Guillain-Barré Syndrome Associated with COVID-19 Vaccination.

To the Editor: With interest we read the article by Shao et al. () about the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination–associated Guillain-​Barré syndrome (SCoVaG) among 18,269 healthcare workers in Taiwan who had received the AstraZeneca vaccine (AZV; https://www.astrazeneca.com). Only 1 vaccinee experienced SCoVaG during the study period (). The study is appealing but raises concerns.

Recently, our review of 19 SCoVaG patients, for whom data were collected through June 2021, was published (). The 9 men and 10 women in the study were 20–86 years of age. All patients experienced SCoVaG after the first vaccine dose. AZV was given to 14 patients, the Pfizer-BioNTech (https://www.pfizer.com) vaccine to 4 patients, and the Johnson & Johnson (https://www.jnj.com) vaccine to 1 patient. Latency between vaccination and SCoVaG onset ranged from 3 hours to 39 days. Patients received intravenous immune globulin (n = 13), steroids (n = 3), or no therapy (n = 3). Six patients required mechanical ventilation. One patient recovered completely; 9 achieved partial recovery (). Only 1 of the studies included in our review mentioned the total number of vaccinated persons (); in that study, 7 persons among 1.2 million vaccinated persons were found to have SCoVaG ().

In addition, data on 389 patients with SCoVaG were collected in a recent review about the neurologic adverse events of SARS-CoV-2 vaccination (). However, no individual data were provided for 337 of these patients (). Among the 53 patients for whom individual data were available, AZV was given to 39 patients, Pfizer-BioNTech vaccine to 9 patients, and Johnson & Johnson vaccine to 2 patients.

For the Shao et al. report (), we wondered why the oldest healthcare worker was 86 years of age. Also missing were the specific treatment and outcome of the patient with SCoVaG.

Available data suggest that SCoVaG is a rare complication of SARS-CoV-2 vaccination, irrespective of the vaccine brand used. SCoVaG should be diagnosed early so treatment can be initiated promptly. Whether the beneficial effect of SARS-CoV-2 vaccination outweighs the risk for adverse events (e.g., Guillain-​Barré syndrome) remains a matter of discussion ().