You pose a very difficult question. I would normally say, without hesitation, that former GBS patients should get vaccinated but having had what certainly sounds like neuropathic symptoms following the initial dose does give one pause. I think you need to bear in mind that every decision any doctor makes is a calculated assessment of risk versus benefit. If one has a life-threatening illness a life-threatening treatment may be justified but a risky treatment for a trivial illness would not. In the case of all vaccinations, the risk from getting the disease is 100’s to 1000’s times greater than the risk from getting the vaccine. I think in your case the balance is still in favour of giving the 2nd dose. Every study has shown that the risk of the vaccines triggering an initial attack or a recurrence of GBS, particularly with the Pfizer vaccine, is extremely small, Conversely, the risk of getting GBS following COVID infection, while still very small, is many times greater than any risk attached to the vaccine. With the delta variant inching farther south every day, and with it’s extremely high infectivity we know it is only a matter of time before it gets to Palmerston North. I am pleased that you have clearly given this issue a lot of thought and have already discussed it with your GP and a local neurologist and that they concur with my thoughts. You are already past the recommended 3 week inter-vaccine interval and there is some attraction in your suggestion that you delay the 2nd dose a little – let’s say until 6 weeks. I do not think there is merit in taking a lower dose. I wish there was some data on which to base my recommendation but, as you point out, neither the Israeli study nor any of the other studies specifically address the issue that you raise. Good luck with making this very difficult decision.
Unfortunately, I have no simple answer. Residual pain after GBS is not rare, affecting about 40% of patients. It is unusual for it to be as severe as you describe but certainly can happen. The good news is that it usually improves over time and, until it does, there are a number of treatments that can take the edge of the pain. You need to be insistent with your GP that follow-up with neurology is needed.
There is very little information about the risk of the Pfizer (or any other vaccine for that matter) specific to CIDP. There no reports that I have been able to find indicating that these vaccines precipitate worsening in CIDP. There is abundant evidence that the Pfizer vaccine is safe for people who have had GBS and, by analogy, we would expect it to be safe for people with CIDP. What is clear is that the risk of COVID infection is several orders of magnitude greater than any risk that might attach to the vaccines. I strongly recommend that you get vaccinated. Please discuss this with your GP and, if possible, with the neurologist who is treating your CIDP.
I am sorry but this request is beyond the scope of the Medical Advisory Board. It could be seen as getting involved with the care of another doctor’s patient. I can say that having had GBS is not a reason not to get the COVID vaccine and that the severity of previous GBS does not increase the risk of getting vaccinated.