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Justiz-Vaillant A, Roopnarine K, Solomon S, Phillips A, Sandy S, Subero A, Seepersad S, Span N, Ramnath P, Ramnarine A, Ramdath B, Rampaul C, Ramdial R, Phagoo D, Ramdhanie T, Moonilal V, Poliah EM, Poonwassie S, Punilal K, Panchoo S, Parris J, Oudit S, Muir T, Nicholas-Joseph J, Pandit BR, Pakeerah S, Sookoo V, Richards P, John T, Gopaul D, Soodeen S, Arozarena-Barbosa O, Williams A, Unakal C, Fundora RA, Thompson R, Akpaka PE. COVID-19 Vaccines Effectiveness and Safety in Trinidad and Tobago: A Systematic Review and Meta-Analysis. Microorganisms 2025; 13:135. [PMID: 39858903 PMCID: PMC11767614 DOI: 10.3390/microorganisms13010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 12/03/2024] [Accepted: 01/07/2025] [Indexed: 01/27/2025] Open
Abstract
This systematic review evaluated the effectiveness and side effects of various COVID-19 vaccines, with a focus on Trinidad and Tobago. The Pfizer-BioNTech and Moderna vaccines demonstrated the highest efficacy, particularly against COVID-19 variants, while Janssen and Sinopharm were comparatively less effective. mRNA vaccines, such as Pfizer-BioNTech and Oxford-AstraZeneca, were associated with more frequent and severe side effects, including soreness, fever, and cardiovascular issues. The review also identified significant gaps in the current scientific literature regarding COVID-19 vaccination issues in Trinidad and Tobago. These gaps highlight the need for comprehensive research to address vaccination challenges, including public health communication, equitable access, and local perceptions of vaccine safety. This analysis provides a foundation for developing targeted strategies to improve vaccine effectiveness in the region.
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Affiliation(s)
- Angel Justiz-Vaillant
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Kimberly Roopnarine
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Shaundell Solomon
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Alyssa Phillips
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Solange Sandy
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Alyssa Subero
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Sarah Seepersad
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Nicholas Span
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Phalmanie Ramnath
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Akaasha Ramnarine
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Bimala Ramdath
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Chelsea Rampaul
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Renissa Ramdial
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Dana Phagoo
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Thalia Ramdhanie
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Vinaya Moonilal
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Emily-Marie Poliah
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Steffan Poonwassie
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Karishta Punilal
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Sarah Panchoo
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Justice Parris
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Steven Oudit
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Trudy Muir
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Johnson Nicholas-Joseph
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Bijey Raj Pandit
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Sanjeev Pakeerah
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Vesham Sookoo
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Patrice Richards
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Tishia John
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Darren Gopaul
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Sachin Soodeen
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Odette Arozarena-Barbosa
- Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Champs Fleurs 330912, Trinidad and Tobago (R.A.F.)
| | - Arlene Williams
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Chandrashehkar Unakal
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Rodolfo Arozarena Fundora
- Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Champs Fleurs 330912, Trinidad and Tobago (R.A.F.)
- Department of Clinical and Surgical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine 330912, Trinidad and Tobago
| | - Reinand Thompson
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
| | - Patrick Eberechi Akpaka
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 330912, Trinidad and Tobago; (K.R.); (S.S.); (A.P.); (A.S.); (S.S.); (N.S.); (P.R.); (A.R.); (B.R.); (C.R.); (R.R.); (D.P.); (T.R.); (V.M.); (E.-M.P.); (S.P.); (K.P.); (S.P.); (J.P.); (S.O.); (T.M.); (J.N.-J.); (B.R.P.); (S.P.); (V.S.); (P.R.); (T.J.); (S.S.); (A.W.); (C.U.); (R.T.); (P.E.A.)
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Platschek B, Boege F. The Post-Acute COVID-19-Vaccination Syndrome in the Light of Pharmacovigilance. Vaccines (Basel) 2024; 12:1378. [PMID: 39772040 PMCID: PMC11680367 DOI: 10.3390/vaccines12121378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 11/29/2024] [Accepted: 12/03/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Objectives: Clinical studies show that SARS-CoV-2 vaccination sometimes entails a severe and disabling chronic syndrome termed post-acute-COVID-19-vaccination syndrome (PACVS). PACVS shares similarities with long COVID. Today, PACVS is still not officially recognised as a disease. In contrast, long COVID was registered by health authorities in December 2021. Here, we address possible reasons for that discrepancy. Methods: We analyse whether common symptoms of PACVS have been registered by European pharmacovigilance as adverse vaccination reactions and which consequences have been drawn thereof. Results: (i) PACVS is distinguished from normal vaccination reactions solely by prolonged duration. (ii) Symptom duration is poorly monitored by post-authorisation pharmacovigilance. (iii) PACVS-specific signals were faithfully recorded by pharmacovigilance systems but have not prompted appropriate reactions of health authorities. (iv) The most widely applied SARS-CoV-2 mRNA-vaccine has been modified after roll-out without renewed phase III evaluation; the modification has increased DNA contaminations suspected to extend the spectrum of adverse events. (v) Crossing of pharmacovigilance data with corresponding estimates of applied vaccine doses suggest a PACVS prevalence of 0.003% in the general population. In contrast, occupational surveillance studies suggest a PACVS prevalence of 0.9% in young and middle-aged persons. Conclusions: (a) Denial of official recognition of PACVS is unjustified. (b) PACVS seems to target preferentially young and middle-aged persons. (c) Without official disease recognition, access to public healthcare and welfare services is made difficult for PACVS-affected persons, which creates considerable socio-economic problems. (d) Without official disease recognition, development and evaluation of PACVS therapies is impaired.
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Affiliation(s)
| | - Fritz Boege
- Central Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University, University Hospital, 40255 Düsseldorf, Germany
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3
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Chen Y, Li K, Lv W, Xie J, Qian Y, Cui C, Deng B. What Is the Impact of the Novel Coronavirus and the Vaccination on Guillain-Barre Syndrome? Mol Neurobiol 2024; 61:9835-9850. [PMID: 37728848 DOI: 10.1007/s12035-023-03638-8] [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: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
The COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has resulted in devastating medical and economic consequences worldwide over the past 3 years. As the pandemic enters a new stage, it is essential to consider the potential impact on rare diseases such as Guillain-Barre syndrome (GBS), which has been intimately associated with COVID-19 since the first COVID-19-related GBS case was reported in January 2020. There are notable differences between COVID-19-related GBS and GBS without COVID-19 in terms of diagnostic types and clinical manifestations. Furthermore, with the widespread administration of COVID-19 vaccines, there have been reports of GBS occurring shortly after vaccination, which requires close attention despite its rarity. This review also explores the vaccines associated with heightened GBS risks, offering insights that may guide vaccination policies and clinical practice. To provide a visual summary of these findings, we have included a graphical abstract.
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Affiliation(s)
- Yinuo Chen
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Kezheng Li
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wenjing Lv
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiali Xie
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Yuqin Qian
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Can Cui
- Department of Clinical Sciences Malmö, Lund University, Skåne, Sweden
| | - Binbin Deng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- First Clinical College of Wenzhou Medical University, Wenzhou, China.
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du Preez HN, Lin J, Maguire GEM, Aldous C, Kruger HG. COVID-19 vaccine adverse events: Evaluating the pathophysiology with an emphasis on sulfur metabolism and endotheliopathy. Eur J Clin Invest 2024; 54:e14296. [PMID: 39118373 DOI: 10.1111/eci.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
In this narrative review, we assess the pathophysiology of severe adverse events that presented after vaccination with DNA and mRNA vaccines against COVID-19. The focus is on the perspective of an undersulfated and degraded glycocalyx, considering its impact on immunomodulation, inflammatory responses, coagulation and oxidative stress. The paper explores various factors that lead to glutathione and inorganic sulfate depletion and their subsequent effect on glycocalyx sulfation and other metabolites, including hormones. Components of COVID-19 vaccines, such as DNA and mRNA material, spike protein antigen and lipid nanoparticles, are involved in possible cytotoxic effects. The common thread connecting these adverse events is endotheliopathy or glycocalyx degradation, caused by depleted glutathione and inorganic sulfate levels, shear stress from circulating nanoparticles, aggregation and formation of protein coronas; leading to imbalanced immune responses and chronic release of pro-inflammatory cytokines, ultimately resulting in oxidative stress and systemic inflammatory response syndrome. By understanding the underlying pathophysiology of severe adverse events, better treatment options can be explored.
