3.3 The exacerbation pooled incidence rate of post-vaccination adverse events in different neuroimmune diseases.
23 (82.1%) studies reported an exacerbation of pre-existing ANC post-vaccination .The pooled incidence rate of exacerbation of pre-existing disease in ANC patients following COVID-19 vaccination was calculated to be 0.05(95%CI,0.04–0.07,I² = 84%) (Fig.3-bottom panel ). Subgroup analysis by disease type showed that the pooled incidence rate of MS exacerbation after vaccination was the lowest at 0.05 (95% CI, 0.03-0.07, I² = 89%). MG and NMOSD of (95% CI, 0.05-0.10, I² = 0%), and 0.06 (95% CI, 0.05-0.08, I² = 32%), respectively(Fig.4 );Subgroup analysis by vaccination dose showed that the incidence of exacerbation of pre-existing disease was the lowest after the first dose, 0.04 (95% CI, 0.02 – 0.05, I² = 77%), and was basically the same after the second dose and the third dose, 0.07 (95% CI, 0.04 – 0.11, I² = 67%) and 0.07 (95% CI, 0.04 – 0.10, I² = 0%)(Fig5 ); Subgroup analysis by vaccine type showed that the incidence of pre-existing disease exacerbations was 0.06 (95% CI, 0.04–0.08, I² = 83%) after mRNA vaccination, 0.04 (95% CI, 0.00–0.10, I² = 94%) for inactivated vaccines, and 0.06 (95% CI, 0.02–0.09, I² = 79%) for mixed vaccines(Fig6 ). Four (14.3%) studies reported post-vaccination neurologic adverse events, with a pooled incidence of 0.11 (95% CI, 0.01 – 0.21, I² = 96%) (Fig.3-Top Panel ).