{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:36:40Z","timestamp":1777379800329,"version":"3.51.4"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T00:00:00Z","timestamp":1645142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University College London Hospitals"},{"name":"Biomedical Research Centre"},{"DOI":"10.13039\/100013560","name":"GBS-CIDP Foundation International","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100013560","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Vaccination against viruses has rarely been associated with Guillain-Barr\u00e9 syndrome (GBS), and an association with the COVID-19 vaccine is unknown. We performed a population-based study of National Health Service data in England and a multicentre surveillance study from UK hospitals to investigate the relationship between COVID-19 vaccination and GBS.<\/jats:p>\n                  <jats:p>Firstly, case dates of GBS identified retrospectively in the National Immunoglobulin Database from 8 December 2021 to 8 July 2021 were linked to receipt dates of COVID-19 vaccines using data from the National Immunisation Management System in England. For the linked dataset, GBS cases temporally associated with vaccination within a 6-week risk window of any COVID-19 vaccine were identified. Secondly, we prospectively collected incident UK-wide (four nations) GBS cases from 1 January 2021 to 7 November 2021 in a separate UK multicentre surveillance database. For this multicentre UK-wide surveillance dataset, we explored phenotypes of reported GBS cases to identify features of COVID-19 vaccine-associated GBS.<\/jats:p>\n                  <jats:p>Nine hundred and ninety-six GBS cases were recorded in the National Immunoglobulin Database from January to October 2021. A spike of GBS cases above the 2016\u20132020 average occurred in March\u2013April 2021. One hundred and ninety-eight GBS cases occurred within 6 weeks of the first-dose COVID-19 vaccination in England [0.618 cases per 100,000 vaccinations; 176 ChAdOx1 nCoV-19 (AstraZeneca), 21 tozinameran (Pfizer) and one mRNA-1273 (Moderna)]. The 6-week excess of GBS (compared to the baseline rate of GBS cases 6\u201312 weeks after vaccination) occurred with a peak at 24 days post-vaccination; first-doses of ChAdOx1 nCoV-19 accounted for the excess. No excess was seen for second-dose vaccination. The absolute number of excess GBS cases from January\u2013July 2021 was between 98\u2013140 cases for first-dose ChAdOx1 nCoV-19 vaccination. First-dose tozinameran and second-dose of any vaccination showed no excess GBS risk. Detailed clinical data from 121 GBS patients were reported in the separate multicentre surveillance dataset during this timeframe. No phenotypic or demographic differences identified between vaccine-associated and non-vaccinated GBS cases occurring in the same timeframe.<\/jats:p>\n                  <jats:p>Analysis of the linked NID\/NIMS dataset suggested that first-dose ChAdOx1 nCoV-19 vaccination is associated with an excess GBS risk of 0.576 (95% confidence interval 0.481\u20130.691) cases per 100 000 doses. However, examination of a multicentre surveillance dataset suggested that no specific clinical features, including facial weakness, are associated with vaccination-related GBS compared to non-vaccinated cases. The pathogenic cause of the ChAdOx1 nCoV-19 specific first dose link warrants further study.<\/jats:p>","DOI":"10.1093\/brain\/awac067","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T15:12:22Z","timestamp":1645024342000},"page":"739-748","source":"Crossref","is-referenced-by-count":82,"title":["COVID-19 vaccination and Guillain-Barr\u00e9 syndrome: analyses using the National Immunoglobulin Database"],"prefix":"10.1093","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0799-2703","authenticated-orcid":false,"given":"Ryan Y S","family":"Keh","sequence":"first","affiliation":[{"name":"MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust , London , UK"},{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust , Manchester , UK"}]},{"given":"Sophie","family":"Scanlon","sequence":"additional","affiliation":[{"name":"Medicines and Healthcare products Regulatory Agency , UK"}]},{"given":"Preeti","family":"Datta-Nemdharry","sequence":"additional","affiliation":[{"name":"Medicines and Healthcare products Regulatory Agency , UK"}]},{"given":"Katherine","family":"Donegan","sequence":"additional","affiliation":[{"name":"Medicines and Healthcare products Regulatory Agency , UK"}]},{"given":"Sally","family":"Cavanagh","sequence":"additional","affiliation":[{"name":"NHS England & Improvement (NHSEI), National Health Service , London , UK"}]},{"given":"Mark","family":"Foster","sequence":"additional","affiliation":[{"name":"Medical Data Solutions and Services , Ardwick, Manchester , UK"}]},{"given":"David","family":"Skelland","sequence":"additional","affiliation":[{"name":"NHS Arden and Greater East Midlands (GEM) Commissioning Support Unit (CSU) , Warwick , UK"}]},{"given":"James","family":"Palmer","sequence":"additional","affiliation":[{"name":"NHS England & Improvement (NHSEI), National Health Service , London , UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-7972","authenticated-orcid":false,"given":"Pedro M","family":"Machado","sequence":"additional","affiliation":[{"name":"MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust , London , UK"},{"name":"Institute of Neurology, University College London , London , UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2102-6053","authenticated-orcid":false,"given":"Stephen","family":"Keddie","sequence":"additional","affiliation":[{"name":"MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust , London , UK"},{"name":"Institute of Neurology, University College London , London , UK"},{"name":"Department of Neurology, The Royal London Hospital, Barts Health NHS Trust , London , UK"}]},{"given":"Aisling S","family":"Carr","sequence":"additional","affiliation":[{"name":"MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust , London , UK"},{"name":"Institute of Neurology, University College London , London , UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3174-6027","authenticated-orcid":false,"given":"Michael P","family":"Lunn","sequence":"additional","affiliation":[{"name":"MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust , London , UK"},{"name":"Institute of Neurology, University College London , London , UK"}]},{"name":"BPNS\/ABN COVID-19 Vaccine GBS Study Group","sequence":"additional","affiliation":[]},{"given":"Hadi","family":"Manji","sequence":"additional","affiliation":[]},{"given":"Tim","family":"Lavin","sequence":"additional","affiliation":[]},{"given":"James B","family":"Lilleker","sequence":"additional","affiliation":[]},{"given":"David","family":"Gosal","sequence":"additional","affiliation":[]},{"given":"Robert DM","family":"Hadden","sequence":"additional","affiliation":[]},{"given":"Taylor","family":"Watson-Fargie","sequence":"additional","affiliation":[]},{"given":"Kathryn","family":"Brennan","sequence":"additional","affiliation":[]},{"given":"Andreas","family":"Themistocleous","sequence":"additional","affiliation":[]},{"given":"Jacquie","family":"Deeb","sequence":"additional","affiliation":[]},{"given":"Ana","family":"Romeiro","sequence":"additional","affiliation":[]},{"given":"Puja R","family":"Mehta","sequence":"additional","affiliation":[]},{"given":"Dimitri","family":"Kullmann","sequence":"additional","affiliation":[]},{"given":"James","family":"Miller","sequence":"additional","affiliation":[]},{"given":"Amar","family":"Elsaddig","sequence":"additional","affiliation":[]},{"given":"Adam","family":"Molyneux","sequence":"additional","affiliation":[]},{"given":"Plamen","family":"Georgiev","sequence":"additional","affiliation":[]},{"given":"Aaron","family":"Ben-Joseph","sequence":"additional","affiliation":[]},{"given":"James","family":"Holt","sequence":"additional","affiliation":[]},{"given":"Jacob","family":"Roelofs","sequence":"additional","affiliation":[]},{"given":"Fadi","family":"Alkufri","sequence":"additional","affiliation":[]},{"given":"David","family":"Allen","sequence":"additional","affiliation":[]},{"given":"Simon","family":"Shields","sequence":"additional","affiliation":[]},{"given":"Stephen","family":"Murphy","sequence":"additional","affiliation":[]},{"given":"Harri","family":"Sivasathiaseelan","sequence":"additional","affiliation":[]},{"given":"Richard","family":"Sylvester","sequence":"additional","affiliation":[]},{"given":"Abdul","family":"Al-Saleh","sequence":"additional","affiliation":[]},{"given":"Rhys","family":"Roberts","sequence":"additional","affiliation":[]},{"given":"Kannan","family":"Nithi","sequence":"additional","affiliation":[]},{"given":"Lahiru","family":"Handdunnethi","sequence":"additional","affiliation":[]},{"given":"Kate","family":"Wannop","sequence":"additional","affiliation":[]},{"given":"Amit","family":"Batla","sequence":"additional","affiliation":[]},{"given":"Anna","family":"Sadnicka","sequence":"additional","affiliation":[]},{"given":"Jananee","family":"Sivaganasundaram","sequence":"additional","affiliation":[]},{"given":"Tatyana","family":"Yermakova","sequence":"additional","affiliation":[]},{"given":"Ravi","family":"Dasari","sequence":"additional","affiliation":[]},{"given":"Graziella","family":"Quattrocchi","sequence":"additional","affiliation":[]},{"given":"Harriet","family":"Ball","sequence":"additional","affiliation":[]},{"given":"Rebecca","family":"Cooper","sequence":"additional","affiliation":[]},{"given":"Daniel","family":"Whittam","sequence":"additional","affiliation":[]},{"given":"Mohanned","family":"Mustafa","sequence":"additional","affiliation":[]},{"given":"Gabriel","family":"Yiin","sequence":"additional","affiliation":[]},{"given":"Shayan","family":"Ashjaei","sequence":"additional","affiliation":[]},{"given":"Andrew