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LETTER TO EDITOR
Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 385-386  

Is the second jab of an anti-SARS-CoV-2 vaccine reasonable after guillain–Barre syndrome following the first dose?


Department of Neurology, Neurology and Neurophysiology Center, Vienna, Austria

Date of Submission24-Jan-2022
Date of Decision12-Jul-2022
Date of Acceptance30-Jul-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Josef Finsterer
Postfach 20, Vienna 1180
Austria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_106_22

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How to cite this article:
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;66:385-6

How to cite this URL:
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 [serial online] 2022 [cited 2022 Sep 28];66:385-6. Available from: https://www.ijph.in/text.asp?2022/66/3/385/356584



Dear Editor,

We eagerly read the article by Biswas et al. about a 49-year-old male with quadriparesis and facial diplegia 1 week following the first dose of a vector-based anti-SARS-CoV-2 vaccine (Astra Zeneca).[1] The patient was diagnosed with acute, inflammatory demyelinating polyneuropathy (AIDP), a frequent subtype of Guillain–Barre syndrome (GBS), upon the clinical presentation and nerve conduction studies, and treated with intravenous immunoglobulin. Under this regimen, he partially recovered and received the second dose of the vaccine 7 weeks after the first jab. The study is appealing but raises concerns that require discussion.

We do not agree with the statement that the side effects of anti-SARS-CoV-2 vaccines are rare.[1] In a recent review about the neurological side effects of SARS-CoV-2 vaccinations, >3000 patients with headache, almost 400 patients with GBS, and >300 patients with venous sinus thrombosis following a SARS-CoV-2 vaccination have been reported as per the end of September 2021.[2]

We also do not agree with the statement that facial diplegia can be responsible for dysphagia and dysarthria. Dysphagia and dysarthria are more likely attributable to the involvement of the IX and X cranial nerves rather than the VII cranial nerve. We should be told whether only the VII cranial nerve or also the IX and X cranial nerves were affected. We should know if dysphagia was documented by video-cinematography or X-ray of the swallowing act with barium. Was the gag reflex preserved or diminished?

There is also disagreement regarding the statement that GBS occurred only after application of vector-based SARs-CoV-2 vaccines.[1] In a recent review of 19 patients with SARS-CoV-2 vaccination-associated GBS, 14 patients had received the Astra Zeneca vaccine, four the Pfizer vaccine, and one the Johnson & Johnson vaccine.[3]

GBS can be diagnosed according to the Brighton, Ashford, Besta, or Hadden criteria.[4] Most frequently applied are the Brighton criteria. Application of the Brighton criteria requires investigations of the cerebrospinal fluid (CSF). Typically, the diagnosis GBS is supported by a discrepancy between elevated CSF protein and normal CSF cell count (dissociation cyto-albumin). We should be told why the patient did not undergo CSF investigations.

It is not comprehensible why the patient received the second dose of the Astra Zeneca vaccine although the application of the first dose was complicated by GBS, from which he only partially recovered under immunoglobulin and physiotherapy. In a previously published case of a 32-year-old male with a history of GBS at age 18 years, the application of the first dose of a vector-based SARS-CoV-2 vaccine triggered a severe relapse of GBS with only partial recovery.[5] We should be told if persisting weakness of the upper limbs increased again after the second dose of the vaccine.

Overall, the report is appealing but has limitations that challenge the results and their interpretation. Application of the second dose of an anti-SARS-CoV-2 vaccine should be carefully weighed regarding benefit and disadvantages if severe side effects had developed after the first dose.

Informed consent

Informed consent was obtained. The study was approved by the institutional review board.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Biswas A, Pandey SK, Kumar D, Vardhan H. Post coronavirus disease-2019 vaccination Guillain-Barré syndrome. Indian J Public Health 2021;65:422-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Finsterer J. Neurological side effects of SARS-CoV-2 vaccinations. Acta Neurol Scand 2022;145:5-9.  Back to cited text no. 2
    
3.
Finsterer J, Scorza FA, Scorza CA. Post SARS-CoV-2 vaccination Guillain-Barre syndrome in 19 patients. Clinics (Sao Paulo) 2021;76:e3286.  Back to cited text no. 3
    
4.
Leonhard SE, Mandarakas MR, de Assis Aquino Gondim F, Bateman K, Brito Ferreira ML, Cornblath DR, et al. Evidence based guidelines. Diagnosis and management of Guillain-Barré syndrome in ten steps. Medicina (B Aires) 2021;81:817-36.  Back to cited text no. 4
    
5.
Finsterer J. Exacerbating Guillain-Barré syndrome eight days after vector-based COVID-19 vaccination. Case Rep Infect Dis 2021;2021:3619131.  Back to cited text no. 5
    




 

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