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Valaparla VL, Rane SP, Patel C, Li X. Guillain-Barre syndrome and link with COVID-19 infection and vaccination: a review of literature. Front Neurol 2024; 15:1396642. [PMID: 38899056 PMCID: PMC11185933 DOI: 10.3389/fneur.2024.1396642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an autoimmune disease associated with significant morbidity. A wide variety of infectious and non-infectious triggers have been identified to be associated with GBS. COVID-19 has gained attention in recent years for its role in GBS pathogenesis. Our study aims to review the literature on GBS and its epidemiological and pathophysiological association with COVID-19. Description Recent literature on GBS associated with COVID-19 infections, such as case reports, case series, systematic reviews, and large-scale epidemiological studies, were reviewed. We also reviewed studies that included vaccines against COVID-19 in association with GBS. Studies that focused on understanding the pathobiology of GBS and its association with infectious agents including COVID-19 were reviewed. Conclusion Despite a lack of consensus, GBS is strongly associated with COVID-19 infection. The exact pathophysiological mechanism regarding COVID-19 as a causative agent of GBS is unknown. Mechanisms, such as the proinflammatory state, triggering of autoimmunity, and direct viral invasion, are postulated and remain to be investigated. Adenovirus vector vaccines are most likely associated with GBS, and the consensual reports clearly suggest mRNA vaccines are associated with low risk and may be protective against GBS by reducing the risk of COVID-19 infection.
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Affiliation(s)
| | | | | | - Xiangping Li
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
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Padilla‐Flores T, Sampieri A, Vaca L. Incidence and management of the main serious adverse events reported after COVID-19 vaccination. Pharmacol Res Perspect 2024; 12:e1224. [PMID: 38864106 PMCID: PMC11167235 DOI: 10.1002/prp2.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2n first appeared in Wuhan, China in 2019. Soon after, it was declared a pandemic by the World Health Organization. The health crisis imposed by a new virus and its rapid spread worldwide prompted the fast development of vaccines. For the first time in human history, two vaccines based on recombinant genetic material technology were approved for human use. These mRNA vaccines were applied in massive immunization programs around the world, followed by other vaccines based on more traditional approaches. Even though all vaccines were tested in clinical trials prior to their general administration, serious adverse events, usually of very low incidence, were mostly identified after application of millions of doses. Establishing a direct correlation (the cause-effect paradigm) between vaccination and the appearance of adverse effects has proven challenging. This review focuses on the main adverse effects observed after vaccination, including anaphylaxis, myocarditis, vaccine-induced thrombotic thrombocytopenia, Guillain-Barré syndrome, and transverse myelitis reported in the context of COVID-19 vaccination. We highlight the symptoms, laboratory tests required for an adequate diagnosis, and briefly outline the recommended treatments for these adverse effects. The aim of this work is to increase awareness among healthcare personnel about the serious adverse events that may arise post-vaccination. Regardless of the ongoing discussion about the safety of COVID-19 vaccination, these adverse effects must be identified promptly and treated effectively to reduce the risk of complications.
