key: cord-0943035-fh5s1s4p
authors: James, Joe; Jose, James; Gafoor, V. Abdul; Smita, B; Balaram, Neetha
title: Guillain‐Barré syndrome following ChAdOx1 nCoV‐19 COVID‐19 vaccination: A case series
date: 2021-07-21
journal: Neurol Clin Neurosci
DOI: 10.1111/ncn3.12537
sha: fab81577fe2ccdd4f25d7d23c685d741411bb6e2
doc_id: 943035
cord_uid: fh5s1s4p

ChAdOx1 nCoV‐19 is an effective and well‐tolerated coronavirus disease 2019 (COVID‐19) vaccine. Rare cases of serious adverse events have been reported with this vaccine. We report three patients who developed Guillain‐Barré syndrome following ChAdOx1 nCoV‐19 vaccination, who did not have active or prior COVID‐19 infection. The neurological illness in all patients had an onset of 11‐13 days after the first dose of vaccine. All were characterized by sensorimotor weakness of the upper and lower limbs, with facial diplegia in one and dysautonomia in the other. Nerve conduction studies were consistent with demyelination in two and axonopathy in one. Cerebrospinal fluid analysis showed albuminocytological dissociation in two patients. All patients had moderate‐to‐severe disability. They were treated with intravenous immunoglobulin, with stabilization of the disease. Proper monitoring and prompt reporting of such cases is required to ensure safety of the vaccine.

As per World Health Organization, there are more than 150 million confirmed cases of coronavirus disease 2019 (COVID-19) with more than 3 million deaths as of May 2021. Since December 2020, several vaccines have been approved on an emergency basis to curb down the pandemic. The ChAdOx1 nCoV-19 vaccine consists of a replication-deficient chimpanzee adenoviral vector, containing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surface spike protein, and has an efficacy of 70.4% after two standard doses. 1 However, serious adverse events such as transverse myelitis and thrombotic thrombocytopenia after vaccination have been a cause for concern. 2 Here, we report three patients who developed Guillain-Barré syndrome (GBS) after the first dose of ChAdOx1 nCoV-19 vaccination. Lower limb power was grade 2/5 proximally and grade 4+/5 distally.

Upper limb reflexes were normal, lower limb reflexes were absent, and plantar reflexes were flexor bilaterally. Sensory examination was normal. Nerve conduction study (NCS) showed sensorimotor axonal neuropathy. Cerebrospinal fluid (CSF) analysis showed elevated protein, normal sugar, and no cells ( Table 1) . MRI of the spine was normal. He was treated with intravenous immunoglobulin (IVIG) 2 g/kg divided over five days. The progression of the illness got arrested, and subsequently, the upper limb power improved. However, the lower limb weakness was persisting at the time of discharge. Patient 2 was a 66 years-old male who presented with numbness of fingers and toes with weakness 12 days after the first dose 

The nCoV-19 vaccine, may also be the trigger for GBS. GBS after vaccination is rare and is reported with many vaccines, but the association is especially strong with influenza vaccination. The incidence of Guillain-Barré syndrome after influenza A (H1N1) vaccination is 1.6 per million. 6 Three cases of GBS have been reported with COVID-19

vaccines, including one with ChAdOx1 nCoV-19 vaccine. [7] [8] [9] In some cases of vaccine-related autoimmunity, rechallenge with booster doses of the vaccine resulted in recurrence or worsening of the disease; hence, it is prudent to avoid the second dose of vaccine in such patients. As the number of vaccinations increases, there must be an active surveillance for such cases, since early recognition and treatment can result in better recovery.

We thank our colleagues Dr Geetha P, Department of Medicine, Government Medical College, Kozhikode, and Dr Devarajan E,

College, Kozhikode.

The authors declare no conflicts of interests for this article.

Written informed consent was obtained from all the participants for inclusion in this study. 

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination

Risk factors for treatment related clinical fluctuations in Guillain-Barre syndrome

Guillain-Barré syndrome Associated with SARS-CoV-2

The spectrum of antecedent infections in Guillain-Barré syndrome

Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis

Guillain-barré syndrome in the placebo and active arms of a COVID-19 vaccine clinical trial

Neurological complications of COVID-19: guillain-barre syndrome following pfizer COVID-19 vaccine

Guillain-Barre syndrome following the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1