Risk of Guillain-Barré Syndrome After COVID-19 Vaccination Following COVID-19 Infection
There is no evidence that receiving a scheduled COVID-19 vaccine after having COVID-19 increases the risk of Guillain-Barré Syndrome (GBS). In fact, guidelines recommend that patients with previous COVID-19 infection should still receive a full vaccination program.
Evidence-Based Recommendations
Vaccination After COVID-19 Infection
- Patients with previous SARS-CoV-2/COVID-19 infection should be vaccinated with a full program 1
- This recommendation applies to both general patients and those with hematological malignancies or who have undergone hematopoietic stem cell transplantation 1
- The European Conference on Infections in Leukemia (ECIL 9) gives this recommendation a strong evidence grade of AIItu 1
GBS Risk Assessment
- While there have been isolated case reports of GBS following COVID-19 vaccination 2, 3, 4, 5, these represent temporal associations rather than proven causality
- The risk of GBS following COVID-19 vaccines appears to be lower than the risk following influenza vaccines 3
- A systematic review found only 29 reported cases of GBS following COVID-19 vaccination worldwide, with an average onset of 14.4 days after vaccination 6
Special Populations and Considerations
Patients with Neurological Disorders
- For patients with pre-existing neurological conditions, including GBS, vaccination against COVID-19 is still vital due to their increased risk of severe COVID-19 infection 1
- Patients with autoimmune neurological disorders should be vaccinated, with timing considerations around their disease-modifying therapies 7
Immunocompromised Patients
- Cancer patients and those with rheumatic diseases should receive COVID-19 vaccination regardless of prior COVID-19 infection 1, 7
- The American College of Rheumatology states that the benefit of COVID-19 vaccination outweighs the potential risk for new-onset autoimmunity 1
Clinical Approach to Vaccination After COVID-19
Timing:
- No specific waiting period is required between COVID-19 recovery and vaccination
- Vaccination can proceed once the patient has recovered from acute illness and isolation period has ended
Monitoring:
- Normal post-vaccination monitoring is sufficient
- Be aware of rare potential neurological symptoms (ascending weakness, paresthesias) but do not expect increased risk
Patient Education:
- Reassure patients that having had COVID-19 does not increase their risk of GBS after vaccination
- Explain that the benefits of vaccination (prevention of severe disease) outweigh the extremely rare risk of GBS
Conclusion
The current evidence does not support an increased risk of GBS when COVID-19 vaccination follows COVID-19 infection. Multiple guidelines strongly recommend complete vaccination regardless of prior infection history. The extremely rare cases of GBS following vaccination appear to be independent of prior COVID-19 status and are far outweighed by the benefits of vaccination in preventing severe COVID-19 outcomes.