Bell’s Palsy, an Adverse Event Following COVID Vaccines

Document Type : Systematic Review

Authors

1 Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan.

2 Department of Pediatrics and child health, Aga Khan University Hospital, Karachi, Pakistan.

3 Liaquat National Hospital and Medical College, Karachi, Pakistan.

Abstract

Introduction:
Bell’s palsy is one of the most concerning complications of the COVID vaccine that has impacted vaccine acceptance among the general population. These vaccines were introduced to provide immunity against the SARS-CoV-2 coronavirus and have been found to be quite effective. Little did we know that Bell’s palsy could be one of its serious complications.
Materials and Methods:
We used various search engines to gather data in the form of a case series and case reports related to patients who were affected by the vaccine and had developed Bell’s palsy.
Results:
A total of eleven case reports and 4 case series were included in the analysis. The vaccines mentioned in the case reports were Pfizer, Moderna, Sinovac, AstraZeneca, and Janssen, while the case series included Pfizer and Sinovac. The majority of patients were female and aged between 31-40 years. Right-sided laterality was observed in 45.45% of patients, left-sided laterality in 45.45% of patients, and bilateral laterality in 9.1% of patients. Three patients had a history of Bell’s palsy or stroke. After treatment, three patients showed partial improvement, six patients fully recovered, and the status of two patients was unknown.
Conclusions:
Bell's palsy is a rare complication that can occur after receiving the COVID-19 vaccine. This review aims to increase awareness about this rare adverse event of the vaccine so that it can be properly addressed and managed. Additionally, it will serve as a foundation for future research on the administration of the COVID-19 vaccine.

