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COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database

Vaccination against viruses has rarely been associated with Guillain-Barré syndrome (GBS), and an association with the COVID-19 vaccine is unknown. We performed a population-based study of National Health Service data in England and a multicentre surveillance study from UK hospitals to investigate t...

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Autores principales: Keh, Ryan Y S, Scanlon, Sophie, Datta-Nemdharry, Preeti, Donegan, Katherine, Cavanagh, Sally, Foster, Mark, Skelland, David, Palmer, James, Machado, Pedro M, Keddie, Stephen, Carr, Aisling S, Lunn, Michael P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903477/
https://www.ncbi.nlm.nih.gov/pubmed/35180300
http://dx.doi.org/10.1093/brain/awac067
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author Keh, Ryan Y S
Scanlon, Sophie
Datta-Nemdharry, Preeti
Donegan, Katherine
Cavanagh, Sally
Foster, Mark
Skelland, David
Palmer, James
Machado, Pedro M
Keddie, Stephen
Carr, Aisling S
Lunn, Michael P
author_facet Keh, Ryan Y S
Scanlon, Sophie
Datta-Nemdharry, Preeti
Donegan, Katherine
Cavanagh, Sally
Foster, Mark
Skelland, David
Palmer, James
Machado, Pedro M
Keddie, Stephen
Carr, Aisling S
Lunn, Michael P
author_sort Keh, Ryan Y S
collection PubMed
description Vaccination against viruses has rarely been associated with Guillain-Barré syndrome (GBS), and an association with the COVID-19 vaccine is unknown. We performed a population-based study of National Health Service data in England and a multicentre surveillance study from UK hospitals to investigate the relationship between COVID-19 vaccination and GBS. Firstly, case dates of GBS identified retrospectively in the National Immunoglobulin Database from 8 December 2021 to 8 July 2021 were linked to receipt dates of COVID-19 vaccines using data from the National Immunisation Management System in England. For the linked dataset, GBS cases temporally associated with vaccination within a 6-week risk window of any COVID-19 vaccine were identified. Secondly, we prospectively collected incident UK-wide (four nations) GBS cases from 1 January 2021 to 7 November 2021 in a separate UK multicentre surveillance database. For this multicentre UK-wide surveillance dataset, we explored phenotypes of reported GBS cases to identify features of COVID-19 vaccine-associated GBS. Nine hundred and ninety-six GBS cases were recorded in the National Immunoglobulin Database from January to October 2021. A spike of GBS cases above the 2016–2020 average occurred in March–April 2021. One hundred and ninety-eight GBS cases occurred within 6 weeks of the first-dose COVID-19 vaccination in England [0.618 cases per 100,000 vaccinations; 176 ChAdOx1 nCoV-19 (AstraZeneca), 21 tozinameran (Pfizer) and one mRNA-1273 (Moderna)]. The 6-week excess of GBS (compared to the baseline rate of GBS cases 6–12 weeks after vaccination) occurred with a peak at 24 days post-vaccination; 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 from January–July 2021 was between 98–140 cases for first-dose ChAdOx1 nCoV-19 vaccination. First-dose tozinameran and second-dose of any vaccination showed no excess GBS risk. Detailed clinical data from 121 GBS patients were reported in the separate multicentre surveillance dataset during this timeframe. No phenotypic or demographic differences identified between vaccine-associated and non-vaccinated GBS cases occurring in the same timeframe. Analysis of the linked NID/NIMS dataset suggested that first-dose ChAdOx1 nCoV-19 vaccination is associated with an excess GBS risk of 0.576 (95% confidence interval 0.481–0.691) cases per 100 000 doses. However, examination of a multicentre surveillance dataset suggested that no specific clinical features, including facial weakness, are associated with vaccination-related GBS compared to non-vaccinated cases. The pathogenic cause of the ChAdOx1 nCoV-19 specific first dose link warrants further study.
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spelling pubmed-89034772022-03-09 COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database Keh, Ryan Y S Scanlon, Sophie Datta-Nemdharry, Preeti Donegan, Katherine Cavanagh, Sally Foster, Mark Skelland, David Palmer, James Machado, Pedro M Keddie, Stephen Carr, Aisling S Lunn, Michael P Brain Original Article Vaccination against viruses has rarely been associated with Guillain-Barré syndrome (GBS), and an association with the COVID-19 vaccine is unknown. We performed a population-based study of National Health Service data in England and a multicentre surveillance study from UK hospitals to investigate the relationship between COVID-19 vaccination and GBS. Firstly, case dates of GBS identified retrospectively in the National Immunoglobulin Database from 8 December 2021 to 8 July 2021 were linked to receipt dates of COVID-19 vaccines using data from the National Immunisation Management System in England. For the linked dataset, GBS cases temporally associated with vaccination within a 6-week risk window of any COVID-19 vaccine were identified. Secondly, we prospectively collected incident UK-wide (four nations) GBS cases from 1 January 2021 to 7 November 2021 in a separate UK multicentre surveillance database. For this multicentre UK-wide surveillance dataset, we explored phenotypes of reported GBS cases to identify features of COVID-19 vaccine-associated GBS. Nine hundred and ninety-six GBS cases were recorded in the National Immunoglobulin Database from January to October 2021. A spike of GBS cases above the 2016–2020 average occurred in March–April 2021. One hundred and ninety-eight GBS cases occurred within 6 weeks of the first-dose COVID-19 vaccination in England [0.618 cases per 100,000 vaccinations; 176 ChAdOx1 nCoV-19 (AstraZeneca), 21 tozinameran (Pfizer) and one mRNA-1273 (Moderna)]. The 6-week excess of GBS (compared to the baseline rate of GBS cases 6–12 weeks after vaccination) occurred with a peak at 24 days post-vaccination; 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 from January–July 2021 was between 98–140 cases for first-dose ChAdOx1 nCoV-19 vaccination. First-dose tozinameran and second-dose of any vaccination showed no excess GBS risk. Detailed clinical data from 121 GBS patients were reported in the separate multicentre surveillance dataset during this timeframe. No phenotypic or demographic differences identified between vaccine-associated and non-vaccinated GBS cases occurring in the same timeframe. Analysis of the linked NID/NIMS dataset suggested that first-dose ChAdOx1 nCoV-19 vaccination is associated with an excess GBS risk of 0.576 (95% confidence interval 0.481–0.691) cases per 100 000 doses. However, examination of a multicentre surveillance dataset suggested that no specific clinical features, including facial weakness, are associated with vaccination-related GBS compared to non-vaccinated cases. The pathogenic cause of the ChAdOx1 nCoV-19 specific first dose link warrants further study. Oxford University Press 2022-02-18 /pmc/articles/PMC8903477/ /pubmed/35180300 http://dx.doi.org/10.1093/brain/awac067 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Keh, Ryan Y S
Scanlon, Sophie
Datta-Nemdharry, Preeti
Donegan, Katherine
Cavanagh, Sally
Foster, Mark
Skelland, David
Palmer, James
Machado, Pedro M
Keddie, Stephen
Carr, Aisling S
Lunn, Michael P
COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database
title COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database
title_full COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database
title_fullStr COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database
title_full_unstemmed COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database
title_short COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database
title_sort covid-19 vaccination and guillain-barré syndrome: analyses using the national immunoglobulin database
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903477/
https://www.ncbi.nlm.nih.gov/pubmed/35180300
http://dx.doi.org/10.1093/brain/awac067
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