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Affiliation(s)
- Teresa Padilla‐Flores
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Alicia Sampieri
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Luis Vaca
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
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Choi MJ, Na Y, Hyun HJ, Nham E, Yoon JG, Seong H, Seo YB, Choi WS, Song JY, Kim DW, Kim YE, Jung J, Cheong HJ. Comparative safety analysis of mRNA and adenoviral vector COVID-19 vaccines: a nationwide cohort study using an emulated target trial approach. Clin Microbiol Infect 2024; 30:646-652. [PMID: 38101473 DOI: 10.1016/j.cmi.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This nationwide cohort study compared the incidence of adverse events of special interest (AESIs) between adenoviral vector-based (ChAdOx1) and mRNA-based (BNT162b2 or mRNA-1273) coronavirus disease 2019 (COVID-19) vaccines. METHODS A targeted trial emulation study was conducted using data from the National Health Insurance Service database. Vaccinees aged 18-85 years who had received at least one dose of ChAdOx1 or an mRNA-based vaccine were identified. The 42-day risks of AESIs were calculated. RESULTS A total of 1 767 539 ChAdOx1 vaccinees were matched exactly with mRNA vaccinees according to their risk factors. The 42-day risks of adverse events were low (∼0 to 176 events per 100 000 persons in both vaccine groups), and the incidence rates of AESIs were comparable between the two platforms, except for a higher occurrence of acute cardiac injury (incidence rate ratio [IRR], 1.22; 95% CI, 1.10-1.35), myocarditis or pericarditis (IRR, 2.14; 95% CI, 1.14-4.04), and arrhythmia (IRR, 1.46; 95% CI, 1.24-1.71) in mRNA vaccinees. The incidence of Guillain-Barré syndrome (IRR, 0.20; 95% CI, 0.06-0.69), vasovagal syncope (IRR, 0.77; 95% CI, 0.62-0.97), radiculopathy (IRR = 0.59, 95% CI, 0.41-0.84), and aseptic arthritis (IRR, 0.81; 95% CI, 0.70-0.93) was significantly lower in mRNA-based vaccinees compared with ChAdOx1 vaccinees. DISCUSSION A remarkable platform-dependent difference was observed in the safety profiles of COVID-19 vaccines, particularly for myocarditis or pericarditis and Guillain-Barré syndrome. However, the overall risk of AESIs was low for both vaccine platforms.
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Affiliation(s)
- Min Joo Choi
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Yewon Na
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Artificial Intelligence and Big-data Convergence Center, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hak Jun Hyun
- Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Eliel Nham
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Yoon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu Bin Seo
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Information and Statistics, Research Institute of Natural Science, Gyeongsang National University, Jinju, Republic of Korea; Department of Bio and Medical Bigdata Department, Research Institute of Natural Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Young-Eun Kim
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Republic of Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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Coraci D, Tognolo L, Ronconi G, Ferrara PE, Masiero S. Nerve ultrasound in Guillain-Barré syndrome: what the recent literature says. Acta Neurol Belg 2024; 124:665-667. [PMID: 37526900 DOI: 10.1007/s13760-023-02349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Via Nicolò Giustiniani 2, 35128, Padua, Italy.
| | - Lucrezia Tognolo
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Via Nicolò Giustiniani 2, 35128, Padua, Italy
| | - Gianpaolo Ronconi
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Paola Emilia Ferrara
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Stefano Masiero
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Via Nicolò Giustiniani 2, 35128, Padua, Italy
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Oliveira AM, Varela Ramos P, Durão-Carvalho G, Almeida V, Gonçalves Pereira J. Guillain-Barré Syndrome After a SARS-CoV-2 Vaccine. Cureus 2024; 16:e57705. [PMID: 38711707 PMCID: PMC11071625 DOI: 10.7759/cureus.57705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
The worldwide mass vaccination campaign against COVID-19 has been the largest one ever undertaken. Although the short-term safety profile of the different vaccines has been well established, neuroinflammatory complications have been described, including rare cases of acute demyelinating inflammatory polyneuropathy. We report a 63-year-old man who presented to the emergency department with proximal muscle weakness and paresthesia. He had received the first dose of the AZD1222 SARS-CoV-2 vaccine (Oxford, AstraZeneca) two weeks before presentation. The diagnosis of Guillain-Barré syndrome (GBS) was confirmed by clinical features, cerebrospinal fluid analysis, and electromyography. On the second hospital day, progression to flaccid tetraplegia, cranial nerve involvement, and respiratory failure, requiring invasive mechanical ventilation, were noted, and he was admitted to the intensive care unit. Despite the prompt diagnosis and immunosuppressive treatment initiation, the patient was left with severe disability. Although the COVID-19 vaccination was generally safe and socially beneficial, individual adverse reactions, including neuroinflammatory severe complications, may occur.
