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Science News: Guillain-Barré Syndrome Following COVID-19 Vaccines: A Scoping Review

Submitted by: Shan Chen, MD
Edited by: Rebecca A. O'Bryan, MD

Lahoz Fernandez PE, Miranda Pereira J, Fonseca Risso I, et al. Guillain-Barré syndrome following COVID-19 vaccines: A scoping review. Acta Neurol Scand. 2022;145(4):393-398. doi:10.1111/ane.13575

Summary: The association of Guillain-Barré syndrome (GBS) with COVID-19 vaccines has been unclear.
As part of postauthorization safety surveillance, the US Food and Drug Administration (FDA) has identified a potential safety concern for GBS following receipt of the COVID-19 vaccine.
In this study, the authors did a structured review based on two case reports of GBS following COVID-19 vaccination, a systematic review, and Vaccine Adverse Event Reporting System (VAERS) analysis. The authors' goal was to estimate the risk and describe the clinical characteristics of these events.
They searched on MEDLINE and Embase, from the inception to May 20, 2021, using the keywords: "Guillain barré syndrome" and cross-referenced with "COVID-19 vaccines." They compared the risk of GBS following COVID-19 vaccination with the risk of GBS following the influenza vaccine. They identified in the literature 43 reported cases of GBS following COVID-19 vaccination compared to the expected 160-320 cases following the influenza vaccination (this estimate is based on risk of 1-2 cases per million influenza vaccine doses). Among these 43 cases, the mean age was 54 years and 23 (56%) were male. The types of vaccines used: Pfizer (22), Moderna (9), AstraZeneca (3), Janssen (3), and Johnson & Johnson (1). 24 cases of GBS occurred after the first dose, with clinical onset of 7 days. Cerebrospinal fluid (CSF) albuminocytological dissociation was reported in 7 patients, and EMG revealed a predominant demyelinating pattern.
These data showed that GBS following COVID-19 vaccination is lower than the influenza vaccines. Most cases of GBS were middle-aged males within a week following the first dose of the COVID-19 vaccine, showing a typical demyelinating neuropathy with albuminocytological dissociation.

Comments: The review was based on published data, which are subject to the limitations of passive reporting systems.
Another similar study identified 130 cases of presumptive GBS in VAERS from February to July 2021 with the median time to onset of GBS following vaccination of 13 days. 121 cases (93.1%) were serious, including 1 death. Their data suggested a potential small but statistically significant safety concern for GBS following receipt of the Ad26.COV2.S (Janssen) vaccine per the authors. 
The discrepancy in the data between these two studies seems to be quite significant and may be due to different search criteria and time frame.
A further similar study on literature search after May 2021 would be very helpful and also reveal the data for the booster dose of COVID-19 vaccination.

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