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

Patone, M. et al. (2021) Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nature Medicine, 27(12), pp. 2144-2153. (doi: 10.1038/s41591-021-01556-7) (PMID:34697502) (PMCID:PMC8629105)

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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.

Item Type:Articles
Additional Information:QResearch has been supported by funding from the National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford, grants from John Fell Oxford University Press Research Fund, grants from Cancer Research UK (CR-UK) (grant number C5255/A18085) through the Cancer Research UK Oxford Centre, grants from the Oxford Wellcome Institutional Strategic Support Fund (204826/Z/16/Z) and other research councils, during the conduct of the study. NHS Digital and PHE bear no responsibility for the analysis or interpretation of the data. This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office For National Statistics and funded by UK Research and Innovation (grant ref. MC_PC_20029). K.K. is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC-EM) and NIHR Lifestyle BRC. S.V.K. is supported by an NRS Senior Clinical Fellowship (SCAF/15/02), the UK Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). L.H. is supported by an NIHR-funded clinical lectureship (CL-2019-13-001).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Razvi, Dr Saif
Authors: 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., and Hippisley-Cox, J.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
Journal Name:Nature Medicine
Publisher:Nature Research
ISSN:1078-8956
ISSN (Online):1546-170X
Published Online:25 October 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Nature Medicine 27(12): 2144-2153
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
Inequalities in healthMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
Office of the Chief Scientific Adviser (CSO)SPHSU17