From the Department of Neurology (H.B., S.B.), and Department of Internal Medicine B (A.A., S.C.), Lady Davis Carmel Medical Center; Ruth and Bruce Rappaport Faculty of Medicine (A.A., S.B., S.C., R.N.-D., N.G., W.S.), Technion-Israel Institute of Technology; Statistical Unit (O.B.-G., W.S.), Department of Community Medicine and Epidemiology (O.B.-G., N.G.), and Infection Control and Prevention Unit (R.N.-D.), Lady Davis Carmel Medical Center, Haifa; Sackler Faculty of Medicine (E.A.), Tel Aviv University; Department of Neurology (E.A.), Rabin Medical Center, Petach Tikva; and Translational Epidemiology Unit and Research Authority (W.S.), Lady Davis Carmel Medical Center, Haifa, Israel.
Neurology. 2023 Nov 14;101(20):e2035-e2042. doi: 10.1212/WNL.0000000000207900. Epub 2023 Oct 18.
Existing data regarding occurrence of Guillain-Barré syndrome (GBS) after coronavirus disease 2019 (COVID-19) infection and vaccination are inconclusive. We aimed to assess the association between GBS and both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccine.
We conducted a nested case-control study in a cohort of 3,193,951 patients aged 16 years or older, without a diagnosis of prior GBS, from the largest health care provider in Israel. Participants were followed from January 1, 2021, until June 30, 2022, for the occurrence of GBS. Ten randomly selected controls were matched to each case of GBS on age and sex. We assessed both SARS-CoV-2 infection and COVID-19 vaccine administration in the prior 6 weeks in cases and controls.
Overall, 76 patients were diagnosed with GBS during follow-up and were matched to 760 controls. A positive test for SARS-CoV-2 was detected in 9 (11.8%) cases and 18 (2.4%) controls. An administration of COVID-19 vaccine was detected in 8 (10.5%) cases (all Pfizer-BioNTech [BNT162b2] vaccine) and 136 (17.9%) controls (134 Pfizer-BioNTech vaccine). Multivariable conditional logistic regression models showed that the odds ratio for GBS associated with SARS-CoV-2 infection and COVID-19 vaccine administration was 6.30 (95% CI 2.55-15.56) and 0.41 (95% CI 0.17-0.96), respectively. The results were similar when exposure to SARS-CoV-2 infection or COVID-19 vaccine administration was ascertained in the prior 4 and 8 weeks, although did not reach statistical significance for COVID-19 vaccine at 4 weeks.
Our study suggests that SARS-CoV-2 infection is associated with increased risk of GBS, whereas Pfizer-BioNTech COVID-19 vaccine is associated with decreased risk of GBS.
关于新冠肺炎（COVID-19）感染和疫苗接种后发生格林-巴利综合征（GBS）的现有数据尚无定论。我们旨在评估 GBS 与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染和 COVID-19 疫苗之间的关联。
我们在以色列最大的医疗保健提供者的 3193951 名年龄在 16 岁或以上、无 GBS 既往诊断的患者队列中开展了一项巢式病例对照研究。参与者自 2021 年 1 月 1 日至 2022 年 6 月 30 日期间，对 GBS 的发生情况进行随访。每例 GBS 病例均匹配 10 名在年龄和性别上与之相匹配的随机对照。我们评估了病例和对照在 6 周内 SARS-CoV-2 感染和 COVID-19 疫苗接种情况。
总体而言，在随访期间共诊断出 76 例 GBS 患者，与 760 例对照相匹配。9 例（11.8%）病例和 18 例（2.4%）对照检测到 SARS-CoV-2 阳性。8 例（10.5%）病例（均为辉瑞-生物技术公司[BNT162b2]疫苗）和 136 例（17.9%）对照（134 例辉瑞-生物技术公司疫苗）接受了 COVID-19 疫苗接种。多变量条件逻辑回归模型显示，与 SARS-CoV-2 感染和 COVID-19 疫苗接种相关的 GBS 比值比分别为 6.30（95%CI 2.55-15.56）和 0.41（95%CI 0.17-0.96）。当 SARS-CoV-2 感染或 COVID-19 疫苗接种暴露情况在前 4 周和 8 周确定时，结果相似，但 COVID-19 疫苗在前 4 周时未达到统计学意义。
我们的研究表明，SARS-CoV-2 感染与 GBS 风险增加相关，而辉瑞-生物技术公司的 COVID-19 疫苗与 GBS 风险降低相关。
