Reports of Guillain-Barré Syndrome following adenovirus vector COVID-19 vaccines

Advisory Alert

July 30, 2021

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To: Local Health System Partners

FOR IMMEDIATE ATTENTION

Rare reports of Guillain-Barré Syndrome following vaccination with adenovirus vector COVID-19 vaccines.

Guillain-Barré Syndrome (GBS) is a rare immune system disorder that results in muscle weakness, pain or numbness, and, in more severe cases, paralysis. GBS could result from different causes, including infections, and occurs more frequently in males and persons over 50 years old. Cases may occur coincidentally following vaccination.

Rare cases of GBS have been reported following vaccinations with adenovirus vector COVID-19 vaccines.

On July 26, the World Health Organization released a statement on increased reports of GBS following adenovirus vector vaccines reported from Europe, the United States, and abroad.

Current Canadian data from the Public Health Agency of Canada, reports a total of 48 cases of GBS following COVID-19 vaccination, 25 cases occurring among individuals who received COVISHIELD/AstraZeneca vaccines (0.91 reports per 100,000 doses administered).

Preliminary analysis shows the rate of GBS following COVISHIELD/AstraZeneca COVID-19 vaccination is higher than the rate of GBS following Pfizer-BioNTech or Moderna vaccination. As well, the number of cases of GBS following COVISHIELD/AstraZeneca vaccination are higher than would normally be expected in the general population.

Among the 25 reports of GBS following COVISHIELD/AstraZeneca vaccines:

• Symptom onset was between 3 and 25 days after vaccination.
• Median age was 56 years (age range 40 to 77 years old).
• 19 were males [median age 57 years (age range 40 to 66 years old)], 5 were females [median age 51 years (age range 40 to 77 years old)], and the age and sex of one was unspecified.
• 16 reports following the first vaccine dose, and the dose number for 9 were unspecified.

Based on this information, please consider the following recommendations for your clinical practice:

• Have an increased index of suspicion of possible GBS in patients presenting to you with signs and symptoms compatible with the syndrome post vaccination to allow for early diagnosis and treatment. Symptoms may include weakness/tingling and paralysis in the extremities that may progress to other parts of the body including the chest and face. Other symptoms may include difficulty with eye muscles and vision; difficulty swallowing, speaking or chewing; pain that can be severe (particularly at night); coordination problems and unsteadiness; abnormal health rate or blood pressure; and problems with digestion and/or bladder control.

• Alert any patients receiving AstraZeneca COVID-19 vaccine to signs and symptoms of GBS and advise them to seek prompt medical attention should these develop. Most people fully recover from GBS.
• Continue to monitor for and report all adverse events, including GBS, among patients receiving COVID-19 vaccines.

The potential benefits of adenovirus viral vector COVID-19 vaccines continue to outweigh any potential risk of GBS, particularly given the increase in the more transmissible Delta (B.1.617.2) variant.

We will continue to share information on COVID-19 vaccine safety as it is received. Please contact the immunization program at 705.522.9200, ext. 458 or toll-free 1.866.522.9200 with any questions you may have.

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

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This item was last modified on July 30, 2021