COVID-19 vaccine exhibits minimal risk for recurrent Guillain-Barré syndrome

The mRNA COVID-19 vaccine was safe in patients previously diagnosed with Guillain-Barré syndrome, with only one patient needing medical care for a short period, according to a study published in JAMA Neurology.

“On Dec. 20, 2020, Israel initiated a national vaccination program against COVID-19,” Shirley Shapiro Ben David, MD, from Health Division, Maccabi Healthcare Services, Tel Aviv, Israel, and colleagues wrote. “National and international vaccine guidelines did not preclude patients who have previously been diagnosed with Guillain-Barré syndrome (GBS) from receiving the COVID-19 vaccine. However, previous association between vaccines and GBS raises the level of caution and hesitancy among clinicians and patients regarding administering the vaccine. The aim of this study was to establish rates of GBS relapse among Pfizer-BioNTech BNT162b2 vaccine receivers.”

Shapiro Ben David and colleagues conducted a descriptive retrospective cohort study using medical records from Israel Maccabi Healthcare Services. They collected data from medical records of members who were recorded as having an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for GBS recorded between 2000 and 2020 (n = 702; mean age, 53; 48% women). The data included information on GBS, vaccine administration, medical care encounters and hospital visits after receiving at least one COVID vaccine dose.

Most of the patients who had GBS received at least one does of the COVID vaccine (n = 579) and most of those patients then received a second dose (n = 539). Median follow up after the first vaccine administration was 108 days, and 90 days for the second dose.

Thirty-eight of the 40 patients who received only one dose of the vaccine previously had COVID-19 and only required one dose per Israeli Ministry of Health guidelines.

After receiving one dose, 48 patients were seen in a hospital; 24 patients visited the ED and after less than 24 hours were released for transient non-neurologic concerns.

Investigators reported five patients were referred to the hospital for neurological concerns. Two patients had paresthesia, one patient had several months' duration of tremor, and one patient was assessed for a seizure. These patients were release from the ED within a few hours and did not require further medical attention.

The fifth patient was treated with plasmapheresis with no residual neurological symptoms. This patient experienced progressive leg weakness and paresthesia shortly after receiving the first dose of the vaccine. Several days after the second dose, the patient had to be admitted to the hospital. Shapiro Ben David and colleagues noted the clinical picture and electrodiagnostic evidence suggested sensorimotor demyelinating polyneuropathy. By day of hospital discharge, the patient had significant improvement of her lower limb weakness and only minor proximal weakness with no sensory disturbance.

“The Israeli Ministry of Health and national immunization guidelines did not include a history of GBS as a precaution or contraindication to receiving the COVID-19 vaccine, and our study supports this approach,” the investigators wrote.