With the widespread use of vaccines to protect against infection by the SARS-Cov2 virus, there is intense interest in possible low-frequency but clinically significant complications. Annals of Neurology announces two new research articles, one from India and one from England, both reporting clusters of an unusual variant of Guillain-Barre syndrome characterized by prominent bilateral facial weakness.
Seven cases are reported from a regional medical center in Kerali, India where about 1.2 million people were vaccinated with the AstraZeneca vaccine. Four cases are reported from Nottingham, England, in an area in which about 700,000 people received the same vaccine. All eleven cases were among people who had received that vaccine 10 to 22 days earlier. The frequency of Guillain-Barre syndrome in these areas was estimated to be about 4-10 times greater than expected baseline frequency. But it was the unusually severe bilateral facial weakness and precise timing with respect to vaccination that made these occurrences stand out.
In an accompanying Editorial, the neuromuscular and statistical editors for Annals of Neurology report an additional similar case seen in Boston in a patient who had received the Johnson & Johnson SARS-Cov2 vaccine. They also analyzed cases of onset of severe bilateral facial weakness (with or without Guillain-Barre syndrome) reported in the Vaccine Adverse Events Reporting System (VAERS) in the US. They note that 5 of 8 cases of GBS with bilateral facial weakness in the US were reported in people who had received the Johnson & Johnson vaccine, which, like the AstraZeneca vaccine, is adenovirus-based (the AstraZeneca vaccine is not available in the US); only 3 cases were seen in the much larger number of patients who had received the Pfizer and Moderna vaccines.
These observations suggest that, like the thrombocytopenic thrombosis associated with these two adenovirus-based vaccines, Guillain-Barre syndrome with bilateral facial weakness may be a rare, but specific complication. Hence, it is important for physicians to be aware of this condition so that they can identify it and promptly treat it with standard therapy (e.g., intravenous immunoglobulin).