J","family":"Westwood","sequence":"additional","affiliation":[]},{"given":"Michelle","family":"Dsouza","sequence":"additional","affiliation":[]},{"given":"Eng Chuan","family":"Foo","sequence":"additional","affiliation":[]},{"given":"Shwe Zin","family":"Tun","sequence":"additional","affiliation":[]},{"given":"Khine Khine","family":"Lwin","sequence":"additional","affiliation":[]},{"given":"Gorande","family":"Kanabar","sequence":"additional","affiliation":[]}],"member":"286","published-online":{"date-parts":[[2022,2,18]]},"reference":[{"issue":"9","key":"2023021318514540500_awac067-B1","first-page":"932","article-title":"Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives","volume":"92","author":"Rogers","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2023021318514540500_awac067-B2","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S1474-4422(20)30109-5","article-title":"Guillain-Barr\u00e9 syndrome associated with SARS-CoV-2 infection: causality or coincidence?","volume":"19","author":"Zhao","year":"2020","journal-title":"Lancet Neurol"},{"key":"2023021318514540500_awac067-B3","doi-asserted-by":"crossref","first-page":"2574","DOI":"10.1056\/NEJMc2009191","article-title":"Guillain\u2013Barr\u00e9 syndrome associated with SARS-CoV-2","volume":"382","author":"Toscano","year":"2020","journal-title":"N Engl J Med"},{"issue":"2","key":"2023021318514540500_awac067-B4","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1093\/brain\/awaa433","article-title":"Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barr\u00e9 syndrome","volume":"144","author":"Keddie","year":"2021","journal-title":"Brain"},{"issue":"2","key":"2023021318514540500_awac067-B5","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1111\/jns.12439","article-title":"Guillain-Barr\u00e9 syndrome decreases in Singapore during the COVID-19 pandemic","volume":"26","author":"Umapathi","year":"2021","journal-title":"J Peripher Nerv Syst"},{"issue":"6","key":"2023021318514540500_awac067-B6","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1093\/oxfordjournals.aje.a113809","article-title":"An epidemiologic and clinical evaluation of Guillain-Barr\u00e9 syndrome reported in association with the administration of swine influenza vaccines","volume":"119","author":"Langmuir","year":"1984","journal-title":"Am J Epidemiol"},{"issue":"9876","key":"2023021318514540500_awac067-B7","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0140-6736(12)62189-8","article-title":"Association between Guillain-Barr\u00e9 syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis","volume":"381","author":"Salmon","year":"2013","journal-title":"Lancet"},{"issue":"43","key":"2023021318514540500_awac067-B8","doi-asserted-by":"crossref","first-page":"6543","DOI":"10.1016\/j.vaccine.2019.08.045","article-title":"Surveillance for Guillain-Barr\u00e9 syndrome after 2015-2016 and 2016-2017 influenza vaccination of Medicare beneficiaries","volume":"37","author":"Arya","year":"2019","journal-title":"Vaccine"},{"key":"2023021318514540500_awac067-B9","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1056\/NEJMe2106315","article-title":"SARS-CoV-2 vaccine\u2013induced immune thrombotic thrombocytopenia","volume":"384","author":"Cines","year":"2021","journal-title":"N Engl J Med"},{"issue":"12","key":"2023021318514540500_awac067-B10","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1001\/jama.2021.13443","article-title":"Myocarditis and pericarditis after vaccination for COVID-19","volume":"326","author":"Diaz","year":"2021","journal-title":"JAMA"},{"issue":"44","key":"2023021318514540500_awac067-B11","doi-asserted-by":"crossref","first-page":"6760","DOI":"10.1016\/j.vaccine.2019.08.087","article-title":"Adverse events following adenovirus type 4 and type 7 vaccine, live, oral in the Vaccine Adverse Event Reporting System (VAERS), United States, October 2011-July 2018","volume":"37","author":"McNeil","year":"2019","journal-title":"Vaccine"},{"key":"2023021318514540500_awac067-B12","author":"Foster"},{"key":"2023021318514540500_awac067-B13"},{"key":"2023021318514540500_awac067-B14","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1093\/brain\/awy232","article-title":"Regional