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Meta-Analysis
. 2024 Mar;271(3):1063-1071.
doi: 10.1007/s00415-024-12186-7. Epub 2024 Jan 17.

Guillain-Barré syndrome and COVID-19 vaccination: a systematic review and meta-analysis

Stefano Censi  1 , Giandomenico Bisaccia  1 , Sabina Gallina  1 , Valentina Tomassini  1   2 , Antonino Uncini  3
Affiliations
Meta-Analysis

Guillain-Barré syndrome and COVID-19 vaccination: a systematic review and meta-analysis

Stefano Censi et al. J Neurol. 2024 Mar.

Abstract

Background: Case-reports/series and cohorts of Guillain-Barré syndrome (GBS) associated with COVID-19 vaccination have been reported.

Methods: A systematic review and meta-analysis of cohort studies of GBS after COVID-19 vaccination was carried out. Incidence and incidence rate ratio for a number of vaccine doses and risk of GBS, also considering the specific vaccine technology, were calculated in a random-effects model.

Results: Of 554 citations retrieved, 518 were discarded as irrelevant. We finally included 15 studies. The random effect model yielded, regardless of the vaccine technology, 1.25 (95%CI 0.21; 2.83) GBS cases per million of COVID-19 vaccine doses, 3.93 (2.54; 5.54) cases per million doses for adenovirus-vectored vaccines and 0.69 (0.38; 1.06) cases per million doses for mRNA vaccines. The GBS risk was 2.6 times increased with the first dose. Regardless of the vaccine technology, the GBS risk was not increased but disaggregating the data it was 2.37 (1.67; 3.36) times increased for adenovirus-vectored vaccines and 0.32 (0.23; 0.47) for mRNA vaccines. Mortality for GBS after vaccination was 0.10 per million doses and 4.6 per GBS cases.

Conclusions: Adenovirus-vectored vaccines showed a 2.4 times increased risk of GBS that was about seven times higher compared with mRNA-based vaccines. The decreased GBS risk associated with mRNA vaccines was possibly due to an elicited reduction of infections, including SARS-CoV-2, associated with GBS during the vaccination period. How adenovirus-vectored COVID-19 vaccines may trigger GBS is unclear and further studies should investigate the relationship between vaccine technologies and GBS risk.

Keywords: COVID-19 vaccines; Epidemiology; Guillain-Barré syndrome; Meta-analysis; Systematic review.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flowchart of studies selection and search terms used
Fig. 2
Fig. 2
Forest plot of GBS incidence with respect to COVID-19 vaccine doses administered regardless of the vaccine technology. Events: number of GBS cases; Total: number of vaccine doses
Fig. 3
Fig. 3
Forest plot about risk ratio between GBS cases linked to first and second doses of COVID-19 vaccine. Events: number of GBS cases; Total: number vaccine doses
Fig. 4
Fig. 4
Forest plot of GBS incidence with respect to A adenoviral-vectored COVID-19 vaccine doses administered, and B with respect to mRNA-based COVID-19 vaccine doses administered. Events: number of GBS cases; Total: number of A adenoviral-vectored or B mRNA-based vaccine doses
Fig. 5
Fig. 5
Forest plots of risk ratio between observed and expected GBS linked to COVID-19 vaccine doses administered regardless the vaccine technology; B with respect to vector-based vaccines; C with respect to mRNA vaccines. For vaccinated, Events: number of GBS cases; Total: number of vaccine doses. For expected, Events: number of expected GBS cases; Total: number of subjects in the population considered. AdV: adenoviral-vectored vaccines
Fig. 6
Fig. 6
Forest plot about risk ratio between GBS cases linked to COVID-19 vaccine doses administered; A with respect to adenoviral-vectored vaccines; B with respect to mRNA vaccines. For vaccinated, Events: number of GBS cases; Total: number of vaccine doses. For expected, Events: number of expected GBS cases; Total: number of subjects in the population considered
Fig. 7
Fig. 7
Forest plots of GBS mortality after COVID-19 vaccination. A with respect to administered doses; B with respect to GBS cases after vaccination. Events: number of deaths; Total: number of total COVID-19 vaccine doses (A) and GBS cases (B)
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