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Affiliation(s)
- Heidi N du Preez
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Glenn E M Maguire
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
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Mundorf AK, Semmler A, Heidecke H, Schott M, Steffen F, Bittner S, Lackner KJ, Schulze-Bosse K, Pawlitzki M, Meuth SG, Klawonn F, Ruhrländer J, Boege F. Clinical and Diagnostic Features of Post-Acute COVID-19 Vaccination Syndrome (PACVS). Vaccines (Basel) 2024; 12:790. [PMID: 39066428 PMCID: PMC11281408 DOI: 10.3390/vaccines12070790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Post-acute COVID-19 vaccination syndrome (PACVS) is a chronic disease triggered by SARS-CoV-2 vaccination (estimated prevalence 0.02%). PACVS is discriminated from the normal post-vaccination state by altered receptor antibodies, most notably angiotensin II type 1 and alpha-2B adrenergic receptor antibodies. Here, we investigate the clinical phenotype using a study registry encompassing 191 PACVS-affected persons (159 females/32 males; median ages: 39/42 years). Unbiased clustering (modified Jaccard index) of reported symptoms revealed a prevalent cross-cohort symptomatology of malaise and chronic fatigue (>80% of cases). Overlapping clusters of (i) peripheral nerve dysfunction, dysesthesia, motor weakness, pain, and vasomotor dysfunction; (ii) cardiovascular impairment; and (iii) cognitive impairment, headache, and visual and acoustic dysfunctions were also frequently represented. Notable abnormalities of standard serum markers encompassing increased interleukins 6 and 8 (>80%), low free tri-iodine thyroxine (>80%), IgG subclass imbalances (>50%), impaired iron storage (>50%), and increased soluble neurofilament light chains (>30%) were not associated with specific symptoms. Based on these data, 131/191 participants fit myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and simultaneously also several other established dysautonomia syndromes. Furthermore, 31/191 participants fit none of these syndromes. In conclusion, PACVS could either be an outlier of ME/CFS or a dysautonomia syndrome sui generis.
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Affiliation(s)
- Anna Katharina Mundorf
- Central Institute for Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (A.K.M.); (A.S.); (K.S.-B.)
| | - Amelie Semmler
- Central Institute for Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (A.K.M.); (A.S.); (K.S.-B.)
| | | | - Matthias Schott
- Division for Specific Endocrinology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (F.S.); (S.B.)
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (F.S.); (S.B.)
| | - Karl J. Lackner
- University Medical Center, Johannes Gutenberg University Mainz, 55122 Mainz, Germany;
| | - Karin Schulze-Bosse
- Central Institute for Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (A.K.M.); (A.S.); (K.S.-B.)
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (M.P.); (S.G.M.)
| | - Sven Guenther Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (M.P.); (S.G.M.)
| | - Frank Klawonn
- Biostatistics Research Group, Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany;
- Department of Computer Science, Ostfalia University, 38302 Wolfenbüttel, Germany
| | - Jana Ruhrländer
- Selbsthilfegruppe Post-Vac-Syndrom Deutschland e.V., 34121 Kassel, Germany;
| | - Fritz Boege
- Central Institute for Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (A.K.M.); (A.S.); (K.S.-B.)
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Kopańko M, Zabłudowska M, Zajkowska M, Gudowska-Sawczuk M, Mucha M, Mroczko B. The Impact of COVID-19 on the Guillain-Barré Syndrome Incidence. Biomedicines 2024; 12:1248. [PMID: 38927455 PMCID: PMC11201746 DOI: 10.3390/biomedicines12061248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Despite the fact that the global COVID-19 pandemic has officially ended, we continue to feel its effects and discover new correlations between SARS-CoV-2 infection and changes in the organism that have occurred in patients. It has been shown that the disease can be associated with a variety of complications, including disorders of the nervous system such as a characteristic loss of smell and taste, as well as less commonly reported incidents such as cranial polyneuropathy or neuromuscular disorders. Nervous system diseases that are suspected to be related to COVID-19 include Guillain-Barré syndrome, which is frequently caused by viruses. During the course of the disease, autoimmunity destroys peripheral nerves, which despite its rare occurrence, can lead to serious consequences, such as symmetrical muscle weakness and deep reflexes, or even their complete abolition. Since the beginning of the pandemic, case reports suggesting a relationship between these two disease entities have been published, and in some countries, the increasing number of Guillain-Barré syndrome cases have also been reported. This suggests that previous contact with SARS-CoV-2 may have had an impact on their occurrence. This article is a review and summary of the literature that raises awareness of the neurological symptoms' prevalence, including Guillain-Barré syndrome, which may be impacted by the commonly occurring COVID-19 disease or vaccination against it. The aim of this review was to better understand the mechanisms of the virus's action on the nervous system, allowing for better detection and the prevention of its complications.
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Affiliation(s)
- Magdalena Kopańko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Magdalena Zabłudowska
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Monika Zajkowska
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
| | - Mateusz Mucha
- Department of Oncological Surgery with Specialized Cancer Treatment Units, Maria Sklodowska-Curie Oncology Center, 15-027 Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland (M.G.-S.); (B.M.)
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland
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Nikitina V, Santi Laurini G, Montanaro N, Motola D. Safety profile of paediatric COVID-19 vaccines: An analysis of the US Vaccine Adverse Event Reporting System. Acta Paediatr 2023; 112:2426-2433. [PMID: 37608686 DOI: 10.1111/apa.16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
AIM To provide further evidence on the safety profile of COVID-19 vaccines in paediatrics by analysing the spontaneous reports of adverse effects related to these vaccines. METHODS Reports related to US paediatric population (from 0 to 17 years) vaccinated with authorised COVID-19 vaccines were extracted from Vaccine Adverse Event Reporting System from December 2020 to 17 November 2022. We conducted a descriptive analysis of Adverse Events Following Immunization (AEFI), calculating reporting rate of serious AEFIs and focusing on myocarditis and Guillain-Barré Syndrome after mRNA COVID-19 vaccines. RESULTS Overall, 52 720 reports were retrieved: 77% (40541)-Pfizer-BioNTech, 19% (10083)-Moderna, a small proportion for other vaccines 4% (2096). Most of AEFIs were non-serious and listed in corresponding SPCs. Of serious AEFIs, 96% were related to the Pfizer-BioNTech vaccine. Roughly 91% (47874) were related to people from 6 to 17 years, a small percentage of 9% (4773) to the younger group (0-5 years). In both groups, most of the reports were related to mRNA vaccines and the percentage of AEFIs experienced by females were similar to males. CONCLUSIONS Data showed that events most frequently reported were non-serious and listed in the corresponding SPCs, extending the evidence of safety of COVID-19 vaccines authorised in the United States in children.
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Affiliation(s)
- Victoria Nikitina
- Unit of Pharmacology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Greta Santi Laurini
- Unit of Pharmacology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Finsterer J, Scorza FA. Needle EMG of the vagus-innervated striated larynx muscles cannot indicate laryngeal sensory neuropathy. Eur Arch Otorhinolaryngol 2023; 280:3901-3902. [PMID: 37115327 PMCID: PMC10140702 DOI: 10.1007/s00405-023-07999-7] [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: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Josef Finsterer
- Neurology and Neurophysiology Center, Postfach 20, 1180 Vienna, Austria
| | - Fulvio A. Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brasil
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9
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Finsterer J, Scorza FA. Only blame SARS-CoV-2 vaccination for facial palsy after alternative etiologies have been ruled out. Therapie 2023; 78:463-464. [PMID: 37268504 PMCID: PMC10186848 DOI: 10.1016/j.therap.2023.05.001] [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: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Josef Finsterer
- Neurology and Neurophysiology Center, Postfach 20, 1180 Vienna, Austria.
