Guillain-Barré syndrome following SARS-CoV-2 vaccination in the UK: A prospective surveillance study

Arina A. Tamborska, Bhagteshwar Singh, Sonja E. Leonhard, Eva Maria Hodel, Julia Stowe, Taylor Watson-Fargie, Peter M. Fernandes, Andreas C. Themistocleous, Jacob Roelofs, Kathryn Brennan, Caroline Morrice, Benedict D. Michael, Bart C. Jacobs, Helen McDonald, Tom Solomon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article numbere000309
JournalBMJ Neurology Open
Volume4
Issue number2
DOIs
Publication statusPublished - 12 Jul 2022

Bibliographical note

Funding Information: This work was supported by funding from the National Institute for Health Research (NIHR) and the UK Medical Research Council.

AAT is funded by the UK NIHR via academic clinical fellowship scheme (Award No. ACF-2020-07-003). TS is supported by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (Grant No. NIHR200907), NIHR Global Health Research Group on Brain Infections (No. 17/63/110) and the UK Medical Research Council’s Global Effort on COVID-19 Programme (MR/V03). TS is the president of the Encephalitis Society. BCJ received unrestricted research grants for work outside the current study from Baxalta, Grifols, CSL-Behring, Annexon, Hansa Biooharma, Prinses Beatrix Spierfonds, Horizon 2020 and GBS-CIDP Foundation International. BCJ also received consultancy fees from Roche for activities outside of the current study and is a chair of Steering Committee of International GBS Outcome Study (IGOS). BS reports non-financial support from UK NIHR Global Health Research Group on Brain Infections, grants from DHSC-UKRI Global Effort on COVID-19 (GECO) Research Grant for COVID-Neurological Disease global health research programme, outside the submitted work; and is a Clinical Management Consultant for WHO South-East Asia Regional Office, via GOARN, since April 2020 with focus on COVID-19 but not involved in any postvaccination work as part of the role. BDM received honoraria for lectures to SCRIPPS and Valneva. KB received support from CSL Behring to travel to the peripheral nerve society meeting in 2019. HM is funded by the NIHR Health Protection Research Unit in Vaccines and Immunisation.

TS was chair/cochair of the UK Research and Innovation/National Institute for Health Research COVID-19 Rapid Response and Rolling Funding Initiatives, was an Advisor to the UK COVID-19 Therapeutics Advisory Panel and is a member of the UK Medicines and Healthcare Products Regulatory Agency COVID-19 Vaccines Benefit Risk Expert Working Group. BCJ is a chair of Steering Committee of IGOS. HM is an invited expert for the Commission on Human Medicines COVID-19 Vaccines Safety Surveillance Methodologies Expert Working Group. The remaining authors have no relevant conflict of interest to declare.

Open Access: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Citation: Tamborska AA, Singh B, Leonhard SE UK Covid Vaccine GBS Study Group, et al. Guillain-Barré syndrome following SARS-CoV-2 vaccination in the UK: a prospective surveillance study. BMJ Neurology Open 2022;4:e000309.

DOI: 10.1136/bmjno-2022-000309

Keywords

  • Clinical neurology
  • Covid-19
  • Guillain-barre syndrome

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