Summary: Studies reveal a small number of people developed symptoms associated with Guillain-Barre syndrome following the Astra-Zeneca COVID-19 vaccine. As with all vaccines, while a tiny percentage of people may develop adverse side effects, it is still vital that people continue to get vaccinated against COVID.
In two separate articles in the Annals of Neurology, clinicians in India and England report a tiny number of cases of a rare neurological disorder called Guillain-Barre syndrome after individuals were vaccinated against COVID-19.
Both reports describe an unusual variant of Guillain-Barre syndrome characterized by prominent facial weakness.
Seven cases were reported from a regional medical center in Kerala, India, where approximately 1.2 million people were vaccinated with the AstraZeneca COVID-19 vaccine.
Four cases were reported from Nottingham, England, in an area in which approximately 700,000 people received the same vaccine. All eleven cases were among people who had received that vaccine 10-22 days earlier.
The frequency of Guillain-Barre syndrome in these areas was estimated to be up to 10 times greater than expected.
“If the link is causal it could be due to a cross-reactive immune response to the SARS-CoV-2 spike protein and components of the peripheral immune system,” wrote the authors of the report from England.
The authors of both articles stress that clinicians should be vigilant in looking for this rare neurological syndrome following administration of COVID-19 vaccines.
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Guillain-Barré syndrome variant occurring after SARS-CoV-2 vaccination
Whilst SARS-CoV-2 vaccines are very safe, we report four cases of the bifacial weakness with paraesthesias variant of Guillain-Barré syndrome (GBS) occurring within three weeks of vaccination with the Oxford-AstraZeneca SARS-CoV-2 vaccine.
This rare neurological syndrome has previously been reported in association with SARS-CoV-2 infection itself. Our cases were given either intravenous immunoglobulin, oral steroids, or no treatment.
We suggest vigilance for cases of bifacial weakness with paraesthesias variant GBS following vaccination for SARS-CoV-2 and that post-vaccination surveillance programs ensure robust data capture of this outcome, to assess for causality.
Guillain-Barré syndrome following ChAdOx1-S/nCoV-19 vaccine
As of April 22, 2021, around 1.5 million individuals in 3 districts of Kerala, India had been vaccinated with COVID-19 vaccines. Over 80% of these individuals (1.2 million) received the ChAdOx1-S/nCoV-19 vaccine. In this population, during this period of 4 weeks (mid-March to mid-April 2021), we observed seven cases of Guillain-Barre syndrome (GBS) that occurred within two weeks of the first dose of vaccination.
All 7 patients developed severe GBS. The frequency of GBS was 1.4 to10 fold higher than that expected in this period for a population of this magnitude. In addition, the frequency of bilateral facial weakness, which typically occurs in <20% of GBS cases, suggests a pattern associated with the vaccination.
While the benefits of vaccination substantially outweigh the risk of this relatively rare outcome (5.8 per million), clinicians should be alert to this possible adverse event, as six out of seven patients progressed to areflexic quadriplegia and required mechanical ventilatory support.