variation of Guillain-Barre\u00b4 syndrome","volume":"141","author":"Doets","year":"2018","journal-title":"Brain"},{"issue":"3","key":"2023021318514540500_awac067-B15","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.vaccine.2010.06.003","article-title":"Guillain-Barr\u00e9 syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data","volume":"29","author":"Sejvar","year":"2011","journal-title":"Vaccine"},{"key":"2023021318514540500_awac067-B16","author":"StataCorp","year":"2019","journal-title":"Stata Statistical Software: Release 16"},{"key":"2023021318514540500_awac067-B17","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2020"},{"issue":"2","key":"2023021318514540500_awac067-B18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1159\/000184748","article-title":"The epidemiology of Guillain-Barr\u00e9 syndrome worldwide. A systematic literature review","volume":"32","author":"McGrogan","year":"2009","journal-title":"Neuroepidemiology"},{"key":"2023021318514540500_awac067-B19"},{"key":"2023021318514540500_awac067-B20"},{"issue":"11","key":"2023021318514540500_awac067-B21","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1001\/jamaneurol.2021.3287","article-title":"Rate of recurrent guillain-barr\u00e9 syndrome after mRNA COVID-19 vaccine BNT162b2","volume":"78","author":"David","year":"2021","journal-title":"JAMA Neurol"},{"issue":"8","key":"2023021318514540500_awac067-B22","first-page":"e17602","article-title":"Bilateral facial nerve palsy and COVID-19 vaccination: causation or coincidence?","volume":"13","author":"Mason","year":"2021","journal-title":"Cureus"},{"issue":"3","key":"2023021318514540500_awac067-B23","doi-asserted-by":"crossref","first-page":"404","DOI":"10.3390\/neurolint13030040","article-title":"A novel case of bifacial diplegia variant of guillain-barr\u00e9 syndrome following janssen COVID-19 vaccination","volume":"13","author":"Prasad","year":"2021","journal-title":"Neurol Int"},{"key":"2023021318514540500_awac067-B24","doi-asserted-by":"crossref","first-page":"100217","DOI":"10.1016\/j.bbih.2021.100217","article-title":"Bell\u2019s Palsy after second dose of Pfizer COVID-19 vaccination in a patient with history of recurrent Bell\u2019s palsy","volume":"13","author":"Repajic","year":"2021","journal-title":"Brain Behav Immun Health"},{"key":"2023021318514540500_awac067-B25","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/ncn3.12537","article-title":"Guillain-Barr\u00e9 syndrome following ChAdOx1 nCoV-19 COVID-19 vaccination: a case series","volume":"9","author":"James","year":"2021","journal-title":"Neurol Clin Neurosci"},{"issue":"4","key":"2023021318514540500_awac067-B26","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1212\/WNL.51.4.1110","article-title":"The spectrum of antecedent infections in Guillain-Barr\u00e9 syndrome: a case-control study","volume":"51","author":"Jacobs","year":"1998","journal-title":"Neurology"},{"key":"2023021318514540500_awac067-B27","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1038\/s41582-019-0250-9","article-title":"Diagnosis and management of Guillain\u2013Barr\u00e9 syndrome in ten steps","volume":"15","author":"Leonhard","year":"2019","journal-title":"Nat Rev Neurol"},{"issue":"12","key":"2023021318514540500_awac067-B28","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1038\/s41591-021-01556-7","article-title":"Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection","volume":"27","author":"Patone","year":"2021","journal-title":"Nat Med"}],"container-title":["Brain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/brain\/advance-article-pdf\/doi\/10.1093\/brain\/awac067\/47057028\/awac067.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/brain\/article-pdf\/146\/2\/739\/49171686\/awac067.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/brain\/article-pdf\/146\/2\/739\/49171686\/awac067.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T13:52:35Z","timestamp":1676296355000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/brain\/article\/146\/2\/739\/6532037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,18]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,18]]},"published-print":{"date-parts":[[2023,2,13]]}},"URL":"https:\/\/doi.org\/10.1093\/brain\/awac067","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.12.14.21267418","asserted-by":"object"}]},"ISSN":["0006-8950","1460-2156"],"issn-type":[{"value":"0006-8950","type":"print"},{"value":"1460-2156","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2,1]]},"published":{"date-parts":[[2022,2,18]]}}}