Impact of the COVID-19 Pandemic and Vaccination Coverage on the Global Burden of Guillain–Barré Syndrome: A Cross-Sectional Study in 204 Countries and Territories

Abstract

Background: Guillain-Barré syndrome (GBS) is an autoimmune neurological disorder linked to certain infections and vaccinations. However, evidence regarding the global dynamics of the GBS burden during the COVID-19 pandemic is lacking. This study aims to fill this gap by providing comprehensive estimates of the burden of GBS with a particular focus on 2020 and 2021. Additionally, we explore the potential impact of vaccination on the burden of GBS. 

Methods: This study analyzed data from the Global Burden of Diseases Study 2021 and Our World in Data, using years lived with disability (YLD) to assess GBS burden as counts and age-standardized rates per 100,000. Temporal trends (1990–2019, 2019–2021) were evaluated using estimated annual percentage changes (EAPC) and Joinpoint regression. Associations between vaccination coverage and changes in GBS YLD rates were examined using univariate and multivariate generalized linear models (GLIMs) adjusted for standardized covariates. Mediation analysis quantified the indirect effect of vaccination coverage on GBS burden through COVID-19 incidence rates, with bootstrapping ensuring robust confidence interval estimation. 

Findings: Globally, the burden of GBS significantly increased during the COVID-19 pandemic, age-standardized YLD rates were 0·86 (95% UI: 0·56 to 1·24) per 100,000 people in 2020, rising to 1·75 (95% UI: 1·12 to 2·54) per 100,000 people in 2021, reflecting an EAPC of 70·35% (95% UI: 38·73 to 109·06) from 2019 to 2021. During the first two years of the pandemic, age-standardized YLD rates rose 3·7 times faster in countries with a low SDI versus countries with a high SDI (103·21% per year (95% UI: 71·10 to 141·35%) vs 28·02% per year (11·46 to 47·03)). The increase in YLD rates was more pronounced in females and younger populations aged 15-29 years. Higher vaccination coverage was significantly associated with reduced GBS burden in GLIM based on directed acyclic graph (β = -0·39, 95% CI: -0·54 to -0·25, p < 0·0001), with a non-linear pattern favoring moderate and high vaccination coverage levels. Causal mediation analysis revealed that 44.6% of the effect was mediated through reduced COVID-19 incidence, highlighting both direct and indirect benefits of vaccination against COVID-19. 

Interpretation: Predominantly driven by the surge of COVID-19 cases, the burden of GBS significantly increased during the first two years of the pandemic, especially in countries with lower SDI levels, females, and younger populations (15-29 years). Vaccination had significant benefits in controlling the post-COVID-19 GBS burden. These data are crucial for policymakers and healthcare professionals to refine management strategies and prepare for future potential epidemics. 

Note:
Bill & Melinda Gates grant number(s): Grant No. INV5 035024.

Data availability statement: The data used for the analyses are publicly available at the following URL: https://ghdx.healthdata.org/gbd-results-tool, and https://ourworldindata.org/.

Keywords: Guillain-Barré syndrome, Epidemiology, COVID-19 pandemic, Vaccination, Socio-demographic Index