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Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection

Patone, Martina; Handunnetthi, Lahiru; Saatci, Defne; Pan, Jiafeng; Katikireddi, Srinivasa Vittal; Razvi, Saif; Hunt, David; Mei, Xue W.; Dixon, Sharon; Zaccardi, Francesco; Khunti, Kamlesh; Watkinson, Peter; Coupland, Carol A. C.; Doidge, James; Harrison, David A.; Ravanan, Rommel; Sheikh, Aziz; Robertson, Chris; Hippisley-Cox, Julia

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Authors

Martina Patone

Lahiru Handunnetthi

Defne Saatci

Jiafeng Pan

Srinivasa Vittal Katikireddi

Saif Razvi

David Hunt

Xue W. Mei

Sharon Dixon

Francesco Zaccardi

Kamlesh Khunti

Peter Watkinson

CAROL COUPLAND carol.coupland@nottingham.ac.uk
Professor of Medical Statistics

James Doidge

David A. Harrison

Rommel Ravanan

Aziz Sheikh

Chris Robertson

Julia Hippisley-Cox



Abstract

Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns. We undertook a self-controlled case series study to investigate hospital admissions from neurological complications in the 28 days after a first dose of ChAdOx1nCoV-19 (n = 20,417,752) or BNT162b2 (n = 12,134,782), and after a SARS-CoV-2-positive test (n = 2,005,280). There was an increased risk of Guillain–Barré syndrome (incidence rate ratio (IRR), 2.90; 95% confidence interval (CI): 2.15–3.92 at 15–21 days after vaccination) and Bell’s palsy (IRR, 1.29; 95% CI: 1.08–1.56 at 15–21 days) with ChAdOx1nCoV-19. There was an increased risk of hemorrhagic stroke (IRR, 1.38; 95% CI: 1.12–1.71 at 15–21 days) with BNT162b2. An independent Scottish cohort provided further support for the association between ChAdOx1nCoV and Guillain–Barré syndrome (IRR, 2.32; 95% CI: 1.08–5.02 at 1–28 days). There was a substantially higher risk of all neurological outcomes in the 28 days after a positive SARS-CoV-2 test including Guillain–Barré syndrome (IRR, 5.25; 95% CI: 3.00–9.18). Overall, we estimated 38 excess cases of Guillain–Barré syndrome per 10 million people receiving ChAdOx1nCoV-19 and 145 excess cases per 10 million people after a positive SARS-CoV-2 test. In summary, although we find an increased risk of neurological complications in those who received COVID-19 vaccines, the risk of these complications is greater following a positive SARS-CoV-2 test.

Citation

Patone, M., Handunnetthi, L., Saatci, D., Pan, J., Katikireddi, S. V., Razvi, S., …Hippisley-Cox, J. (2021). Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nature Medicine, 27(12), 2144-2153. https://doi.org/10.1038/s41591-021-01556-7

Journal Article Type Article
Acceptance Date Sep 24, 2021
Online Publication Date Oct 25, 2021
Publication Date Oct 25, 2021
Deposit Date Nov 1, 2021
Publicly Available Date Nov 2, 2021
Journal Nature Medicine
Print ISSN 1078-8956
Electronic ISSN 1546-170X
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 27
Issue 12
Pages 2144-2153
DOI https://doi.org/10.1038/s41591-021-01556-7
Keywords Neurological complications; COVID-19 vaccines; SARS-CoV-2 infection
Public URL https://nottingham-repository.worktribe.com/output/6605260
Publisher URL https://www.nature.com/articles/s41591-021-01556-7

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