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP 05508-220, Brazil
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10
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Yang Y, Huang L. Neurological Disorders following COVID-19 Vaccination. Vaccines (Basel) 2023; 11:1114. [PMID: 37376503 PMCID: PMC10302665 DOI: 10.3390/vaccines11061114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Nowadays, people all over the world have been receiving different types of coronavirus disease 2019 (COVID-19) vaccines. While their effectiveness has been well recognized, various post-vaccination disorders are not fully understood. In this review, we discuss neurological disorders related to vascular, immune, infectious, and functional factors following COVID-19 vaccination, and attempt to provide neuroscientists, psychiatrists, and vaccination staff with a reference for the diagnosis and treatment of these diseases. These disorders may present as a recurrence of previous neurological disorders or new-onset diseases. Their incidence rate, host and vaccine characteristics, clinical manifestations, treatment, and prognosis differ significantly. The pathogenesis of many of them remains unclear, and further studies are needed to provide more evidence. The incidence rate of severe neurological disorders is relatively low, most of which are reversible or treatable. Therefore, the benefits of vaccination outweigh the risk of COVID-19 infection, especially among fragile populations.
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Affiliation(s)
| | - Lisu Huang
- Department of Infectious Diseases, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
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11
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Martic V, Fejzic E, Danilovic M, Lazarevic S, Rajic S, Roganovic M, Stojanov A, Jovin Z, Debeljevic M, Raicevic R. Guillain-Barre Syndrome Followed by Covid-19 Infection, Vaccination and Other Precipitating Factors during the Pandemic. Ann Indian Acad Neurol 2023; 26:256-260. [PMID: 37538436 PMCID: PMC10394436 DOI: 10.4103/aian.aian_974_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background and Aims Guillain-Barré syndrome (GBS) is usually triggered by an infection. Vaccination is mentioned as a possible trigger in a small number of GBS cases. The aim of this study was to notice GBS distinctness provoked by various triggers during the COVID-19 pandemic. Material and Methods A total of 109 GBS patients were divided into three groups, respectively: COVID-19 infection associated (19 patients), COVID-19 vaccination associated (16 patients) and precipitated by some other factors (74 patients). We compared the clinical, neurophysiological and laboratory characteristics of these three groups. Results Neither were differences recorded in the age of the patients of these three groups at the time of illness, nor in the number of days from the precipitating factor to the onset of symptoms. There were no clinical differences between groups related to severity of the disease or patients' recovery. The only clinical difference was observed in relation to facial nerve bilateral affection because it was significantly higher in the post-vaccination group. According to neurophysiological findings, demyelinating form dominated in all three groups. Conclusion Clinical characteristics, electrophysiological findings and laboratory characteristics did not differ significantly in Guillain-Barre syndrome followed by COVID-19 infection, vaccination and other precipitating factors during the pandemic. The bilateral involvement of facial nerves was significantly higher in the post-vaccination group. Most of these cases had a mild form of the disorder-distal paresthesias GBS variant.
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Affiliation(s)
- Vesna Martic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
| | - Esmer Fejzic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
| | - Milos Danilovic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
| | - Snezana Lazarevic
- Department of Neurology, University of Kragujevac, Serbia, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Sonja Rajic
- Clinical Center of Vojvodina, Neurology Clinic, Medical Faculty, University in Novi Sad, Montenegro, Serbia
| | - Milovan Roganovic
- Clinical Centre of Montenegro, Clinic for Neurology, Podgorica, Montenegro, Serbia
| | | | - Zita Jovin
- Clinical Center of Vojvodina, Neurology Clinic, Medical Faculty, University in Novi Sad, Montenegro, Serbia
| | - Mladen Debeljevic
- Clinical Centre of Montenegro, Clinic for Neurology, Podgorica, Montenegro, Serbia
| | - Ranko Raicevic
- Military Medical Academy, Clinic of Neurology, Belgrade, Serbia
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12
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Boruah AP, Heydari K, Wapniarski AE, Caldwell M, Thakur KT. Neurological Considerations with COVID-19 Vaccinations. Semin Neurol 2023. [PMID: 37094803 DOI: 10.1055/s-0043-1767725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
The benefits of coronavirus disease 2019 (COVID-19) vaccination significantly outweigh its risks on a public health scale, and vaccination has been crucial in controlling the spread of SARS-CoV-2. Nonetheless, several reports of adverse events following vaccination have been published.To summarize reports to date and assess the extent and quality of evidence regarding possible serious adverse neurological events following COVID-19 vaccination, focusing on Food and Drug Administration (FDA)-approved vaccines in the United States (BNT162b2, mRNA-1273, and Ad26.COV2.S).A review of literature from five major electronic databases (PubMed, Medline, Embase, Cochrane Library, and Google Scholar) was conducted between December 1, 2020 and June 5, 2022. Articles included in the review were systematic reviews and meta-analysis, cohort studies, retrospective studies, case-control studies, case series, and reports. Editorials, letters, and animal studies were excluded, since these studies did not include quantitative data regarding adverse side effects of vaccination in human subjects.Of 149 total articles and 97 (65%) were case reports or case series. Three phase 3 trials initially conducted for BNT162b2, MRNA-1273, and Ad26.COV2.S were included in the analysis.The amount and quality of evidence for possible neurological adverse events in the context of FDA-approved COVID-19 vaccinations is overall low tier. The current body of evidence continues to suggest that COVID-19 vaccinations have a high neurological safety profile; however, the risks and benefits of vaccination must continue to be closely monitored.
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Affiliation(s)
- Abhilasha P Boruah
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP), New York, NY
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kimia Heydari
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP), New York, NY
| | - Anne E Wapniarski
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP), New York, NY
| | - Marissa Caldwell
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP), New York, NY
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP), New York, NY
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13
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Guillain-Barre Syndrome After the Third BNT162b2 Dose in an Adolescent Without Side Effects After the First and Second Jab. J Clin Neuromuscul Dis 2023; 24:162-163. [PMID: 36809204 DOI: 10.1097/cnd.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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14
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Hosseini R, Askari N. A review of neurological side effects of COVID-19 vaccination. Eur J Med Res 2023; 28:102. [PMID: 36841774 PMCID: PMC9959958 DOI: 10.1186/s40001-023-00992-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 01/04/2023] [Indexed: 02/27/2023] Open
Abstract
Following the COVID-19 virus epidemic, extensive, coordinated international research has led to the rapid development of effective vaccines. Although vaccines are now considered the best way to achieve collective safety and control mortality, due to the critical situation, these vaccines have been issued the emergency use licenses and some of their potential subsequence side effects have been overlooked. At the same time, there are many reports of side effects after getting a COVID-19 vaccine. According to these reports, vaccination can have an adverse event, especially on nervous system. The most important and common complications are cerebrovascular disorders including cerebral venous sinus thrombosis, transient ischemic attack, intracerebral hemorrhage, ischemic stroke, and demyelinating disorders including transverse myelitis, first manifestation of MS, and neuromyelitis optica. These effects are often acute and transient, but they can be severe and even fatal in a few cases. Herein, we have provided a comprehensive review of documents reporting neurological side effects of COVID-19 vaccines in international databases from 2020 to 2022 and discussed neurological disorders possibly caused by vaccination.
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Affiliation(s)
- Roya Hosseini
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, P.O.Box 76135-133, Kerman, Islamic Republic of Iran
| | - Nayere Askari
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, P.O.Box 76135-133, Kerman, Islamic Republic of Iran.
- Immunoregulation Research Center, Shahed University, Tehran, Islamic Republic of Iran.
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15
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Shishido AA, Barnes AH, Narayanan S, Chua JV. COVID-19 Vaccines-All You Want to Know. Semin Respir Crit Care Med 2023; 44:143-172. [PMID: 36646092 DOI: 10.1055/s-0042-1759779] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has led to an unprecedented public health crisis. The collective global response has led to production of multiple safe and effective vaccines utilizing novel platforms to combat the virus that have propelled the field of vaccinology forward. Significant challenges to universal vaccine effectiveness remain, including immune evasion by SARS-CoV-2 variants, waning of immune response, inadequate knowledge of correlates of protection, and dosing in special populations. This review serves as a detailed evaluation of the development of the current SARS-CoV-2 vaccines, their effectiveness, and challenges to their deployment as a preventive tool.
