{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:09:27Z","timestamp":1788307767761,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T00:00:00Z","timestamp":1624320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>As of April 22, 2021, around 1.5 million individuals in three districts of Kerala, India had been vaccinated with COVID\u201019 vaccines. Over 80% of these individuals (1.2 million) received the ChAdOx1\u2010S\/nCoV\u201019 vaccine. In this population, during this period of 4\u2009weeks (mid\u2010March to mid\u2010April 2021), we observed seven cases of Guillain\u2010Barre syndrome (GBS) that occurred within 2\u2009weeks of the first dose of vaccination. All seven patients developed severe GBS. The frequency of GBS was 1.4\u2010 to 10\u2010fold higher than that expected in this period for a population of this magnitude. In addition, the frequency of bilateral facial weakness, which typically occurs in &lt;20% of GBS cases, suggests a pattern associated with the vaccination. While the benefits of vaccination substantially outweigh the risk of this relatively rare outcome (5.8 per million), clinicians should be alert to this possible adverse event, as six out of seven patients progressed to areflexic quadriplegia and required mechanical ventilatory support. 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Co\u2010Win Statistics. Available at:cowin.gov.in. Accessed April 22 2021."},{"key":"e_1_2_7_3_1","unstructured":"COVID\u201019 Vaccination Status. Available at:https:\/\/dashboard.kerala.gov.in\/. Last accessed April 22 2021."},{"key":"e_1_2_7_4_1","article-title":"Thrombotic thrombocytopenia after ChAdOx1 nCov\u201019 vaccination","volume":"9","author":"Greinacher A","year":"2021","journal-title":"N Engl J Med"},{"key":"e_1_2_7_5_1","article-title":"Neurological complications of COVID\u201019: Guillain\u2010Barre syndrome following Pfizer COVID\u201019 vaccine","volume":"13","author":"Waheed S","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(71)90010-4"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jns5.12050"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-011-0194-8"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaa433"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaa444"},{"key":"e_1_2_7_12_1","unstructured":"FDA Requires a Warning about Guillain\u2010Barr\u00e9 Syndrome (GBS) be Included in the Prescribing Information for Shingrix. Silver Spring MD: Food and Drug Administration 2021. Available at:https:\/\/www.fda.gov\/vaccines-blood-biologics\/safety-availability-biologics\/fda-requires-warning-about-guillain-barre-syndrome-gbs-be-included-prescribing-information-shingrix. Accessed April 22 2021."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-2327.132662"},{"key":"e_1_2_7_14_1","unstructured":"National Health Portal India. Guillain\u2010Barr\u00e9 syndrome: 2021. Available at:https:\/\/www.nhp.gov.in\/disease\/neurological\/guillain-barr-syndrome. Accessed April 22 2021."}],"container-title":["Annals of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.26143","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ana.26143","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ana.26143","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T04:10:11Z","timestamp":1692245411000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ana.26143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,22]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1002\/ana.26143"],"URL":"https:\/\/doi.org\/10.1002\/ana.26143","archive":["Portico"],"relation":{},"ISSN":["0364-5134","1531-8249"],"issn-type":[{"value":"0364-5134","type":"print"},{"value":"1531-8249","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,22]]},"assertion":[{"value":"2021-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}