UK Study Of COVID-19 Shots And Excess Rates Of Guillain-Barré Syndrome

Update April 15, 2022: Originally published on December 21, 2022. The same study is now peer-reviewed and published in the journal Brain, COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database.

This post presents a study done by several government health agencies in the UK about the excess cases of Guillan Barré syndrome in people who received the AstraZeneca COVID-19 vaccine.

The preprint study, COVID-19 vaccination, and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database, is available at medRxiv.

Contents hide

1 Guillain-Barré Syndrome

1.1 data Sources

1.2 Baseline GBS cases outside of 2021

1.3 study Findings

2 GBS Symptoms in the study

2.1 Facial weakness

2.2 Recurrent GBS in one patient

2.3 Comparison to previous vaccine-related GBS

2.4 Know the early signs of GBS

3 Share this:

4 Like this:

5 Related

Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is a neurological disease involving peripheral nerves.

GBS can range from a mild case with brief weakness to complete paralysis, leaving the person unable to breathe independently. If this happens, intubation and mechanical ventilation are needed.

GBS is an autoimmune disease where the body’s immune system attacks the nerves. Exposure to some vaccines, chemicals, and viral and bacterial infections has been implicated as the initial stimuli that form the autoimmune antibodies.

Typically, protein sequences are similar between the inciting substance or germ and the nerves. The resulting antibodies and immune system then get confused and attack the nerves thinking it was the initial agent.

The treatments are hospitalization, steroids, and the administration of immunoglobulins to bind the autoimmune antibodies to halt further nerve damage and respiratory failure.

The UK study used multiple national data sources to investigate any relationship between COVID-19 vaccination and excess cases of GBS during the 2021 UK COVID-19 vaccination.

data Sources

The authors were aware that the UK population is aware of vaccine-related GBS and possible bias that may affect the study results. That is why they did not rely on a passive reporting system like the Vaccine Adverse Reaction System (VAERS) of the US or the EudraVigilance.

Instead, they used data from the National Immunoglobulin Database (NID). The NID is an extensive database of patients hospitalized with GBS in England, Scotland, and Northern Ireland treated with immunoglobulin.

Then they used the unique identifier of the patients and looked them up in the National Immunisation Management System (NIMS) to see if they had a COVID shot. They looked at the age, sex, vaccination date (first and second), and onset of GBS symptoms.

Baseline GBS cases outside of 2021

To know the excess cases, we have to know the usual number of GBS first.

Baseline GBS between 2016-2020 in the UK (England, Scotland, and Northern Ireland) is 1.57-2.1 per 100,000 individuals per year

Previous European and North American studies have incidence rates of between 0.84-1.91 per 100,000 individuals per year

study Findings

996 GBS cases were recorded in the National Immunoglobulin Database (NID) from January to October 2021. A spike of GBS cases above the 2016-2020 average occurred in March-April 2021.

In England, among all cases of GBS, 198 occurred within 6 weeks of the first-dose COVID-19 vaccination (0.618 cases per 100,000 vaccinations, 176 ChAdOx1 nCoV-19 (AstraZeneca), 21 tozinameran (Pfizer), 1 mRNA-1273 (Moderna)).

The excess of GBS occurs with a peak at 24 days; first-doses of ChAdOx1 nCoV-19 accounted for the excess. No excess was seen for second-dose vaccination.

The absolute number of excess GBS cases was between 98-140 cases for first-dose ChAdOx1 nCoV-19 vaccination from January-July 2021. First-dose tozinameran and second-dose of any vaccination showed no excess GBS risk.

Data from the linked NID/NIMS (National Immunisation Management System) dataset suggest that first-dose ChAdOx1 nCoV-19 vaccination is associated with an excess GBS risk of 0.576 (95%CI 0.481-0.691) cases per 100,000 doses.

The screenshot shows the number of GBS symptoms per vaccine from week 1 to 23 of 2021. Note the increase in GBS cases among people who received the AstraZeneca vaccine or ChAdOx1 nCoV-19. Tozinameran is the Pfizer shot.

Uk Study Of Covid-19 Shots And Excess Rates Of Guillain-Barré Syndrome — Source: Keh Et Al

GBS Symptoms in the study

Facial weakness

Forty-two patients (34.7%) were reported to have facial weakness in association with other GBS findings.

Facial weakness was bilateral in 37 of these patients. Only 7 patients (5.8%) had pure bilateral facial paralysis with paraesthesia.

Recurrent GBS in one patient

A single patient was reported to have a recurrent GBS-like illness following second-dose vaccination.

After the first dose of ChAdOx1 nCov-19 vaccine the patient initially developed a facial diplegia and paraesthesia phenotype with subsequent gait disturbance and elevated CSF protein, and improved with IVIg (intravenous immonoglobulin).

Two months later, two weeks after their second dose of ChAdOx1 nCoV-19vaccination, they developed increasing weakness with neuropathic pain, with elevated CSF protein, demyelinating changes on nerve conduction studies and MRI enhancement of the cauda equina, with only partial response to IVIg treatment.

Lesson: If at first jab you had GBS, don’t take the second!

Comparison to previous vaccine-related GBS

The excess incidence is estimated to be 5.8 cases per million doses, similar to the estimates for the 1976 ‘swine flu’ vaccine and higher as the reported excess cases for the modern influenza and yellow fever vaccines.

It is unclear to the authors what is the exact cause but the simian adenovirus vector may account for the increased risk.

Know the early signs of GBS

According to The National Institute of Neurological Disorders and Stroke,

Unexplained sensations often occur first, such as tingling in the feet or hands, or even pain (especially in children), often starting in the legs or back.

Children will also show symptoms with difficulty walking and may refuse to walk. These sensations tend to disappear before the major, longer-term symptoms appear.

Weakness on both sides of the body is the major symptom that prompts most people to seek medical attention. The weakness may first appear as difficulty climbing stairs or with walking.

Symptoms often affect the arms, breathing muscles, and even the face, reflecting more widespread nerve damage. Occasionally symptoms start in the upper body and move down to the legs and feet.

If you develop any of the symptoms, call your physician. Immediate diagnosis is vital to prevent respiratory failure.

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References:

Keh et al. BPNS/ABN COVID-19 Vaccine GBS Study Group COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database medRxiv 2021.12.14.21267418; doi: https://doi.org/10.1101/2021.12.14.21267418
McMahon AW, Eidex RB, Marfin AA, et al. Neurologic disease associated with 17D-204 yellow fever vaccination: a report of 15 cases. Vaccine. 2007;25(10):1727-34. doi:
10.1016/j.vaccine.2006.11.027.
Salmon DA, Proschan M, Forshee R, et al. Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis. Lancet. 2013;381(9876):1461-8. doi: 10.1016/S0140-6736(12)62189-8.

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