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Affiliation(s)
- Akira A Shishido
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia
| | - Ashley H Barnes
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shivakumar Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joel V Chua
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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16
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McAlpine LS, Zubair AS. Neurological sequelae of vaccines. Neurol Sci 2023; 44:1505-1513. [PMID: 36622478 PMCID: PMC9838503 DOI: 10.1007/s10072-022-06581-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Vaccines are a safe and efficacious way to prevent a variety of infectious diseases. Over the course of their existence, vaccines have prevented immeasurable morbidity and mortality in humans. Typical symptoms of systemic immune activation are common after vaccines and may include local soreness, myalgias, nausea, and malaise. In the vast majority of cases, the severity of the infectious disease outweighs the risk of mild adverse reactions to vaccines. Rarely, vaccines may be associated with neurological sequela that ranges in severity from headache to transverse myelitis, acute disseminated encephalomyelitis, and Guillain-Barre syndrome (GBS). Often, a causal link cannot be confirmed, and it remains unclear if disease onset is directly related to a recent vaccination. OBSERVATIONS This review serves to summarize reported neurologic sequelae of commonly used vaccines. It will also serve to discuss potential pathogenesis. It is important to note that many adverse events or reactions to vaccines are self-reported into databases, and causal proof cannot be obtained. CONCLUSIONS AND RELEVANCE Recognition of reported adverse effects of vaccines plays an important role in public health and education. Early identification of these symptoms can allow for rapid diagnosis and potential treatment. Vaccines are a safe option for prevention of infectious diseases.
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Affiliation(s)
- Lindsay S. McAlpine
- grid.47100.320000000419368710Department of Neurology, Yale University School of Medicine, 20 York Street, New Haven, CT 06510 USA
| | - Adeel S. Zubair
- grid.47100.320000000419368710Department of Neurology, Yale University School of Medicine, 20 York Street, New Haven, CT 06510 USA
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17
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Yu M, Nie S, Qiao Y, Ma Y. Guillain-Barre syndrome following COVID-19 vaccines: A review of literature. Front Immunol 2023; 14:1078197. [PMID: 36875094 PMCID: PMC9975597 DOI: 10.3389/fimmu.2023.1078197] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to retrospectively analyze reported Guillain-Barré syndrome (GBS) cases that occurred after COVID-19 vaccination. Methods Case reports of GBS following COVID-19 vaccination that were published before May 14, 2022, were retrieved from PubMed. The cases were retrospectively analyzed for their basic characteristics, vaccine types, the number of vaccination doses before onset, clinical manifestations, laboratory test results, neurophysiological examination results, treatment, and prognosis. Results Retrospective analysis of 60 case reports revealed that post-COVID-19 vaccination GBS occurred mostly after the first dose of the vaccination (54 cases, 90%) and was common for DNA vaccination (38 cases, 63%), common in middle-aged and elderly people (mean age: 54.5 years), and also common in men (36 cases, 60%). The mean time from vaccination to onset was 12.3 days. The classical GBS (31 cases, 52%) was the major clinical classification and the AIDP subtype (37 cases, 71%) was the major neurophysiological subtype, but the positive rate of anti-ganglioside antibodies was low (7 cases, 20%). Bilateral facial nerve palsy (76% vs 18%) and facial palsy with distal paresthesia (38% vs 5%) were more common for DNA vaccination than for RNA vaccination. Conclusion After reviewing the literature, we proposed a possible association between the risk of GBS and the first dose of the COVID-19 vaccines, especially DNA vaccines. The higher rate of facial involvement and a lower positive rate of anti-ganglioside antibodies may be a characteristic feature of GBS following COVID-19 vaccination. The causal relationship between GBS and COVID-19 vaccination remains speculative, more research is needed to establish an association between GBS and COVID-19 vaccination. We recommend surveillance for GBS following vaccination, because it is important in determining the true incidence of GBS following COVID-19 vaccination, as well as in the development of a more safer vaccine.
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Affiliation(s)
- Miao Yu
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Neurology, Shenyang First People's Hospital, Shenyang, China
| | - Shuang Nie
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Qiao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Ma
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Brola W, Wilski M. Neurological consequences of COVID-19. Pharmacol Rep 2022; 74:1208-1222. [PMID: 36180640 PMCID: PMC9524739 DOI: 10.1007/s43440-022-00424-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 12/13/2022]
Abstract
In December 2019, cases of pneumonia caused by infection with the previously unknown severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to coronavirus disease 2019 (COVID-19), were identified. Typical manifestations of COVID-19 are fever, cough, fatigue and dyspnoea. Initially, it was thought that the mechanism of action of SARS-CoV-2 was only associated with respiratory tract invasion, but it was later revealed that the infection might involve many other organs and systems, including the central and peripheral nervous systems. Neurological complications associated with SARS-CoV-2 infection include encephalopathy, encephalitis, meningitis, acute disseminated encephalomyelitis (ADEM), ischaemic and haemorrhagic stroke and cerebral venous sinus thrombosis. In cases of peripheral nervous system involvement, smell and taste disorders, myopathy or the signs and symptoms of Guillain‒Barré syndrome are observed. The most common early neurological complications, particularly during the first year of the epidemic, were anosmia and taste disorders, which, according to some studies, occurred in over 80 percent of patients with COVID-19. The proportion of patients with serious neurological manifestations was small compared to the global number of patients, but the numbers of SARS-CoV-2 infections and critical patients increased substantially. The experience from 2 years of the pandemic has shown that approximately 13% of infected patients suffer from severe neurological complications. The relationship between SARS-CoV-2 and the nervous system is not only a cause of neurological complications in previously healthy individuals but also directly and indirectly affects the courses of many nervous system diseases.
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Affiliation(s)
- Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Al. IX Wieków Kielc 19, 25-317, Kielce, Poland.
| | - Maciej Wilski
- Department of Adapted Physical Activity, Poznań University of Physical Education, Poznan, Poland
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19
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Gunawan PY, Tiffani P, Lalisang L. Guillain-Barre Syndrome Following SARS-CoV-2 Vaccination: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:777-780. [PMID: 36263653 PMCID: PMC9606431 DOI: 10.9758/cpn.2022.20.4.777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 12/23/2022]
Abstract
After more than a year of Coronavirus disease 2019 pandemic, in 2021 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination have been made possible and vaccine was distributed globally. Since then, there have been reports of symptoms following SARS-CoV-2 vaccination, including neurological symptoms of ascending paralysis known as Guillain-Barre syndrome. In this report, we describe the first case of Guillain-Barre syndrome following vaccination in Indonesia. Symptoms of ascending paralysis were of late onset after the first dose, however, were full blown after receiving the second dose followed by left-sided facial paralysis.
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Affiliation(s)
- Pricilla Yani Gunawan
- Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - Pamela Tiffani
- Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Lilie Lalisang
- Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia
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20
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Muacevic A, Adler JR. COVID-19 Vaccination a Cause of Guillain-Barré Syndrome? A Case Series. Cureus 2022; 14:e30888. [PMID: 36465787 PMCID: PMC9709351 DOI: 10.7759/cureus.30888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 01/25/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare autoimmune neuropathic disorder of peripheral nerves usually following an infection or on rarer occasions following vaccinations, but the exact underlying pathophysiology is still unclear. The most common etiology of GBS is a bacterial infection caused by Campylobacter jejuni. Viral infections like Zika virus, Epstein-Barr virus, and Cytomegalovirus also add to the list of GBS etiology. COVID-19 (SARS-CoV-2) has also been reported to cause GBS. Vaccines like the rabies vaccine, influenza vaccine, and poliovirus vaccine account for a very small fraction of Guillain-Barré syndrome. GBS as an adverse effect of COVID-19 vaccination was not reported by the Vaccine Adverse Event Reporting System (VAERS), but an update was later released in the course of the pandemic from FDA news, reporting several patients developing GBS after receiving the COVID-19 vaccine. In this case series, we discuss five cases that developed the GBS post-COVID-19 AstraZeneca vaccine, along with its pathophysiology, management, and outcome.
