Potential Temporal Association Found Between Guillain-Barré Syndrome and COVID-19 Vaccination in Pediatrics


From the pre-COVID period to 6 weeks after vaccination, the reporting rate of GBS was significantly different, regardless of whether Brighton criteria was applied to the analysis. The authors noted that passive surveillance limitations warrant further analysis.

Nizar Souayah, MD, Department of Neurology, Newark Beth Israel Medical Center

Nizar Souayah, MD

Findings from the Vaccine Adverse Event Reporting System database showed that although the prevalence of Guillain-Barré (GBS) syndrome following COVID-19 vaccination was not different in pediatrics compared with the general population, there was an increased prevalence within the first 6 weeks following vaccination, suggesting a potential temporal associaiton.1 The investigators noted that these findings warrant caution, as they were based off passive surveillance.

The study, presented at the 2022 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, September 21-24, in Nashville, Tennessee, compared the rate of pediatric GBS following COVID-19 vaccination to the rate after influenza, human papillomavirus (HPV), and meningococcal vaccinations. Investigators used a pre-COVID period (October 2018-August 2019), prevaccine period (January 2020-November 2020), and vaccine period (December 2020-October 2021), as well as a risk period of probably cause-effect relationship, defined as 6 weeks post vaccination.

Led by Nizar Souayah, MD, Department of Neurology, Newark Beth Israel Medical Center, the findings showed that the rates for GBS after COVID-19 vaccination were within the incidence rate of GBS typically reported in children. In total, there were 31, 3, 1, and 1 cases of GBS reported after COVID-19, influenza, HPV, and meningococcal vaccinations, respectively. Between vaccinations, the reporting rate of GBS after COVID-19 vaccination was significantly higher than the others, at 12.45 per 10 million (P <.005), followed by influenza (1.63), meningococcal (1.19), and HPV vaccinations (1.07).

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Using self-controlled and case centered analysis, the reported rate of GBS after COVID-19 vaccination between the risk and control periods was significantly different (90.32% vs 9.7%, respectively; P <.0001). The findings remained similar when all patients, regardless of Brighton criteria, were included.

COVID-19 has been shown to be associated with several of neurological complications, including GBS, which has been more prominently throughout the pandemic. Recent work by Kayla E. Hanson, MPH, et al further suggested an increased risk of GBS following COVID-19 vaccination with Ad.26.COV2.S (Janssen). The analysis comprised of 15,120,073 doses of COVID-19 vaccines from December 2020 to November 2021, including 483,053 Ad.26.COV2.S doses; 8,806,595 BNY162b2 doses; and 5,830,425 mRNA-1273 doses.

In total, 11 cases of GBS were reported in those vaccinated with Ad.26.COV2.S, resulting in an unadjusted incidence rate of 32.4 (95% CI, 14.8-61.5) per 100,000 person-years in the 1 to 21 days following vaccination that was significantly higher than the background rate. Overall, the adjusted risk ratio (RR) in the 1 to 21 vs 22 to 42 days following Ad.26.COV2.S vaccination was 6.03 (95% CI, 0.79-147.79). The unadjusted incidence rate of GBS after mRNA vaccines was 1.3 (95% CI, 0.7-2.4), and when compared with Ad.26.COV2.S vaccines, the adjusted RR was 20.56 (95% CI, 6.94-64.66).2

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1. Ors M, Jaffry M, Jaffry K, et al. Association of Guillain-Barré syndrome after Pzifer-BioNTech COVID-19 vaccination in pediatric patients: a vaccine adverse event reporting system study. Presented at: 2022 AANEM Annual Meeting; September 15-18; Nashville, TN. Abstract 19
2. Hanson KE, Goddard K, Lewis N, et al. Incidence of Guillain-Barré syndrome after COVID-19 vaccination in the vaccine safety datalink. JAMA Netw Open. 2022;5(4):e228879. doi:10.1001/jamanetworkopen.2022.8879
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