Seven Cases of Guillain-Barré Noted After COVID-19 Vaccine in India

Cases of Guillain-Barré syndrome (GBS) have been reported after receipt of the Oxford-AstraZeneca severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, according to two reports published online June 10 in the Annals of Neurology.

Boby Varkey Maramattom, M.D., from Aster Medcity in Kochi, India, and colleagues describe seven cases of GBS that occurred within two weeks of the first dose of vaccination among 1.2 million individuals who received the ChAdOx1-S/nCoV-19 vaccine during mid-March to mid-April 2021. The researchers noted that all seven patients developed severe GBS. The frequency of GBS was 1.4- to 10-fold higher than would be expected in this period. All patients progressed to areflexic quadriplegia and six required mechanical ventilation for respiratory failure. Bilateral facial weakness, which typically occurs in <20 percent of GBS cases, occurred in all seven cases, suggesting a pattern of association with vaccination.

Christopher Martin Allen, from the Nottingham University Hospitals NHS Trust in the United Kingdom, and colleagues reported four cases of bifacial weakness with paraesthesias variant of GBS occurring within three weeks of vaccination with the Oxford-AstraZeneca SARS-CoV-2 vaccine, which has previously been reported in association with SARS-CoV-2 infection. The researchers found that none of these patients reported previous infection with SARS-CoV-2. There was an interval of 11 to 22 days between vaccination and symptom onset. Patients were treated with intravenous immunoglobulin, oral steroids, or no treatment.

"We suggest vigilance for cases of bifacial weakness with paraesthesias variant GBS following vaccination for SARS-CoV-2 and that post-vaccination surveillance programs ensure robust data capture of this outcome, to assess for causality," Allen and colleagues write.