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21
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Gupta A, Ranga A, Prakash NB, Khanna M. Rehabilitation outcomes in patients with post-COVID-19 vaccine-associated Guillain-Barre syndrome. J Neurosci Rural Pract 2022; 13:684-690. [PMID: 36743741 PMCID: PMC9893936 DOI: 10.25259/jnrp-2022-6-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE With COVID-19 vaccination campaign worldwide, associated Guillain-Barre syndrome (GBS) is being increasingly reported from different countries. The objectives of the study were to observe the clinical profile and rehabilitation outcomes in patients with post-COVID-19 vaccine-associated GBS. MATERIAL AND METHOD This prospective study was conducted in neurological rehabilitation unit with in-patients. A detailed customized rehabilitation program was formulated based on the clinical status and associated complications. Outcome measures were documented on the day of admission and at discharge and compared. RESULTS The study included 16 patients (eight males) of which 15 (93.75%) received the CoviShield (AstraZeneca) and 1 Covaxin (Bharat Biotech) vaccine. The median (IQR) duration of first symptom was 9 (18.25) days and for motor symptoms 18 (12.75) days. Functional improvement was observed in patients using Barthel index scores and Hughes disability scores and overall neuropathy limitation scale. All rehabilitation outcomes showed a statistically significant improvement (P < 0.05) from the time of admission to discharge. At discharge, complete independence in activities of daily living was achieved in 4 (25%) patients and 5 (31.25%) were minimally dependent. Three (18.75%) patients were walking independently, seven (43.75%) with minimal support, and four with walker (25%). Nine (56.25%) patients needed bilateral ankle-foot orthosis and two bilateral knee gaiters for locomotion. CONCLUSION Comprehensive inpatient rehabilitation interventions in patients with post-COVID-19 vaccine-associated GBS result in significant functional recovery.
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Affiliation(s)
- Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anurag Ranga
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naveen B. Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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22
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Tondo G, Virgilio E, Naldi A, Bianchi A, Comi C. Safety of COVID-19 Vaccines: Spotlight on Neurological Complications. Life (Basel) 2022; 12:1338. [PMID: 36143376 PMCID: PMC9502976 DOI: 10.3390/life12091338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has led to unprecedented demand on the global healthcare system. Remarkably, at the end of 2021, COVID-19 vaccines received approvals for human use in several countries worldwide. Since then, a solid base for response in the fight against the virus has been placed. COVID-19 vaccines have been shown to be safe and effective drugs. Nevertheless, all kinds of vaccines may be associated with the possible appearance of neurological complications, and COVID-19 vaccines are not free from neurological side effects. Neurological complications of COVID-19 vaccination are usually mild, short-duration, and self-limiting. However, severe and unexpected post-vaccination complications are rare but possible events. They include the Guillain-Barré syndrome, facial palsy, other neuropathies, encephalitis, meningitis, myelitis, autoimmune disorders, and cerebrovascular events. The fear of severe or fatal neurological complications fed the "vaccine hesitancy" phenomenon, posing a vital communication challenge between the scientific community and public opinion. This review aims to collect and discuss the frequency, management, and outcome of reported neurological complications of COVID-19 vaccines after eighteen months of the World Health Organization's approval of COVID-19 vaccination, providing an overview of safety and concerns related to the most potent weapon against the SARS-CoV-2.
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Affiliation(s)
- Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Eleonora Virgilio
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy
| | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Angelo Bianchi
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
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23
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Jaffry M, Mostafa F, Mandava K, Rosario S, Jagarlamudi Y, Jaffry K, Kornitzer J, Jedidi K, Khan H, Souayah N. No significant increase in Guillain-Barré syndrome after COVID-19 vaccination in adults: A vaccine adverse event reporting system study. Vaccine 2022; 40:5791-5797. [PMID: 36055875 PMCID: PMC9393181 DOI: 10.1016/j.vaccine.2022.08.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
Objective To investigate the association between Guillain-Barré syndrome (GBS) and COVID-19 vaccination. Background On July 13, 2021, the US Food and Drug Administration (FDA) released a new warning that Johnson & Johnson COVID-19 vaccine could increase the risk of developing GBS. Methods The reporting rate of adult GBS after COVID-19 vaccination, ascertained with Brighton criteria, was compared with the reporting rate after other vaccinations during the same time period, and also compared with the reporting rate during control periods. Statistical methods such as proportion tests, and Pearson’s chi-squared test were utilized to identify significant relationships. Self-controlled and case centered analyses were conducted. A machine learning model was utilized to identify the factors associated with a worse outcome defined as emergency room (ER) or doctor visits, hospitalizations, and deaths. Results The reporting rate of GBS after COVID-19 vaccination was significantly higher than after influenza and other vaccinations (49.7, 0.19, 0.16 per 10 million, p < 0.0001). However, the reporting rate was within the incidence range of GBS in the general population. Using self-controlled and case centered analyses, there was a significant difference in the reporting rate of GBS after COVID-19 vaccination between the risk period and control period (p < 0.0001). There was an estimated 0.7–1.7 per million excess reports of GBS within 6 weeks of COVID-19 vaccination. Machine learning model demonstrated that female gender and age between 18 and 44 are associated with worse outcome. No association was found between the onset interval of GBS and its prognosis. Conclusions Although the reporting rate of GBS after COVID-19 vaccination was not statistically different than that of the general population, the increased reporting of GBS within the first 6 weeks after COVID-19 vaccination, more so than with other vaccinations, suggests that some cases of GBS are temporally associated with COVID-19 vaccination. However, there is a reduction in the reporting rate of GBS after other vaccines, compared to reporting rates pre-COVID-19, highlighting limitations inherent in any passive surveillance system. These findings warrant continuous analysis of GBS after COVID-19 vaccination. Further improvement of the machine learning model is needed for clinical use.
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Affiliation(s)
- M Jaffry
- Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - F Mostafa
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, TX, USA
| | - K Mandava
- Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - S Rosario
- Department of Marketing, Columbia Business School, New York City, NY, USA
| | - Y Jagarlamudi
- Khoury College of Computer Science, Northeastern University, Boston, MA, USA
| | - K Jaffry
- Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J Kornitzer
- Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA; New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | - K Jedidi
- Department of Marketing, Columbia Business School, New York City, NY, USA
| | - H Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - N Souayah
- Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA.
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24
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García-Grimshaw M, Galnares-Olalde JA, Bello-Chavolla OY, Michel-Chávez A, Cadena-Fernández A, Briseño-Godínez ME, Antonio-Villa NE, Nuñez I, Gutiérrez-Romero A, Hernández-Vanegas L, Saniger-Alba MDM, Carrillo-Mezo R, Ceballos-Liceaga SE, Carbajal-Sandoval G, Flores-Silva FD, Díaz-Ortega JL, Cortes-Alcalá R, Pérez-Padilla JR, López-Gatell H, Chiquete E, Reyes-Terán G, Arauz A, Valdés-Ferrer SI. Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines. Eur J Neurol 2022; 29:3368-3379. [PMID: 35841212 PMCID: PMC9349509 DOI: 10.1111/ene.15504] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Information on Guillain–Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS‐CoV‐2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti‐SARS‐CoV‐2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. Methods Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA‐based (mRNA‐1273 and BNT162b2), adenovirus‐vectored (ChAdOx1 nCov‐19, rAd26‐rAd5, Ad5‐nCoV, and Ad26.COV2‐S), and inactivated whole‐virion‐vectored (CoronaVac) vaccines. Results We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33–60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97–1.45), with incidence higher among Ad26.COV2‐S (3.86/1,000,000 doses, 95% CI 1.50–9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36–2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3–17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID‐19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy‐five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. Conclusions Guillain–Barré syndrome was an extremely infrequent AEFI against SARS‐CoV‐2. The protection provided by these vaccines outweighs the risk of developing GBS.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Hospital General Tijuana, Tijuana, Mexico
| | | | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Eugenia Briseño-Godínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Isaac Nuñez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alonso Gutiérrez-Romero
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Laura Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roger Carrillo-Mezo
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | | | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Luis Díaz-Ortega
- Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud, Mexico City, Mexico
| | | | | | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
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25
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Vences MA, Canales D, Albujar MF, Barja E, Araujo-Chumacero MM, Cardenas E, Alvarez A, Urrunaga-Pastor D. Post-Vaccinal Encephalitis with Early Relapse after BNT162b2 (COMIRNATY) COVID-19 Vaccine: A Case Report. Vaccines (Basel) 2022; 10:vaccines10071065. [PMID: 35891229 PMCID: PMC9318781 DOI: 10.3390/vaccines10071065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/19/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
We describe the case of a 72-year-old man who received the first dose of the BNT162b2 (COMIRNATY) vaccine against COVID-19 on 18 May 2021, and the second dose on 9 September 2021. One day after receiving the first dose, he cursed with malaise, headache, fever, confusion, aggressiveness, and gait alterations. We performed serum and cerebrospinal fluid (CSF) tests (finding elevated proteins in CSF) with negative results for infectious, systemic, and neoplastic causes. We performed brain nuclear magnetic resonance imaging (MRI), finding circumscribed encephalitis at the anterior frontal and bilateral temporal lobes. We were unable to perform a panel of antineuronal antibodies. The patient was readmitted due to early clinical relapse four days after receiving his second dose. We found sequelae lesions at the frontal level but with new demyelinating lesions at the left temporal level in brain MRI. We indicated methylprednisolone, and he presented a favorable improvement. We report an encephalitis case of probable autoimmune etiology after vaccination with BNT162b2, which presented early clinical relapse after receiving the second dose and presented a favorable response to methylprednisolone.
