What are the characteristics of Guillain-Barré syndrome associated with the new crown vaccine?

The new crown virus has ravaged the world for more than three years, and the widespread vaccination, as an important part of epidemic prevention and control, has significantly reduced the risk of infection and severe disease, and saved a large number of lives
.
However, there have also been reports of neurological adverse reactions after vaccination, including Guillain-Barre Syndrome (GBS) and immune thrombosis, which have caused alarm among health authorities in various countries
.

In 2021 alone, at least dozens of vaccine-related GBS cases were publicly reported
.
The majority of these (64%) were vaccinated with the AstraZeneca ^{vaccine [1]}, followed by the Pfizer-BNT vaccine
.
Other Johnson & Johnson vaccines[2], Sinopharm vaccines[3], and Sinovac ^vaccines[4] have also been reported rarely
。 According to incomplete statistics, GBS
occurs in about 5.
8 cases per million people vaccinated with the AstraZeneca vaccine.
The risk is 1.
4 to 10 times higher than in the general population ^[5].

Similar to GBS in general, vaccine-associated GBS may also be caused by abnormally activated autoimmunity destroying the nerve myelin sheath or axon.

Author: Huang Bo
.

This article is authorized by the author to be published by Yimaitong, please do not reprint
it without authorization.
 

Clinical features

Most onset of GBS occurs within one to two weeks of immune activation and peaks in around four weeks ^[6].

Some scholars counted 39 cases of GBS patients related to the new crown vaccine, and found that from vaccination to onset, the time ranged from 3-28 days, with an average of 11.
3 days
.
Some appear after the first dose, and some appear after
the second dose.

In terms of laboratory tests, the vast majority of patients who have undergone lumbar puncture have protein-cell separation in cerebrospinal fluid
.
Some patients are positive for GM2, GM3, or GM4 antibodies ^[1].

In terms of symptoms, most of the GBS related to the new crown vaccine is also AIDP type, manifested as quadriplegia, facial paralysis, paresthesia, and some have muscle pain and autonomic disorders
.
A few are AMAN and AMSAN, and one case presents with variant Miller-Fisher syndrome ^[2].

Some scholars have pointed out that patients with GBS associated with the new crown vaccine, the incidence of bilateral facial paralysis and other cranial nerve involvement (such as extensor nerve and trigeminal nerve palsy) is particularly high, and often respiratory failure is severe and requires machine assistance, but this study from India only counted 7 patients ^[5], and the conclusion is still debatable
.

Treatment and prognosis

Patients with vaccine-related GBS are treated differently
.
The vast majority of patients received intravenous immunoglobulin (IVIG), and a small number received plasmapheresis
.
Some people with severe respiratory failure are ventilated
.

In terms of prognosis, the severity of GBS patients is usually evaluated using the GBS disability scale, as shown in the figure
.
One study counted 30 patients with vaccine-related GBS at the time of discharge or follow-up, of which 13 patients scored 0-2, 5 scored 3, 11 patients scored 4-5, and 1 scored 6 (death).

^[1]

GBS disability scale ^[6].

• 0 points - health

• 1 point - mild symptoms, can run

• 2 points - can't run, but can walk 10 meters without assistance ≥

• 3 points - can walk 10 meters through the open area with assistance

• 4 points - bed or wheelchair

• 5 points - at least sometimes assisted breathing is required

• 6 points - death

  
  

summary

After vaccination, GBS has been reported in many other vaccines very early, such as H1N1 influenza vaccine, Zika virus vaccine, etc.
^[3], so the new crown vaccine may not be special
.
Especially from the current public reports, GBS is mainly caused by the AstraZeneca vaccine that has not yet been introduced in China, while the incidence of domestic inactivated vaccines is very low, but the benefits of vaccination are very large
.
Therefore, weighing the pros and cons, the extremely limited risk of GBS should not affect normal vaccination.

But this also tells us that the monitoring of adverse reactions after vaccination is very important, and we cannot feel that the task is completed after vaccination, and everything is fine
.

For neurologists, it is important to be aware that GBS may be caused
by COVID vaccination.
In the current era of the new crown epidemic, when receiving relevant patients, it is necessary to pay attention to the vaccination history to achieve rapid identification and diagnosis
.