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Affiliation(s)
- Ana M Oliveira
- Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | - Gonçalo Durão-Carvalho
- Internal Medicine, Centro Hospitalar do Oeste, Unidade de Caldas da Rainha, Caldas da Rainha, PRT
| | - Vânia Almeida
- Neurology, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
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Khan SA, Das PR, Nahar Z, Dewan SMR. An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries. SAGE Open Med 2024; 12:20503121241239538. [PMID: 38533198 PMCID: PMC10964449 DOI: 10.1177/20503121241239538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Guillain-Barré syndrome is a rare condition that can be potentially life-threatening. Guillain-Barré syndrome does not have a definitive etiological agent. It is a syndrome that can arise from multiple factors, including various infectious diseases and immunizations. The severity of Guillain-Barré syndrome is exacerbated by these variables, especially in low-income and middle-income countries where healthcare systems are already constrained and struggle to meet the demands of other diseases. The primary aim of our article is to comprehensively examine the life-threatening nature and intensity of Guillain-Barré syndrome by assessing its etiology, progression, and prevalence in low- and middle-income nations while also considering global trends. Furthermore, we proposed the implementation of standard and efficacious treatment and diagnostic resources that are readily accessible and successful in affluent nations and should also be readily accessible in impoverished nations without any unnecessary delay. Our study also emphasized the epidemiological data with molecular epidemiological analysis and the utilization of artificial technology in low- and middle-income nations. The goal was to decrease the incidence of Guillain-Barré syndrome cases and facilitate early detection.
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Affiliation(s)
- Sakif Ahamed Khan
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Proma Rani Das
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Zabun Nahar
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
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Pfaar O, Portnoy J, Nolte H, Chaker AM, Luna-Pech JA, Patterson A, Pandya A, Larenas-Linnemann D. Future Directions of Allergen Immunotherapy for Allergic Rhinitis: Experts' Perspective. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:32-44. [PMID: 37716529 DOI: 10.1016/j.jaip.2023.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
Allergen immunotherapy (AIT) is broadly used all over the world as the only available disease-modifying treatment option. The aim of this experts' perspective is to address 7 important unmet needs for the further direction of AIT and to provide the readership with the authors' positions on these topics. An international group of experts in the field of AIT have formulated 7 important aspects for the future position of AIT, performed a current literature review, and proposed a consented position on these topics. The aspects discussed and consented by the authors include: (1) alternative routes of allergen application in AIT, (2) potential of recombinant vaccines, (3) the role of allergy diagnosis based on component-resolved diagnosis for AIT composition, (4) the impact of COVID-19 vaccination for further innovations in AIT, (5) potential of combining biologics to AIT, (6) future innovations in high-risk children/adolescents, and (7) the future regulatory position on AIT. Important unmet needs and topics for AIT have been addressed in this expert review. The authors' views and personal position on these 7 aspects have also been elaborated.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Jay Portnoy
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Mo
| | | | - Adam M Chaker
- TUM School of Medicine, Department of Otorhinolaryngology and Center of Allergy and Environment, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jorge A Luna-Pech
- Departamento de Disciplinas Filosófico, Metodológico e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Amber Patterson
- Department of Pediatrics, University of Toledo College of Medicine, Toledo, Ohio; Auni Allergy, Findlay, Ohio
| | - Aarti Pandya
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Mo
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Theodorou DJ, Theodorou SJ, Gelalis ID. Decreased Incidence of Guillain-Barré Syndrome during the COVID-19 Pandemic: A Retrospective Population-Based Study. Neuroepidemiology 2023; 57:271-273. [PMID: 37399791 PMCID: PMC10614448 DOI: 10.1159/000531635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/11/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
| | | | - Ioannis D. Gelalis
- Spine Section, Department of Orthopaedic Surgery, University Hospital of Ioannina, Ioannina, Greece
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