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LETTER TO EDITOR
Year : 2022  |  Volume : 8  |  Issue : 3  |  Page : 165-167

Guillain–Barré syndrome associated with vaccines in Veracruz, Mexico


Guillain–Barre Syndrome Study Group, Veracruz, Mexico

Date of Submission24-May-2022
Date of Decision20-Aug-2022
Date of Acceptance23-Aug-2022
Date of Web Publication21-Sep-2022

Correspondence Address:
Luis Del Carpio-Orantes
Guillain-Barre Syndrome Study Group In Veracruz
Mexico
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bc.bc_25_22

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How to cite this article:
Carpio-Orantes LD, Solís-Sánchez I, Piquet-Uscanga YO. Guillain–Barré syndrome associated with vaccines in Veracruz, Mexico. Brain Circ 2022;8:165-7

How to cite this URL:
Carpio-Orantes LD, Solís-Sánchez I, Piquet-Uscanga YO. Guillain–Barré syndrome associated with vaccines in Veracruz, Mexico. Brain Circ [serial online] 2022 [cited 2022 Sep 26];8:165-7. Available from: http://www.braincirculation.org/text.asp?2022/8/3/165/356529



Dear Editor,

The main agents of Guillain–Barre syndrome (GBS) (the most common autoimmune disease of the peripheral nervous system, with an incidence of 1.1/100,000 worldwide) are infectious, predominantly Campylobacter and some neurotropic viruses such as dengue or Zika, which in past pandemics were one of the main agents suspected of conditioning outbreaks of the syndrome in this region of Southeastern Mexico endemic to arboviruses; however, there are other entities such as the application of vaccines that usually condition the appearance of the syndrome, with various case reports.[1]

Within the history of vaccines, only one has shown a direct association with the development of GBS, being the swine influenza vaccine used in 1976 and 1977; other vaccines that have been associated with cases of the syndrome are tetanus toxoid and oral polio vaccine.[2],[3]

A recent meta-analysis shows a GBS rate of 2.77 cases per million people vaccinated for the influenza vaccine and 2.44 cases per million for the papillomavirus vaccine.[4]

With the arrival of the COVID-19 pandemic and the accelerated efforts of universal vaccination, several cases of the syndrome associated with vaccines against severe acute respiratory syndrome-coronavirus-2 have been reported, the main vaccines that have shown this incidence of cases are those of AstraZeneca, Pfizer, and Moderna, according to recent systematic reviews. However, there is evidence that vaccines with mRNA technology have a low incidence of this type of complication, which does not exceed the global incidence of the syndrome.[5],[6],[7]

The main implicated vaccines are adenoviral vector vaccines (AstraZeneca, Janssen, and Sputnik V) according to a theory that the fact that adenoviruses can trigger stronger innate immune responses, such as interferons, compared to mRNA-based vaccines, can, in turn, stimulate a wide range of cells to increase their surface expression of Human leukocyte antigen (HLA), further setting the stage for a more rigorous immune response and leading to the onset of GBS.[8]

A description is made of a series of cases of GBS associated with the administration of various vaccines presented in the state of Veracruz, in the Mexican southeast from 2019 to 2021.

Four cases of GBS associated with vaccines are reported, 75% are men, with an average age of 60 years; two patients reported concomitant gastrointestinal symptoms; two patients had been vaccinated 2 weeks ago and two patients 1 week or less ago; one patient received two simultaneous vaccines (influenza and tetanus), two received the anti-COVID vaccine from Pfizer and one from AstraZeneca; the clinical variant of GBS was the classic one in three and one presented the cervico-pharyngo-brachial variant; two presented concomitant sensory deficits, one ataxia, and two dysautonomias; one patient presented facial palsy, one oculomotor and bulbar palsy, and one facial and bulbar palsy; regarding the form of progression, two were classic and two were asymmetric and asynchronous; the neuroconduction velocity study reported one case of acute motor-sensory axonal neuropathy (AMSAN), one case of AMAN, and two cases of acute inflammatory demyelinating polyneuropathy (AIDP); cerebrospinal fluid analysis reported hyperproteinorrachia in two cases; all were treated with intravenous immunoglobulin; the initial Hughes scale was four in all cases and at the end of treatment only one presented Hughes 3, the rest remained at 4; one patient developed pneumonia and none died [Table 1] and [Table 2].
Table 1: Characteristics of the patients

