AstraZeneca Vaccine Linked to Cases of Guillain-Barré Syndrome in India

In this video, Boby Varkey Maramattom, MD, DM, FRCP, FRCPE, discusses recent findings published in Annals of Neurology that linked cases of Guillain-Barré syndrome (GBS), a rare neurological syndrome, to the Oxford–AstraZeneca COVID-19 vaccine in India.

Read the transcript:

Dr, Boby Varkey: Hi. My name is Dr. Boby Varkey Maramattom. I'm the head consultant neurologist at Aster Medcity Cochin, Kerala. That's a small state in South India. I'm a general neurologist and a critical care neurointensivist.

I've trained in New York Critical Care in Rochester in the US in 2004 and have been practicing neurocritical care in India for the past 17 years.

Ever since the onset of the COVID pandemic, we've been swamped with COVID complications, as well as neurological complications, for the past one year.

Just when we thought we saw light at the end of the tunnel, there came the COVID vaccines. We launched our co-vaccination drive on January 17th of 2021. After that, there was a little lull in the storm before the second wave hit us sometime in April. About the middle of March 2021, to early April, we started noticing an unusual phenomenon.

We had a young lady who presented to us with rapidly progressive Guillain-Barré syndrome that started with back pain, and then progressed to sending flaccid paralysis, rapidly led to mechanical ventilation due to respiratory failure. She attributed it to the first dose of vaccination.

They call it the AstraZeneca vaccine, which she had received 14 days ago. At that time, we were skeptical, but we could not ignore it. We reported it to the health authorities. Within a span of a week or ten days, we had another case with the exact same temporal and clinical relationship to the COVID vaccine, also had bifacial palsy and also required to go on mechanical ventilation.

Subsequently, when we began looking around on that thought, we came in contact with two other neurologists in area who also contributed about another 3 to 4 cases, so altogether we came across seven cases of GBS all in the same time period. Then, we started collecting the data on these cases. All of them had the same clinical profile.

They had bifacial palsy. They had unusual cranial neuropathies like the involvement of the trigeminal sensory nerve as with abducens of sixth nerve palsies. In 2 of them we had the ophthalmoplegia due to abducens nerve involvement. It had quite strange features in that they would go into remission, and they would relapse again after the ophthalmoplegia would come back. It was explicitly responsive to small doses of IV steroids.

We've given one gram of IV methylprednisolone for about 2 to 3 days, and the sixth nerve palsy would go away, and then reappear again after 10 to 15 days. It could again respond to IV methylprednisolone.

This, and the fact that all the cases had the same temporal relationship, made us correlate our data, look back, and then re-exam the data in light of what knowledge we had of GBS in preceding years.

When we looked at our data and data across India we knew and we corroborated that we had a seasonal prediction of GBS, that is, most cases of GBS tended to occur in our rainy season, that what we call the monsoon season, that is in June to August, and that's the time we're usually swamped with GBS following diarrheas, and following infectious fevers.

This time we were looking at the off-season peak of GBS. Moreover, all these cases, all had also in addition to the similar clinical features that they had, one striking feature that we found was that none of us encountered GBS due to any other cause during this 4 to 6-week period.

Normally, between us we see at least about 7 to 10 cases of GBS across the state in this area and funnily enough, all the 7 cases that we come across have the same clinical and temporal relationships. That's what made us look back at that detail. We already knew that vaccination is linked with GBS, that is, prior historical data and literature available.

GBS is one of the things that we always inquire. I mean, we always inquire about vaccination history, or prior surgical history, or infections, or respiratory infections, or GI infections as precedent to GBS. This is the first time when all of them reported this same exact timing of onset of GBS in relationship to the COVID vaccination jab. That was the strange thing about it.

Although we couldn't really come across any biomarkers, one of the things that when you come across an association like this, one always tries to establish some sort of biomarker, inflammatory marker, or imaging marker, something like that that could corroborate the causal association of GBS with vaccination, but we all know that we haven't reached that far.

Though there is speculation as to the role of heat shock proteins and other proteins or antigenic mimicry between the coronavirus and human neural antigens. We, as yet, do not have the reliable biomarker that can help us to positively identify or to causally link without any speculation whatsoever, the link of the association between GBS and vaccination.

After we published, we've come across another set of similar cases from the UK. In fact, they reported a cohort of 4 patients from somewhere in Nottingham in the UK, who again had similar clinical and temporal relationship to their AstraZeneca COVID vaccination. We think that it's definitely more than a coincidence and there's definitely something going on.

The focus is now to find out whether what is the exact pathogenic mechanism behind this, is that any antigen mimicry that's going on, and to potentially look for any antibody marker, or any biomarker that can tell us that this is the one thing that you should check to somebody comes to you with GBS and either asymptomatic or symptomatic code infection.

In the next 1 year or so COVID is still going to play a huge role in our everyday lives and our interactions. Just like some of the other postponed complications like multisystem inflammatory disease, we can expect a significant number of post-vaccination reactions also.

We should be on the lookout for these, because early identification, characterization and reporting of these big day effects or adverse effects of immunization, will help us to pick out these cases, treat them early and make sure that we are able to identify what components of the vaccine are responsible for this, and hopefully, generate better vaccines or make some technological advances in our vaccination so that we can minimize adverse reactions to vaccination as far as possible.