Is SARS-CoV-2 vaccination related Guillain-Barré syndrome really different from that due to other causes?

Josef Finsterer
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Abstract

We read with interest the article by Reddy et al. [1] on a literature review of 100 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination-related Guillain-Barré syndrome (GBS) who were compared with 61 patients with SARSCoV-2 infection related GBS and 925 patients with GBS due to other causes from the International GBS Outcome Study (IGOS). Three-quarters of the vaccinees had limb weakness with sensory deficits, half of the vaccinees facial palsy, and a quarter each dysautonomia and respiratory insufficiency [1]. Severity and pain occurred more frequently with vector-based vaccines compared to messenger RNA-based vaccines [1]. It was concluded that SARS-CoV-2 vaccination-related GBS more commonly presents with facial palsy and sensory disturbances than GBS due to other causes [1]. The study is compelling but has limitations that should be discussed. The major limitation of the study is the design. A literature review is not the ideal approach to assess whether the clinical presentation and outcome of SARS-CoV-2 vaccination-related GBS differ from the presentation and outcome of GBS due to other causes. A prospective, multicenter study would be more appropriate to answer the question of interest. Literature reviews also have the disadvantage that the data extracted are incomplete or that the methods used to generate the data differ between the included studies. Another limitation of the study is that the vaccination group was inhomogeneous with regard to vaccine types [1]. Patients in this group had received six different types of vaccines [1]. Different vaccine types might elicit different immune responses and hence different clinical presentations. It is also conceivable that components of the vaccine other than the active ingredient itself could cause GBS. Because pharmaceutical companies use different types of stabilizers, solvents, and preservatives, it is conceivable that these components were responsible for different host immune reactions and hence for different clinical presentations. A third limitation is that the IGOS cohort is heterogeneous regarding the cause of GBS. Homogeneous cohorts are required to compare clinical presentation between two groups. Furthermore, the vaccination group and the control groups should be matched for age, sex, comorbidities, and medications, which was not the case in the index study. GBS with cranial nerve involvement and sensory disturbances also occurs in GBS due to Campylobacter jejuni, cytomegaly, Zika, Epstein-Barr, or Dengue virus [2]. Thus, if other control groups had been used, differences between the cohorts © Korean Vaccine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. K O R E A N V A C C I N E S O C I E T Y
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与SARS-CoV-2疫苗接种相关的格林-巴罗综合征与其他原因引起的格林-巴罗综合征真的不同吗?
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来源期刊
CiteScore
3.70
自引率
3.70%
发文量
29
审稿时长
8 weeks
期刊介绍: Clin Exp Vaccine Res, the official English journal of the Korean Vaccine Society, is an international, peer reviewed, and open-access journal. It covers all areas related to vaccines and vaccination. Clin Exp Vaccine Res publishes editorials, review articles, special articles, original articles, case reports, brief communications, and correspondences covering a wide range of clinical and experimental subjects including vaccines and vaccination for human and animals against infectious diseases caused by viruses, bacteria, parasites and tumor. The scope of the journal is to disseminate information that may contribute to elaborate vaccine development and vaccination strategies targeting infectious diseases and tumors in human and animals. Relevant topics range from experimental approaches to (pre)clinical trials for the vaccine research based on, but not limited to, basic laboratory, translational, and (pre)clinical investigations, epidemiology of infectious diseases and progression of all aspects in the health related issues. It is published printed and open accessed online issues (https://ecevr.org) two times per year in 31 January and 31 July. Clin Exp Vaccine Res is linked to many international databases and is made freely available to institutions and individuals worldwide
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