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Affiliation(s)
- Miguel A. Vences
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
- Correspondence: (M.A.V.); (D.U.-P.)
| | - Diego Canales
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
| | - Maria Fe Albujar
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
| | - Ebelin Barja
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
| | - Mary M. Araujo-Chumacero
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
| | - Edu Cardenas
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
| | - Arturo Alvarez
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru; (D.C.); (M.F.A.); (E.B.); (M.M.A.-C.); (E.C.); (A.A.)
| | - Diego Urrunaga-Pastor
- Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola (USIL), Lima 15012, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 14072, Peru
- Correspondence: (M.A.V.); (D.U.-P.)
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Finsterer J. Is the second jab of an anti-SARS-CoV-2 vaccine reasonable after guillain-Barre syndrome following the first dose? Indian J Public Health 2022; 66:385-386. [PMID: 36149133 DOI: 10.4103/ijph.ijph_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Josef Finsterer
- Department of Neurology, Neurology and Neurophysiology Center, Vienna, Austria
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Kim Y, Heo D, Choi M, Lee JM. A Case Presenting with Neuromyelitis Optica Spectrum Disorder and Infectious Polyradiculitis Following BNT162b2 Vaccination and COVID-19. Vaccines (Basel) 2022; 10:vaccines10071028. [PMID: 35891192 PMCID: PMC9321122 DOI: 10.3390/vaccines10071028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 12/31/2022] Open
Abstract
A 37-year-old woman presented with paraparesis and paresthesia in both legs 19 and 3 days after BNT162b2 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, respectively. Cerebrospinal fluid (CSF) analysis, nerve conduction study, electromyography, magnetic resonance imaging, and autoantibody tests were performed. Neurological examination showed hyperesthesia below the T7 level and markedly impaired bilateral leg weakness with absent deep tendon reflexes on the knees and ankles. CSF examination revealed polymorphonuclear dominant pleocytosis and elevated total protein levels. Enhancement of the pia mater in the lumbar spinal cord and positive sharp waves in the lumbar paraspinal muscles indicated infectious polyradiculitis. In contrast, a high signal intensity of intramedullary spinal cord on a T2-weighted image from C1 to conus medullaris and positive anti-aquaporin-4 antibody confirmed neuromyelitis optica spectrum disorder (NMOSD). The patient received intravenous methylprednisolone, antiviral agents, and antibiotics, followed by a tapering dose of oral prednisolone and azathioprine. Two months after treatment, she was ambulatory without assistance. The dual pathomechanism of NMOSD triggered by coronavirus disease 2019 (COVID-19) vaccination and polyradiculitis caused by SARS-CoV-2 infection may have caused atypical clinical findings in our patient. Therefore, physicians should remain alert and avoid overlooking the possibilities of diverse mechanisms associated with neurological manifestations after SARS-CoV-2 infection and COVID-19 vaccination.
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Affiliation(s)
- Youngho Kim
- Department of Neurology, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu 41944, Korea;
| | - Donghyun Heo
- School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea; (D.H.); (M.C.)
| | - Moonjeong Choi
- School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea; (D.H.); (M.C.)
| | - Jong-Mok Lee
- Department of Neurology, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu 41944, Korea;
- Department of Neurology, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-200-5765; Fax: +82-53-422-4265
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Finsterer J. Side effects of SARS-CoV-2 vaccines should be assessed by unbiased professionals on-site. Hum Vaccin Immunother 2022; 18:2090178. [PMID: 35736565 PMCID: PMC9620994 DOI: 10.1080/21645515.2022.2090178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Josef Finsterer
- Department of Neurology, Neurology & Neurophysiology Center, Vienna, Austria
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Khokhar F, Khan A, Hussain Z, Yu J. Small Fiber Neuropathy Associated With the Moderna SARS-CoV-2 Vaccine. Cureus 2022; 14:e25969. [PMID: 35812635 PMCID: PMC9259076 DOI: 10.7759/cureus.25969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/22/2022] Open
Abstract
Efforts of controlling viral transmission began soon after the first cases of coronavirus disease 2019 (COVID-19) infections were identified. Initial efforts were related to contact precautions, hand hygiene, and mask-wearing; however, it was soon evident that a robust global immunization drive was the most effective way to curb disease transmission. In the United States, the first doses of COVID-19 vaccines were rolled out soon after the FDA granted emergency use authorization for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. What this also meant was that many of the routine phases that any new drug or vaccine goes through before being released publicly were bypassed. Over the past two years, various side effects and reactions have been seen after COVID-19 vaccine administration, the most common being local injection site events (e.g., pain, redness, swelling) and systemic effects (e.g., fatigue, headaches, myalgias). We report the case of a 64-year-old female who developed bilateral lower extremity numbness and tingling within weeks of receiving the third dose of Moderna SARS-CoV-2 vaccine. The patient underwent extensive testing to ascertain the diagnosis. She had negative autonomic testing and normal nerve conduction study/electromyography (EMG), which did not reveal large fiber neuropathy. Eventually, the patient underwent a skin biopsy, which revealed small fiber neuropathy. This case report highlights the importance of keeping a broad differential for rare side effects, such as small fiber neuropathy, that are currently being seen and reported in the literature.
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Affiliation(s)
- Farzam Khokhar
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Anum Khan
- Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Zaid Hussain
- Internal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Jianghong Yu
- Rheumatology, State University of New York Upstate Medical University, Syracuse, USA
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Germano F, Bellucci M, Grisanti S, Beronio A, Grazzini M, Coco E, Tassinari T, Fabio DC, Chiara DM, Baldi O, Sivori G, Murialdo A, Cabona C, Durando P, Uccelli A, Schenone A, Franciotta D, Benedetti L. COVID-19 vaccine-related Guillain-Barré syndrome in the Liguria region of Italy: A multicenter case series. J Neurol Sci 2022; 440:120330. [PMID: 35802961 PMCID: PMC9232395 DOI: 10.1016/j.jns.2022.120330] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
Background and purpose Guillain-Barré-Syndrome (GBS) can follow COVID-19 vaccination, with clinical and paraclinical features still to be precisely assessed. We describe a cohort of patients who developed GBS after vaccination with different types of COVID-19 vaccines. Methods Patients with post-COVID-19 vaccination GBS, admitted to the six hospitals that cover the whole Liguria Region, Northwestern Italy, from February 1st to October 30th 2021, were included. Clinical, demographic, and paraclinical data were retrospectively collected. Results Among the 13 patients with post-COVID-19 vaccination GBS (9 males; mean age, 64 year), 5 were vaccinated with Oxford-AstraZeneca, 7 with Pfizer-BioNTech, and one with Moderna. Mean time between vaccination and GBS onset was 11.5 days. Ten patients developed GBS after the first vaccination dose, 3 after the second dose. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the predominant GBS variant, mainly characterized by sensory involvement. Bilateral seventh cranial nerve involvement followed AstraZeneca vaccination in two cases. Three patients presented treatment-related fluctuations, and 4 mild symptoms that delayed treatments and negatively affected prognosis. Prognosis was poor (GBS-disability score, ≥3) in 5/13 patients, with a disability rate of 3/13. Conclusions Our findings confirm that most post-COVID-19 vaccination GBS belong to the AIDP subtype, and occur after the first vaccine dose. Treatment-related fluctuations, and diagnosis-delaying, mild symptoms at onset are clinical features that affect prognosis and deserve particular consideration.
