medRxiv : the preprint server for health sciencesJul 17, 2026

COVID-19 mRNA Vaccines May Lower the Risk of Guillain-Barré Syndrome in a Large Long-Term Study

mRNA Technology Weekly Brief ↗PubMed ↗DOI ↗

Updated Jul 18, 2026

Abstract

COVID-19 vaccination is associated with a 61% lower 30-day risk of Guillain-Barré syndrome compared to unvaccinated and uninfected individuals.

COVID-19 infection is linked to an increased occurrence of Guillain-Barré syndrome.
The significant reduction in GBS risk was primarily observed in individuals receiving mRNA vaccines.
Recipients of the mRNA vaccine BNT162b2 showed a risk ratio of 0.38, while mRNA-1273 recipients had a risk ratio of 0.24.
No protective effect against GBS was found in individuals who received adenoviral-vector vaccines.
Prior COVID-19 vaccination also correlated with a decreased risk of GBS associated with COVID-19 infection.
Additional risk factors for GBS include sex, the number of vaccine doses, and pre-existing health conditions such as stroke and autoimmune diseases.

Simplified

The association between COVID-19 vaccination and Guillain-Barré syndrome (GBS) has been previously investigated with inconsistent results, largely due to limited data and lack of concurrent controls. To address this problem, a large longitudinal cohort study was conducted using National COVID Cohort Collaborative (N3C) data. While COVID-19 infection was associated with increased GBS occurrence, COVID-19 vaccination was associated with significantly reduced GBS risk relative to unexposed (unvaccinated and uninfected) control, corresponding to a 61% lower 30-day risk (incidence risk ratio: IRR = 0.39, P < 0.01), consistent with multivariable Cox regression showing a similar reduction (adjusted hazard ratio: aHR = 0.41, P < 0.01). This protective association was observed only among recipients of mRNA vaccines (BNT162b2: IRR = 0.38, P < 0.01; mRNA-1273: IRR = 0.24, P < 0.01), but not among recipients of adenoviral-vector vaccines (IRR = 1.38, P > 0.05). Prior COVID-19 vaccination also reduced infection-associated GBS risk. Additional factors associated with GBS risk included sex, vaccine dose, and pre-existing comorbidities such as stroke, neurological disorders, and autoimmune diseases. Overall, our N3C large-scale study provides evidence that COVID-19 mRNA vaccination reduces GBS risk, supporting the safety profile of mRNA vaccines and warranting further mechanistic investigation.

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COVID-19 mRNA Vaccines May Lower the Risk of Guillain-Barré Syndrome in a Large Long-Term Study

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