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

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., Hunt, D., Mei, X. W., Dixon, S., Zaccardi, F., Khunti, K., Watkinson, P., Coupland, C. A. C., Doidge, J., Harrison, D. A., Ravanan, R., Sheikh, A., Robertson, C., & 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