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Guillain-Barré syndrome following ChAdOx1-S/nCoV-19 vaccine
Boby Varkey Maramattom MD, DM, FRCP, Parameswaran Krishnan MD, DM, Reji Paul MD, DM, Sandeep Padmanabhan MD, DM, C V Soumya MD,DM, DNB … See all authors

First published: 10 June 2021

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.26143.

As of April 22, 2021, around 1.5 million individuals in 3 districts of Kerala, India had been vaccinated with COVID-19 vaccines. Over 80% of these individuals (1.2 million) received the ChAdOx1-S/nCoV-19 vaccine. In this population, during this period of 4 weeks (mid-March to mid-April 2021), we observed seven cases of Guillain-Barre syndrome (GBS) that occurred within two weeks of the first dose of vaccination. All 7 patients developed severe GBS. The frequency of GBS was 1.4 to10 fold higher than that expected in this period for a population of this magnitude. In addition, the frequency of bilateral facial weakness, which typically occurs in <20% of GBS cases, suggests a pattern associated with the vaccination. While the benefits of vaccination substantially outweigh the risk of this relatively rare outcome (5.8 per million), clinicians should be alert to this possible adverse event, as six out of seven patients progressed to areflexic quadriplegia and required mechanical ventilatory support.

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