Keywords

Main Subjects

References

  1. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021; 384:403-16.
  2. Schoenmaker L, Witzigmann D, Kulkarni JA, Verbeke R, Kersten G, Jiskoot W, et al. mRNA-lipid nanoparticle COVID-19 vaccines: Structure and stability. IntJ Pharm 2021; 601:120586.
  3. Shahcheraghi SH, Ayatollahi J, Aljabali AA, Shastri MD, Shukla SD, Chellappan DK, et al. An overview of vaccine development for COVID-19. Ther Deliv 2021; 12(3):235-44.
  4. Wang J, Peng Y, Xu H, Cui Z, Williams RO. The COVID-19 vaccine race: challenges and opportunities in vaccine formulation. AAPS PharmSciTech 2020; 21(6):1-2.
  5. Hanley KA. The double-edged sword: How evolution can make or break a live-attenuated virus vaccine. Evo Edu Outreach 2011; 4(4):635-43.
  6. Mahase E. Covid-19: AstraZeneca vaccine is not linked to increased risk of blood clots, finds European Medicine Agency. BMJ 2021; 372: n774.
  7. Cirillo N. Reported orofacial adverse effects of COVID‐19 vaccines: The knowns and the unknowns. J Oral Pathol Med 2021; 50(4):424-7.
  8. Menni C, Klaser K, May A, Polidori L, Capdevila J, Louca P, et al. Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. Lancet Infect Dis 2021; 21(7):939-49.
  9. Repajic M, Lai XL, Xu P, Liu A. Bell’s Palsy after second dose of Pfizer COVID-19 vaccination in a patient with history of recurrent Bell’s palsy. BBI-Health 2021; 13:100217.
  10. Wan EY, Chui CS, Lai FT, Chan EW, Li X, Yan VK, et al. Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study. Lancet Infect Dis 2022; 22(1):64-72.
  11. Tamaki A, Cabrera CI, Li S, Rabbani C, Thuener JE, Rezaee RP, et al. Incidence of Bell palsy in patients with COVID-19. JAMA Otolaryngol Head Neck Surg 2021; 147(8):767-8.
  12. Iftikhar H, Noor SM, Masood M, Bashir K. Bell’s palsy after 24 hours of mRNA-1273 SARS-CoV-2 vaccine. Cureus 2021; 13(6) e15935.
  13. Martin-Villares C, Vazquez-Feito A, Gonzalez-Gimeno MJ, de la Nogal-Fernandez B. Bell’s palsy following a single dose of mRNA SARS-CoV-2 vaccine: a case report. J Neurol 2021; 269(1):47-8.
  14. Obermann M, Krasniqi M, Ewers N, Fayad J, Haeberle U. Bell’s palsy following COVID-19 vaccination with high CSF antibody response. Neurol Sci 2021; 42(11):4397-9.
  15. Nishizawa Y, Hoshina Y, Baker V. Bell’s palsy following the Ad26. COV2. S COVID-19 vaccination. QJM: Int J Med 2021; 657-8.
  16. Burrows A, Bartholomew T, Rudd J, Walker D. Sequential contralateral facial nerve palsies following COVID-19 vaccination first and second doses. BMJ Case Rep 2021; 14(7):e243829.
  17. Colella G, Orlandi M, Cirillo N. Bell’s palsy following COVID-19 vaccination. J Neurol 2021; 268(10):3589-91.
  18. Yu BY, Cen LS, Chen T, Yang TH. Bell’s palsy after inactivated COVID-19 vaccination in a patient with history of recurrent Bell’s palsy: A case report. World J Clin Cases 2021; 9(27):8274-9.
  19. Pothiawala S. Bell’s Palsy after Second Dose of Moderna COVID-19 Vaccine: Coincidence or Causa- tion?Acta medica Lituanica 2021;28(2):298-301.
  20. Corrêa DG, Cañete LA, Dos Santos GA, de Oliveira RV, Brandão CO, da Cruz Jr LC. Neurological symptoms and neuroimaging alterations related with COVID-19 vaccine: Cause or coincidence? Clin. Imaging 2021; 80:348-52.
  21. Cellina M, D'Arrigo A, Floridi C, Oliva G, Carrafiello G. Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report. Clin. Imaging 2022; 82:1-4.
  22. Shemer A, Pras E, Hecht I. Peripheral facial nerve palsy following BNT162b2 (COVID-19) vaccination. Isr Med Assoc. J 2021:142-3. PMID: 33734623
  23. Shemer A, Pras E, Einan-Lifshitz A, Dubinsky-Pertzov B, Hecht I. Association of COVID-19 vaccination and facial nerve palsy: a case-control study. JAMA Otolaryngol Head Neck Surg 2021; 147(8):739-43.
  24. El-Shitany NA, Harakeh S, Badr-Eldin SM, Bagher AM, Eid B, Almukadi H, et al. Minor to moderate side effects of Pfizer-BioNTech COVID-19 vaccine among Saudi residents: a retrospective cross-sectional study. Int J Gen Med 2021; 14:1389-1401.
  25. Saeed BQ, Al-Shahrabi R, Alhaj SS, Alkokhardi ZM, Adrees AO. Side effects and perceptions following Sinopharm COVID-19 vaccination. Int J Infect Dis 2021; 111:219-26.
  26. Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013; 149(1_suppl): S1-35.
  27. Eviston TJ, Croxson GR, Kennedy PG, Hadlock T, Krishnan AV. Bell's palsy: aetiology, clinical features, and multidisciplinary care. J Neurol Neurosurg Psychiatry 2015; 86(12):1356-61.
  28. Rath B, Gidudu JF, Anyoti H, Bollweg B, Caubel P, Chen YH, et al. Facial nerve palsy including Bell's palsy: case definitions and guidelines for collection, analysis, and presentation of immunisation safety data. Vaccine 2017; 15(35):1972-83.
  29. Sadoff J, Gray G, Vandebosch A, Cardenas V, Shukarev G, Grinsztejn B, et al. Safety and efficacy of single-dose Ad26. COV2. S vaccine against COVID-19. N Engl J Med 2021, 384(23): 2187-201.
  30. Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet 2011; 378(9790):526-35.
  31. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020; 383:2603-15.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Wong CK, Lau KT, Xiong X, Au IC, Lai FT, Wan EY, et al. Adverse events of special interest and mortality following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines in Hong Kong: A retrospective study. PLoS Med 2022; 19(6):e1004018.
  2. Soeiro T, Salvo F, Pariente A, Grandvuillemin A, Jonville-Béra AP, Micallef J. Type I interferons as the potential mechanism linking mRNA COVID-19 vaccines to Bell's palsy. Therapie 2021; 76(4): 365-7.
  3. Desai UG. Myasthenia Gravis Exacerbation Following Second Dose of mRNA-1273 Vaccine. RRNMF Neuromuscular Journal 2021; 2(2):46-7.
  4. Nanatsue K, Takahashi M, Itaya S, Abe K, Inaba A. A case of Miller Fisher syndrome with delayed onset peripheral facial nerve palsy after COVID-19 vaccination: a case report. BMC Neurol 2022;22(1):1-5.
  5. Abičić A, Adamec I, Habek M. Miller Fisher syndrome following Pfizer COVID-19 vaccine. Neurol Sci 2022; 43(3):1495-7.
Iranian Journal of Otorhinolaryngology
Volume 36, Issue 4
July and August 2024
Pages 527-535

Files

Share

How to cite

Statistics