Guillain-Barré Syndrome After COVID-19 Vaccination: A Systematic Review and Analysis of Case Reports
Mohammad Abuawwad1, Mohammad Jehad Taha1, Ahmad J. Taha1, Yasmeena Abdelall Kozaa2, Obaida Falah1, Ibrahim T. Abuawwad1, Elsayed Mohamed Hammad3, Mohammad Aladawi4
1Kasr Alainy School of Medicine, Cairo University, 2Mansoura Manchester Programme For Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt, 3Department of Clinical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt, 4Department of Neurology, University of Alabama Medical Center, Birmingham
Objective:
Our work aims to investigate the incidence of GBS after COVID-19 vaccination, and describe its clinical characteristics and potential confounders.
Background:
Cases of Guillain-Barré Syndrome (GBS) have been believed to be associated with the novel COVID-19 infection, and also with the following vaccines developed against the infection.
Design/Methods:
An electronic search was conducted through four databases: PubMed, Scopus, medRxiv, and Google Scholar for all case reports and case series describing after COVID-19 vaccine administration. Modified Erasmus GBS Outcome Score (mEGOS) for the ability to walk after GBS was calculated for all cases with sufficient clinical data, and Kaplan-Meier survival analysis was performed to study the effect of vaccine type on the relationship between vaccination time and complication of GBS.
Results:
A 103 studies describing 175 cases of GBS following COVID-19 vaccination were included. The AIDP subtype was the most reported subtype with 74 cases (42.29%). The affected age group averaged around 53.59 ±18.83 years, with AMSAN occurring in a rather older group (63.88 ±20.87 years, p=0.049). AstraZeneca vaccine was associated with AIDP (n=38, 21.71%) more than other vaccines, p=0.02. Bilateral facial palsy subtype was mostly linked to adenoviral vector vaccinations, accounting for an average of 72% of the total BFP cases. Dysesthesias was the most reported sensory complication (60%, p=0.349). Most GBS patients survived (96%, p=0.036), however, most patients had low mEGOS scores (4 ±3.57, p<0.01). On average, patients developed GBS at 13.43 ±11.45 days from vaccination (p=0.73), and survival analysis for complication into mechanical ventilation or walking impairment yielded a severely increased probability of complication after 25 days (p<0.01).
Conclusions:
Most cases occurred after receiving the AstraZeneca or Pfizer vaccines, and despite low mortality rates, ambulation was compromised in most patients. A higher risk of GBS complication is associated with an onset later than 12-13 days, particularly with Pfizer, AstraZeneca, and Moderna vaccines.
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