Cases of Guillan Barre´ Syndrome Following COVID-19 Vaccination: An International Journal of Medical Toxicology and Drug Experience

ABSTRACT

Introduction: Guillain-Barre Syndrome (GBS) is a rare immune system disorder that results in muscle weakness, pain or numbness, and, in severe cases, paralysis. GBS is usually due to infections, and occurs more frequently in males and persons over 50 years old [1]. Some cases were described following vaccination among them COVID-19 vaccines. Objective: To describe features of COVID-19 vaccine-associated GBS. Methods: We carried out a retrospective, descriptive study of GBS patients following COVID-19 vaccine, submitted to the World Health Organization (WHO) global adverse drug reaction database (VigiBase®) from Tunisia during the period between march 2021 and May 2022. We extracted the data using VigiLyze® software with the English version 25 of MedDRA to identify features of COVID-19 vaccine-associated GBS. In addition, we evaluated vaccine causality using the updated French causality assessment method [2]. Results: Overall, we retrieved 8 patients with GBS post COVID-19 vaccination Men were representing 62.5% (5/3) of cases. The median age of affected patients was 59 (range 41;80) years. The most fre- quently reported vaccine type was followed in order by Comirnaty® Pfizer-BioNTech vaccine (n = 3 reports [37.5%]), Vaxzevria® AstraZeneca vaccine (n = 3 [37.5%]) and Janssen® vaccine (n = 2 [25%]). The mean time interval from vaccination to symptom onset was 15.3 days (range 7-30 days). Four patients developed GBS after receiving the first dose of a COVID-19 vaccine, three after the second dose and one after the third dose. Clinical manifestations were dif- ferent with varying severity classical GBS [1] (progressive ascending limb weakness associated with reduced or absent reflexes) in 5 cases, and GBS with unilateral facial palsy in 3. In all cases, electromyog- raphy (EMG) studies were consistent with the demyelinating pathology of GBS. Cerebrospinal fluid (CSF) examination showed albuminocytologic dissociation in 3 cases, was normal in 3 and not done in 2. Five patients were treated with a course of intravenous immune globulin (IVIg) for five days and one patient received a total of 2 sessions of plasma exchange. In 2 patients the nature of the treatment was unknown. Six patients reported clinical improvement within 7-10 days while two showed treatment-related fluctuations (TRF). Conclusion: Our observations suggest that COVID-19 vaccines may be associated with GBS. Continuous surveillance and further studies are warranted to assess the significance of the association.