Guillain-Barré syndrome following SARS-CoV-2 vaccination in the UK: a prospective surveillance study. Issue 2 (12th July 2022)

• Record Type: Journal Article
• Authors: Tamborska, Arina A; Singh, Bhagteshwar; Leonhard, Sonja E; Hodel, Eva Maria; Stowe, Julia; Watson-Fargie, Taylor; Fernandes, Peter M; Themistocleous, Andreas C; Roelofs, Jacob; Brennan, Kathryn; Morrice, Caroline; Michael, Benedict D; Jacobs, Bart C; McDonald, Helen; Solomon, Tom
• Other Names: author non-byline.; Allen Christopher M author non-byline.; Amante Gionathan author non-byline.; Breen David P author non-byline.; Brennan Kathryn author non-byline.; Romeiro Ana Carrilho author non-byline.; Cheng Shue Jun author non-byline.; Crossingham Ginette author non-byline.; Evans Jonathan author non-byline.; Evison Jon author non-byline.; Fernandes Peter M author non-byline.; Furby Julian author non-byline.; Galton Clare author non-byline.; Gregory Ralph author non-byline.; Harris Victoria author non-byline.; Hinze Stephan author non-byline.; Hogg Lucy author non-byline.; Holt James author non-byline.; Isaacs-Itua Alifa author non-byline.; Knight Kathryn author non-byline.; McHattie Andrew author non-byline.; Garrido Mireia Moragas author non-byline.; Murray Katy author non-byline.; Ramsamy Shelby author non-byline.; Ramsay Scott author non-byline.; Roelofs Jacob author non-byline.; Samarasekera Neshika author non-byline.; San Pyae Phyo author non-byline.; Sawcer Stephen author non-byline.; Shields Simon author non-byline.; Tallantyre Emma author non-byline.; Terry Robyn author non-byline.; Themistocleous Andreas C author non-byline.; Tucker Harry author non-byline.; Tuohy Orla author non-byline.; Watson-Fargie Taylor author non-byline.; Whittam Daniel author non-byline.; Wiblin Louise author non-byline.; Zeidler Martin author non-byline.;
• Is Part Of: BMJ neurology open. Volume 4:Issue 2(2022)
• Publication Date: 2022-07-12
• Subjects: clinical neurology -- guillain-barre syndrome -- COVID-19; Neurology -- Periodicals; 616.8
• DOI: 10.1136/bmjno-2022-000309
• Languages: English
• ISSNs: 2632-6140

Abstract

Abstract : Objective: To investigate features of Guillain-Barré syndrome (GBS) following SARS-CoV-2 vaccines and evaluate for a causal link between the two. Methods: We captured cases of GBS after SARS-CoV-2 vaccination through a national, open-access, online surveillance system. For each case, the certainty of GBS was graded using the Brighton criteria, and the relationship to the vaccine was examined using modified WHO Causality Assessment criteria. We compared age distribution of cases with that of prepandemic GBS cases and clinical features with the International GBS Outcome Study (IGOS). Results: Between 1 January and 30 June 2021, we received 67 reports of GBS following the ChAdOx1 vaccine (65 first doses) and three reports following the BNT162b2 vaccine (all first doses). The causal association with the vaccine was classified as probable for 56 (80%, all ChAdOx1), possible for 12 (17%, 10 ChAdOx1) and unlikely for two (3%, 1 ChAdOx1). A greater proportion of cases occurred in the 50–59 age group in comparison with prepandemic GBS. Most common clinical variants were sensorimotor GBS (n=55; 79%) and facial diplegia with paraesthesias (n=10; 14%). 10% (n=7/69) of patients reported an antecedent infection, compared with 77% (n=502/652) of the IGOS cohort (p<0.00001). Facial weakness (63% (n=44/70) vs 36% (n=220/620); p<0.00001) and sensory dysfunction (93% (n=63/68) vs 69% (n=408/588); p=0.00005) were more common but disease severity and outcomes were similar to the IGOS study. Interpretation: Most reports of GBS followed the first dose of ChAdOx1 vaccine. While our study cannot confirm or refute causation, this observation, together with the absence of alternative aetiologies, different than expected age distribution and the presence of unusual clinical features support a causal link. Clinicians and surveillance bodies should remain vigilant to the possibility of this very rare adverse event and its atypical variants.