The US Food and Drug Administration has added Guillain-Barre Syndrome as an adverse event to look out for while receiving the Johnson and Johnson COVID-19 vaccine after over 100 cases of the paralysis were reported from the country.
While only one death has been reported, the regulator decided to include this warning in Johnson and Johnson's factsheet to ensure that people who are receiving this one-shot vaccine are aware about the side effects of the same. Doctors reported that mostly men over the age of 50 reported this paralytic disorder in a span of 42 days after receiving the shot.
The US FDA has also explained that this is a precautionary step as so far there is no causal link derived between this syndrome and the vaccine. It is also not the first time that this autoimmune disorder has been linked to vaccines. There have been earlier reports of people who received other vaccines such as the flu vaccine and developed Guillain-Barre syndrome.
What Is Guillain-Barre Syndrome?
The exact factor causing this neurological disorder has not been identified. It is recognised as an autoimmune disorder as the immune system of the body attacks the peripheral nervous system close to the brain and the spine. The immune system acts against the body and these specific nerves creating an air of weakness or reduction in function of their motor abilities.
According to the UK's National Institute of Neurological Disorders and Stroke, it is believed that at least in some cases, the body fights back assuming there is an infection from a virus or a bacterium and attacks the nerves. Although it has no definite trigger, researchers say that the antibodies created against a Campylobacter jejuni bacterial infection attacks the neurons. This bacterium normally enters the body through contaminated food and the immune system is working to fight the virus.
BOOM contacted Dr. Sunanda Anand, consultant neurologist at Nanavati Hospital, Mumbai to understand if there are any symptoms to identify GBS. "Even though categorised and reported only when there is sudden weakness in the ligaments, GBS actually has prior episodes of fever and diarrhoea which many patients do not recall," explained Dr. Anand.
Concurring with her, Dr. Rajesh Benny, neurologist, Fortis Hospital, Mumbai added, "Patients normally complain about a weakness that starts in their foot moving to the upper limbs and even loss of sensation. They tend to ignore the prior intimations of the disease."
This rare disorder is diagnosed among 3,000-6,000 people in the US every year.
Due to this disorder, many patients feel a reduction or abandonment in their reflexes along with speech issues, too.
Treatment and Recovery
Dr. Anand said that rehabilitative care along with treatment is essential to ensure that the person returns to a normal way of life. She added that India follows two types of medical therapy for the patients.
"Plasmaphoresis and IVIG (specific antibodies) are used in the treatment and have been showing effective results," stated Dr. Anand.
In the process of plasma exchange, a plastic tube (catheter) is inserted into the patient's veins for removing blood as it contains plasma. The blood cells from plasma are extracted and returned to the person. This technique seems to reduce the severity and duration of the Guillain-Barré episode. As plasma contains antibodies, the removal of plasma is efficient as it removes the antibodies that are attacking and damaging the nerves.
IVIG therapy reduces the severity as well as the episode of GBS by binding to the tyrant antibodies. Injected intravenously, the immunoglobulins dilute and nullify the effect of the antibodies destroying the nerves.
Although recovery is imminent, one in five people may face long term repercussions.
"Patients normally have a hospital stay for two weeks. First in the intensive care unit and later in a normal ward to see how they are responding to the treatment. Full recovery can be from a period of few weeks to three to six months depending on the care they take and the rehabilitative exercise they do," Dr. Benny explained.
Guillain Barre Syndrome And Vaccines
While GBS is in the news again due to it being reported among people who received the Johnson and Johnson COVID-19 vaccine, this is not the first time that any type of vaccines have been linked to the syndrome.
To study whether a new vaccine might be causing GBS, the US Centres of Disease Control and Prevention compares the usual rate of GBS to the observed rate of GBS in persons getting vaccinated. This helps to determine whether a vaccine could be causing more cases.
A study conducted by the National Academy of Medicine and published in 2003 found that during the 1976 outbreak of swine flu in the US, there were increased cases of GBS post flu vaccination. People who received the 1976 swine flu vaccine had an increased risk for developing GBS. This increased risk amounted to one additional case of GBS in every 100,000 people who got the swine flu vaccine. Although scientists have several theories about the cause, there is still no established causal link for the same.
Just like the swine flu vaccine incident, the Johnson and Johnson adenoviral COVID-19 vaccine has been reported to fuel GBS among people with males above the age of 50 being at the highest risk. However, there is no derived causal link, yet. One death and close to 100 reports of GBS compelled the US regulator to include GBS as a possible adverse side effect of the vaccine.
Both the neurologists BOOM spoke to have not come across any cases of vaccine induced GBS in Mumbai, so far.
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