Guillain-Barré Syndrome recur after mRNA COVID vaccine, but the risk is really low

Guillain-Barré Syndrome (GBS) is an acquired demyelinating polyneuropathy that often begins in the lower extremities and ascends over time with loss of reflexes, causing muscle weakness, or in the most severe cases, paralysis. Some cases may start a few days or weeks after respiratory or gastrointestinal viral infection. GBS is often reversible.

Researchers from the Maccabi Healthcare Services, the second largest HMO in Israel, searched cases that had been diagnosed by a hospital neurology department, linking them with COVID vaccine records, medical care encounters, and hospital visits after patients received at least one vaccine dose. They conducted a manual review of the electronic medical record of all cases to ensure patients with a GBS diagnosis were accurately identified.

They identified 702 GBS cases between 2000 and 2020; 48% were women and the average age was 53. Of these patients, 579 received one Pfizer vaccine dose and 539 received two doses. The researchers followed these patients for a median of 108 days after the first dose and 90 days after the second. This study is the first to assess the safety of mRNA COVID-19 vaccines in previously diagnosed cases of GBS.

A total of five formerly diagnosed GBS patients were referred to the hospital for neurological concerns after they had the vaccine. Two patients had paresthesia, one had tremor for several months, and one was evaluated for a seizure. These four people were released from the emergency department within a few hours without medical observation. The fifth patient had progressive leg weakness and paresthesia that started soon after she received the first vaccine dose, which lasted for several weeks. She was admitted to the hospital several days after receiving her second dose.

The clinical picture and electrodiagnostic evidence were suggestive of sensorimotor demyelinating polyneuropathy, and the patient was treated with plasmapheresis in the hospital and, by the day of discharge, had a significant improvement in her lower limb weakness and only minor proximal weakness without any sensory disturbance. The analysis was limited because it relied on medical records and diagnosis, the researchers acknowledged. It included only hospital visits and may have underestimated other symptoms that presented only in the community. Nevertheless, any significant serious neurologic concern would probably have been evaluated in a hospital setting.

There were a small number of GBS cases following the swine flu vaccination campaign in 1976, and this question has unfortunately been a vaccination barrier ever since. In reality, patients often are more at risk of neurologic complications such as GBS from the infection than they are from the vaccination designed to prevent it.

Source reference: https://jamanetwork.com/journals/jamaneurology/fullarticle/2783708

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