Brighton level 1 cases and the observed-to-expected (OE) ratio data for the BNT162b2 vaccine 42-day postvaccination interval. The needed terms “increase” or “increased” were missing in descriptions of OE ratios and risk of Guillain-Barré syndrome for BNT162b2 and mRNA-1273 vaccines in the Abstract, Results, and Discussion.…”

mentioning

confidence: 99%

Errors in Abstract, Results, and Discussion

2023

JAMA Netw Open

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In the Original Investigation titled "Reports of Guillain-Barré Syndrome After COVID-19 Vaccination in the United States," 1 published February 1, 2023, there were errors in the Results in the number of Brighton level 1 cases and the observed-to-expected (OE) ratio data for the BNT162b2 vaccine 42-day postvaccination interval. The needed terms "increase" or "increased" were missing in descriptions of OE ratios and risk of Guillain-Barré syndrome for BNT162b2 and mRNA-1273 vaccines in the Abstract, Results, and Discussion. This article has been corrected. 1

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Reports of Guillain-Barré Syndrome After COVID-19 Vaccination in the United States

Cited by 54 publications

References 21 publications

Immune-Mediated Neuropathies: Pathophysiology and Management

Immune-Mediated Neuropathies: Pathophysiology and Management

Guillain-Barré syndrome and COVID-19 vaccines: focus on adenoviral vectors

Errors in Abstract, Results, and Discussion

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