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LETTERS TO EDITOR
Year : 2022  |  Volume : 66  |  Issue : 4  |  Page : 535-536  

Guillain–Barre syndrome after the first dose of Anti-SARS-CoV-2 vaccination is a rare side effect and the second jab is controversial in these cases


1 Senior Resident, Department of Physical Medicine and Rehabilitation, AIIMS, Patna, Bihar, India
2 Additonal Professor and Head, Department of Physical Medicine and Rehabilitation, AIIMS, Patna, Bihar, India

Date of Submission10-Oct-2022
Date of Decision20-Oct-2022
Date of Acceptance21-Oct-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Anurug Biswas
Department of Physical Medicine and Rehabilitation, AIIMS, Patna - 801 507, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1360_22

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How to cite this article:
Biswas A, Pandey SK. Guillain–Barre syndrome after the first dose of Anti-SARS-CoV-2 vaccination is a rare side effect and the second jab is controversial in these cases. Indian J Public Health 2022;66:535-6

How to cite this URL:
Biswas A, Pandey SK. Guillain–Barre syndrome after the first dose of Anti-SARS-CoV-2 vaccination is a rare side effect and the second jab is controversial in these cases. Indian J Public Health [serial online] 2022 [cited 2023 Feb 1];66:535-6. Available from: https://www.ijph.in/text.asp?2022/66/4/535/366564



Respected Editor,

We carefully read the letter wrote by Dr. Finsterer, published in the Indian Journal of Public Health, volume 66, issue 3, page 385–386, July–September, 2022, raising a few concerns about our previous article titled, “Post coronavirus disease 2019 (COVID-19) vaccination Guillain–Barre syndrome” published in your journal in volume 65, issue 4, page 422–424 in 2021. We are writing this letter as a response to Dr. Finsterer.

In our article, we mentioned Guillain–Barre syndrome (GBS) as a rare side effect of the COVID-19 vaccine. PubMed search, official websites of the World Health Organization, Centers for Disease Control and Prevention, and few other government databases also claimed GBS as a rare side effect of COVID-19 vaccination.[1],[2],[3] What Dr. Finsterer stated in his letter is the incidence of the particular side effect. However, rarity is decided as per incidence rate, not according to incidence only. Rare is usually defined as less than one incidence per 1000 person year, though it can vary a little in different countries.[4] Hence, in contrary to Dr. Finsterer's opinion, GBS is still a rare side effect of the post-COVID-19 vaccine.

Facial nerve supplies the buccinators, orbicularis oris, posterior digastric, and stylohyoid muscle which confers a great role in oral preparatory and oropharyngeal phases of swallowing and as it controls perioral muscles, it also plays important role in normal speech.[5] Hence, facial diplegia can cause difficulty in speech and swallowing as seen in our case. In our case, there was no other cranial nerve involvement and the gag reflex was present. A study of dysphagia was not done due to the financial constraints of the patient. However, swallowing difficulty was mild, and the patient presented to us in the recovery stage. For cases with severe dysphagia, a swallowing study should be done.

We agree with Dr. Finsterer that GBS can occur with different types of COVID-19 vaccines in the world, but in India, all cases of post-COVID-19 vaccination GBS were linked to the adenoviral-based vaccine at the time of preparing the manuscript of our case report.

As per Brighton criteria, level 2 diagnostic certainty of GBS, there is a clause stating that if the cerebrospinal fluid study is not available, electrophysiologic studies should be consistent with GBS.[6] In our case, electrophysiologic testing was consistent with GBS but the patient did not give consent for lumbar puncture (already discussed in our article). Moreover, the history, clinical course, blood investigation, and recovery after specific medication and therapy also support it as a case of GBS ruling out other differentials.

At the first visit to our rehabilitation unit, we counseled the patient about the risks of a second dose of the COVID-19 vaccine and advised him not to receive it. However, during the follow-up at 3rd month, he informed that he was counseled by some local quack (an unqualified person who falsely claims to have medical knowledge or other skills) misleading him to take the second jab of the vaccine. Fortunately there was no change in his neurological status after receiving the second dose. However, after searching a few relevant government websites and databases of India, we could not find any guideline that mentioned GBS after the first dose as a contraindication to receive the second dose of the COVID-19 vaccine. As Dr. Finsterer mentioned in his letter, there is a chance of severe relapse of GBS after the second dose of the COVID-19 vaccine if the GBS had developed after the first dose of vaccination. Hence, in these cases, it is better to avoid the second jab of the vaccine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chun JY, Park S, Jung J, Kim SH, Kim TS, Choi YJ, et al. Guillain-Barré syndrome after vaccination against COVID-19. Lancet Neurol 2022;21:117-9.  Back to cited text no. 1
    
2.
3.
Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html [Updated on 2022 Oct 03; accessed on 2022 Oct 07].  Back to cited text no. 3
    
4.
Available from: https://www.medsafe.govt.nz/consumers/Safety-of-Medicines/Medicine-safety. [Last accessed on 2022 Oct 07, Last revised on 2019 May 22].  Back to cited text no. 4
    
5.
Movérare T, Lohmander A, Hultcrantz M, Sjögreen L. Peripheral facial palsy: Speech, communication and oral motor function. Eur Ann Otorhinolaryngol Head Neck Dis 2017;134:27-31.  Back to cited text no. 5
    
6.
Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, et al. Guillain-Barré syndrome and fisher syndrome: Case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599-612.  Back to cited text no. 6
    




 

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