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ElSawi HA, Elborollosy A. Immune-mediated adverse events post-COVID vaccination and types of vaccines: a systematic review and meta-analysis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:44. [PMID: 35607386 PMCID: PMC9117608 DOI: 10.1186/s43162-022-00129-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In late 2019, Coronavirus disease 2019 has been declared as a global emergency by World Health Organization. Hopefully, recent reports of effective and safe vaccines were welcomed, and approved on emergency base. Millions of recipients had received one of the approved COVID 19 vaccines, with lots of adverse events recorded global wide.
Objective
To assess post-COVID vaccination immune-mediated adverse events and evaluate its association to specific type of vaccine global wide.
Methods
Systematic literature review and meta-analysis of published reports (since December 2020 till December 2021) on immune-mediated adverse events post-COVID vaccination.
Results
We evaluated 34 published studies; 460 cases with various adverse events post-COVID vaccination. Studies in current literature are primarily retrospective case series, isolated case reports or narrative studies. Different COVID vaccines were involved. Results’ data was subcategorized according to associated vaccine. Adverse effects of COVID-19 vaccinations included thrombotic, neurological, myocarditis, ocular, dermatological, renal, hematological events timely linked to inoculation. Each vaccine type was linked to adverse profile that differ from others.
Conclusion
High suspicion of post-vaccination adverse events is mandatory to provoke earlier detection, better understanding, optimum prevention, and management. Specific vaccine/patient risk profile is needed to selectively categorize target population to reduce morbidity and mortality post-vaccination.
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Singh S, Sanna F, Adhikari R, Akella R, Gangu K. Chronic Inflammatory Demyelinating Polyneuropathy Post-mRNA-1273 Vaccination. Cureus 2022; 14:e24528. [PMID: 35651399 PMCID: PMC9138197 DOI: 10.7759/cureus.24528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
Massive efforts are being made to develop coronavirus disease 2019 (COVID-19) vaccines at an unprecedented rate. The vaccinations' adverse impact profile, on the other hand, has not been well established. Neurological complications are increasingly reported as a result of these vaccines. One such complication identified is immune-mediated inflammatory polyneuropathy, which affects peripheral nerves and neurons. We report a case of chronic inflammatory demyelinating polyneuropathy (CIDP) post-mRNA-1273 (Moderna) COVID-19 vaccine. Recognizing this complication and distinguishing it from Guillain-Barré syndrome enables timely initiation of treatment. Additionally, our report highlights a possible link between vaccination and subsequent development of CIDP, but conclusive evidence of a causal relationship requires more extensive studies.
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Finsterer J, Scorza FA, Scorza CA. Guillain-Barré Syndrome Associated with COVID-19 Vaccination. Emerg Infect Dis 2022; 28:1079-1080. [PMID: 35447058 PMCID: PMC9045438 DOI: 10.3201/eid2805.212145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kim JE, Min YG, Shin JY, Kwon YN, Bae JS, Sung JJ, Hong YH. Guillain–Barré Syndrome and Variants Following COVID-19 Vaccination: Report of 13 Cases. Front Neurol 2022; 12:820723. [PMID: 35153993 PMCID: PMC8833101 DOI: 10.3389/fneur.2021.820723] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
Background Amidst growing concern about an increased risk of Guillain–Barré syndrome (GBS) following COVID-19 vaccination, clinical and electrodiagnostic features have not been fully characterized. Methods We retrospectively reviewed medical records of the patients diagnosed with GBS and its variants following COVID-19 vaccination at four referral hospitals during the period of the mass vaccination program in South Korea (February to October 2021). Results We identified 13 patients with GBS and variants post COVID-19 vaccination: AstraZeneca vaccine (Vaxzevria) in 8, and Pfizer-BioNTech vaccine (Comirnaty) in 5. The mean time interval from vaccination to symptom onset was 15.6 days (range 4–30 days). Electrodiagnostic classification was demyelinating in 7, axonal in 4 and normal in 2 cases. Clinical manifestations were diverse with varying severity: classical GBS in 8 cases, paraparetic variant in 3, Miller-Fisher syndrome in 1 and acute cervicobrachial weakness in 1. Four patients developed respiratory failure, and 2 of them showed treatment-related fluctuations. Conclusion Our observations suggest that COVID-19 vaccines may be associated with GBS of distinctive clinical features characterized by severe quadriplegia, disproportionately frequent bilateral facial palsy or atypical incomplete variants. Continuous surveillance and further studies using robust study designs are warranted to fully assess the significance of the association.
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Affiliation(s)
- Jee-Eun Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Hanlym University Hospital, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
- *Correspondence: Yoon-Ho Hong
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Kulsirichawaroj P, Sanmaneechai O, Wittawatmongkol O, Chokephaibulkit K. Polyneuritis Cranialis Associated with BNT162b2 mRNA COVID-19 Vaccine in a Healthy Adolescent. Vaccines (Basel) 2022; 10:vaccines10010134. [PMID: 35062795 PMCID: PMC8779427 DOI: 10.3390/vaccines10010134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 02/05/2023] Open
Abstract
A 16-year-old Thai girl developed right facial palsy, a lower motor neuron lesion, and numbness 3 h after receiving the first dose of the BNT162b2 mRNA vaccine. Neurological examination showed the involvement of the right cranial nerves (CN) V, VII, IX, and X. Electrophysiological tests revealed the absence of an F wave response, suggesting a proximal demyelinating process. Magnetic resonance imaging of the brain demonstrated abnormal enhancement of the right CN VII. The cerebrospinal fluid profile on day 7 after the onset of symptoms was normal. The patient was diagnosed with polyneuritis cranialis, a rare variant of Guillain-Barre syndrome. She was successfully treated with intravenous immunoglobulin therapy.
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Salai G, Bilic E, Primorac D, Lakusic DM, Bilic H, Lazibat I, Grgurevic L. Benign Fasciculation Syndrome and Migraine Aura without Headache: Possible Rare Side Effects of the BNT162b2 mRNA Vaccine? A Case Report and a Potential Hypothesis. Vaccines (Basel) 2022; 10:vaccines10010117. [PMID: 35062778 PMCID: PMC8780563 DOI: 10.3390/vaccines10010117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
The BNT162b2 (Pfizer BioNTech) mRNA vaccine is an effective vaccine against COVID-19 infection. Here, we report an adverse event following immunization (AEFI) in a 48-year-old female patient who presented with fasciculations, migraine auras without headaches and in an increased discomfort of previously present palpitations, as well as excitation and insomnia. Her fasciculations were intermittently present until the time this paper was written, starting from the 6th day post-vaccination; they changed localization and frequency, but most commonly they were generalized, affecting almost all muscle groups. The patient also suffered from two incidents of migraine auras with visual kaleidoscope-like phenomena without headaches a few months after the vaccination. These symptoms were considered to be AEFI and no causal relation with the vaccine could be proven.