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Table 2: Neuroconduction studies performed on patients

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This small series of cases alludes to the increase in cases of GBS associated with vaccines coupled with the great vaccination campaign against COVID-19, being only anecdotal cases in this region of the Mexican southeast do not translate into a health alarm, highlighting that, as in other case reports, the most frequent variety was the sensory-motor (AMSAN), in the same way, it highlights that influenza and tetanus vaccine can be one of the main promoters of the appearance of this syndrome, in addition to the vaccines adenoviral for COVID-19.[9],[10]

The incidence of GBS associated with vaccines is relatively low, but it is a possibility that exists during vaccination campaigns and one must be alert to the presence of neurological symptoms for early diagnosis and timely initiation of treatment, limiting neurological sequelae of the illness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Del Carpio-Orantes L, García-Méndez S, Solís-Sánchez I, Perfecto-Arroyo MA, Moreno-Aldama NP, Sánchez-Díaz JS. Neurological symptoms in patients with COVID-19 as manifestation of severity and prognosis, the case of anosmia and dysgeusia. J Neurol Sci 2021;429:119899. doi: 10.1016/j.jns.2021.119899.  Back to cited text no. 1
    
2.
Haber P, Sejvar J, Mikaeloff Y, DeStefano F. Vaccines and Guillain-Barré syndrome. Drug Saf 2009;32:309-23.  Back to cited text no. 2
    
3.
Principi N, Esposito S. Vaccine-preventable diseases, vaccines and Guillain-Barre' syndrome. Vaccine 2019;37:5544-50.  Back to cited text no. 3
    
4.
Wang F, Wang D, Wang Y, Li C, Zheng Y, Guo Z, et al. Population-based incidence of Guillain-Barré syndrome during mass immunization with viral vaccines: A pooled analysis. Front Immunol 2022;13:782198.  Back to cited text no. 4
    
5.
Hanson KE, Goddard K, Lewis N, Fireman B, Myers TR, Bakshi N, et al. Incidence of Guillain-Barré syndrome after COVID-19 vaccination in the vaccine safety datalink. JAMA Netw Open 2022;5:e228879.  Back to cited text no. 5
    
6.
Shao SC, Wang CH, Chang KC, Hung MJ, Chen HY, Liao SC. Guillain-Barré syndrome associated with COVID-19 vaccination. Emerg Infect Dis 2021;27:3175-8.  Back to cited text no. 6
    
7.
García-Grimshaw M, Michel-Chávez A, Vera-Zertuche JM, Galnares-Olalde JA, Hernández-Vanegas LE, Figueroa-Cucurachi M, et al. Guillain-Barré syndrome is infrequent among recipients of the BNT162b2 mRNA COVID-19 vaccine. Clin Immunol 2021;230:108818.  Back to cited text no. 7
    
8.
Kadkhoda K. Post-adenoviral-based vaccines Guillain-Barre syndrome: A proposed mechanism. Med Hypotheses 2022;160:110792.  Back to cited text no. 8
    
9.
Tutar NK, Eyigürbüz T, Yildirim Z, Kale N. A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN. Ideggyogy Sz 2021;74:286-8.  Back to cited text no. 9
    
10.
Min YG, Ju W, Ha YE, Ban JJ, Lee SA, Sung JJ, et al. Sensory Guillain-Barre syndrome following the ChAdO×1 nCov-19 vaccine: Report of two cases and review of literature. J Neuroimmunol 2021;359:577691.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]



 

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