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Voices: I’m a doctor doing research in facial paralysis – let me tell you about Justin Bieber

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Justin Bieber recently posted a video on his Instagram account to his 241 million followers, explaining he had been diagnosed with a condition called Ramsay Hunt Syndrome. He went on to show how half of his face had been paralysed. Soon after, some people online started blaming the Covid vaccine, suggesting his experience could be a side effect of the jab.

I’m an NHS surgeon specialising in facial paralysis research. If you’re wondering what the scientific evidence is for this claim, I’m about to tell you.

Ramsay Hunt Syndrome is caused by the reactivation of a virus called the Varicella Zoster Virus (VZV); the same virus that causes chickenpox and shingles. It remains in the body in a latent or “idle” state once the infection has cleared, but can “reactivate” following a trigger – like trauma, fever, stress or a weakened immune system.

If this happens, it can lead to inflammation of the facial nerve that supplies the muscles of the face – this is what Bieber is talking about in his video. It can also be associated with rash or blisters around the ear, facial weakness on the affected side, difficulty closing the eye, a loss of facial expression, pain in the ear or face, hearing loss and ringing in the ear.

But people with symptoms like Bieber’s shouldn’t lose hope – prompt treatment (within 72 hours) with antiviral medication, steroid and pain killers can help. Many people (70 per cent) have a full recovery if treatment is started early.

So, what about rumours that the Covid vaccine is to blame? Well, during clinical trials of mRNA vaccines, facial paralysis was observed in only seven cases out of 35,654 people (0.020%) in the vaccine group – and just one single case out of 35,611 people (0.003%) in the group that had a placebo (an “inactive” vaccine shot, designed to act as a control substance to allow scientists to study the differing effects). Despite suggestions of an association between the Covid vaccine and activation of the VZV virus – which can cause facial paralysis – as yet, no causal link or relationship has been found.

A team of researchers from the Pharmacovigilance Department, in Grenoble Alpes University Hospital in France, looked into 133,883 reported cases of adverse drug reactions reported with Covid vaccines in the World Health Organisation (WHO) database. They found an extremely low number (0.6 per cent) of cases of facial paralysis-related events.

More than 320 million Covid vaccines were administered at the time this study was carried out, and the rate of facial paralysis reported was not any higher than that of other viral and influenza/flu vaccines. And, while there have been reports of isolated facial paralysis reported for decades with almost all viral vaccines – cases such as Bieber’s – no studies have established a higher risk of facial paralysis after vaccination.

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I have looked at the latest research in light of Bieber’s experience and can tell you that a study published just last month found no significant evidence that Covid vaccination was associated with increased risk of VZV viral infection. An earlier review reached a similar conclusion.

Large scale studies are needed to establish if there is any link between Covid vaccines and facial paralysis caused by VZV infection, but – as any doctor will tell you – the importance of vaccines to end the pandemic is paramount.

To summarise: the current scientific evidence shows that getting this kind of VZV infection is rare and the risk is low, similar to the risk from other viral vaccines. But it should be promptly recognised, managed and reported.

Dr Ankur Khajuria is an NHS doctor and academic researcher

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