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Affiliation(s)
- Grgur Salai
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Teaching Institute of Emergency Medicine of the City of Zagreb, 10000 Zagreb, Croatia
| | - Ervina Bilic
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (E.B.); (D.M.L.); (H.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Dragan Primorac
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia;
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Eberly College of Science, The Pennsylvania State University, University Park, PA 16802, USA
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT 06516, USA
- Medical School, University of Split, 21000 Split, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Medical School REGIOMED, 96450 Coburg, Germany
| | - Darija Mahovic Lakusic
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (E.B.); (D.M.L.); (H.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Hrvoje Bilic
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (E.B.); (D.M.L.); (H.B.)
| | - Ines Lazibat
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Department of Neurology, Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Lovorka Grgurevic
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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Finsterer J. Neurological side effects of SARS-CoV-2 vaccinations. Acta Neurol Scand 2022; 145:5-9. [PMID: 34750810 PMCID: PMC8653194 DOI: 10.1111/ane.13550] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 12/14/2022]
Abstract
SARS-CoV-2 and adverse reactions to SARS-CoV-2 vaccinations show a tropism for neuronal structures and tissues. This narrative review was conducted to collect and discuss published data about neurological side effects of SARS-CoV-2 vaccines in order to discover type, frequency, treatment, and outcome of these side effects. The most frequent neurological side effects of SARS-CoV-2 vaccines are headache, Guillain-Barre syndrome (GBS), venous sinus thrombosis (VST), and transverse myelitis. Other neurological side effects occur in a much lower frequency. Neurological side effects occur with any of the approved vaccines but VST particularly occurs after vaccination with vector-based vaccines. Treatment of these side effects is not at variance from similar conditions due to other causes. The worst outcome of these side effects is associated with VST, why it should not be missed and treated appropriately in due time. In conclusion, safety concerns against SARS-CoV-2 vaccines are backed by an increasing number of studies reporting neurological side effects. The most frequent of them are headache, GBS, VST, and transverse myelitis. Healthcare professionals, particularly neurologists involved in the management of patients having undergone SARS-CoV-2 vaccinations, should be aware of these side effects and should stay vigilant to recognize them early and treat them adequately.
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Finsterer J, Scorza CA, Scorza FA. Guillain-Barre syndrome related to SARS-CoV-2 vaccinations. Clinics (Sao Paulo) 2022; 77:100113. [PMID: 36137343 PMCID: PMC9464593 DOI: 10.1016/j.clinsp.2022.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022] Open
Key Words
- aidp, acute, inflammatory demyelinating polyneuropathy
- aman, acute, motor, axonal neuropathy
- amsan, acute, motor, and sensory axonal neuropathy
- azv, astra zeneca vaccine
- cns, central nervous system
- fda, food and drug administration
- gbs, guillain barres syndrome
- ivig, ntravenous immunoglobulins
- mhra, medicine and healthcare products regulatory agency
- pcb, pharyngo-cervico-brachial
- pe, plasma exchange
- pns, pcripheral nervous system
- sc2vag, sars-cov-2 vaccination associated gbs
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Affiliation(s)
| | - Carla A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
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Shalash A, Belal N, Zaki AS, Georgy SS, Doheim MF, Hazzou A, Abdelnasser A. Guillain–Barré syndrome following different COVID-19 vaccines: a case series. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:153. [PMCID: PMC9734843 DOI: 10.1186/s41983-022-00582-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022] Open
Abstract
Background The COVID-19 vaccine-related Guillain–Barré syndrome (GBS) has been described for both messenger-RNA vaccine and adenovirus-vectored types in a few cases with great public concern and the necessity to inform physicians about the variations of its presentations given its life-threatening consequences. Case presentation This case series highlighted the presentation with GBS following different COVID-19 vaccinations in seven cases with ages ranging from 29 to 59 years. Three patients received the AstraZeneca vaccine, two received the Pfizer vaccine, one received Sinopharm, and one received the Janssen vaccine. Latency ranged from 5 to 60 days and cases achieved either partial or complete improvement after treatment trials. Patients responded to plasmaphereses, but not pulse steroid therapy. Conclusion This case series highlights the variable presentations and outcomes of GBS following different COVID-19 vaccination from one center. The early identification and appropriate management of such cases can lead to better outcomes.
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Affiliation(s)
- Ali Shalash
- grid.7269.a0000 0004 0621 1570Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt
| | - Nourhan Belal
- grid.7269.a0000 0004 0621 1570Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt
| | - Amr S. Zaki
- grid.7269.a0000 0004 0621 1570Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt
| | - Shady S. Georgy
- grid.7269.a0000 0004 0621 1570Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt
| | - Mohamed Fahmy Doheim
- grid.7155.60000 0001 2260 6941Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Hazzou
- grid.7269.a0000 0004 0621 1570Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt
| | - Azza Abdelnasser
- grid.7269.a0000 0004 0621 1570Department of Neurology, Faculty of Medicine, Ain Shams University, 168 Elnozha St, Saint Fatima Square, Heliopolis, Cairo, Egypt
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Devaraj R, Shafi P, Nagesh C, Naidu A, Satishchandra P. Spectrum of Neurological Complications Following COVID-19 Vaccination in India. J Clin Neurol 2022; 18:681-691. [PMID: 36367066 PMCID: PMC9669548 DOI: 10.3988/jcn.2022.18.6.681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE According to WHO statistics, approximately 6.9 billion people worldwide had been vaccinated against SARS-CoV-2 as at October 27, 2021, including around 1.0 billion people in India. Most Indian recipients received the Covishield (ChAdOx1-S/nCoV-19) vaccine, followed by the Covaxin (an inactivated SARS-CoV-2 antigen) vaccine. This study was conducted to characterize the neurological phenotypic spectrum of patients with adverse events following immunization with any of the available COVID-19 vaccines in India (Covishield or Covaxin) during the study period and their temporal relationship with vaccination. METHODS This ambispective multicenter hospital-based cohort study covered the period from March to October 2021. The study included all cases suspected of having neurological complications following COVID-19 vaccination. RESULTS We report a spectrum of serious postvaccination neurological complications comprising primary central nervous system demyelination (4 cases), cerebral venous thrombosis (3 cases), Guillain-Barre syndrome (2 cases), vaccine-induced prothrombotic immune thrombocytopenia syndrome (2 cases), cranial nerve palsies (2 cases), primary cerebral hemorrhage (1 case), vestibular neuronitis (1 case), chronic inflammatory demyelinating polyneuropathy (1 case), generalized myasthenia (1 case), and seizures (1 case). CONCLUSIONS Although the benefits of vaccination far outweigh its risks, clinicians must be aware of possible serious adverse events associated with COVID-19 vaccinations.
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Affiliation(s)
- Rashmi Devaraj
- Department of Neurology, Apollo Specialty Hospital, Jayanagar, Bengaluru, India
| | - Peerzada Shafi
- Department of Neurology, Apollo Specialty Hospital, Jayanagar, Bengaluru, India
| | - Chinmay Nagesh
- Department of Neuro-radiology, Apollo Specialty Hospital, Jayanagar, Bengaluru, India
| | - Amar Naidu
- Department of Neurology, Apollo Specialty Hospital, Jayanagar, Bengaluru, India
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Finsterer J, Matovu D, Scorza FA. SARS-CoV-2 vaccinations reduce the prevalence of post-COVID Guillain-Barre syndrome. Clinics (Sao Paulo) 2022; 77:100064. [PMID: 35751951 PMCID: PMC9189101 DOI: 10.1016/j.clinsp.2022.100064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Guillain-Barre Syndrome (GBS) has been repeatedly reported as a neurological complication of COVID-19 (post-COVID GBS [PCG]). Whether the introduction of SARS-CoV-2 vaccines reduced the prevalence of PCG is unknown. This narrative review aimed to compare the number of published PCG cases between the second half of 2020 (no vaccination available) with those of the first half of 2021 (vaccination available). A total of 124 articles reported 300 patients with PCG between January 2020 and June 2021. The ages ranged from 7 to 94y. There was male dominance. The latency between the onset of COVID-19 and the onset of PCG ranged from -10 to 90d Acute, inflammatory, demyelinating polyneuropathy was diagnosed in 171 patients, acute, motor axonal neuropathy in 24, and acute, motor, and sensory axonal neuropathy in 16 patients. Regarding treatment, 241 patients received immunoglobulins, 28 patients' plasmaphereses, and 7 patients' steroids. Artificial ventilation was required in 59 patients. Full recovery was achieved in 42 cases, partial recovery in 163 cases, and 17 patients died. The number of published PCG patients fell from 192 in the second half of 2020 to 75 patients in the first half of 2021. It is concluded that the prevalence of PCG has decreased since the introduction of SARS-CoV-2 vaccines. SARS-CoV-2 vaccinations have a positive effect on the prevalence of PCG.
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Affiliation(s)
| | - Daniel Matovu
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil
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