Can Guillain-Barré Syndrome Recur After mRNA COVID Vaccine?

Serious relapse of Guillain-Barré syndrome (GBS) after receiving the Pfizer/BioNtech COVID-19 mRNA vaccine (Comirnaty) was rare, an analysis of medical records in Israel showed.

Out of nearly 600 people previously diagnosed with GBS who got the vaccine, one needed brief medical care for relapse afterward, reported Shirley Shapiro Ben David, MD, of Maccabi Healthcare Services in Tel Aviv, and co-authors in JAMA Neurology.

The patient, who had a history of GBS, received plasmapheresis for the relapse and recovered without residual neurologic symptoms.

“An important paper addressing a question we’re asked all the time: what’s the risk of recurrent Guillain-Barré syndrome after the COVID vaccine? The answer: very, very, (very!) low,” Lyell Jones, MD, of the Mayo Clinic in Rochester, Minnesota, who wasn’t involved with the study, observed on Twitter.

“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,” Jones said in an email to MedPage Today. “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.” 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.

This study is the first to assess the safety of mRNA COVID-19 vaccines in previously diagnosed cases of GBS, Shapiro Ben David and colleagues noted. It was based on records from the second largest HMO in Israel, Maccabi Healthcare Services, which serves more than 2.5 million members, or about a quarter of the Israeli population.

The researchers searched the Maccabi database for GBS 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.

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,” Shapiro Ben David and colleagues wrote. “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,” they noted.

Last Updated September 02, 2021