Do Vaccines Cause Facial Nerve Palsy?

Updated November 8, 2023



Natural infections with varicella, tetanus and diphtheria have each been associated with facial nerve palsy. Thus, varicella, tetanus and diphtheria vaccines prevent facial nerve palsy by protecting against these natural infections. Vaccines currently routinely recommended to the general population in the U.S.* have not been shown to cause facial nerve palsy.

Epidemiological Evidence

The only vaccine ever confirmed to cause facial nerve palsy was Berna Biotech’s Nasalflu®, an inactivated intranasal influenza vaccine adjuvanted with E. coli heat-labile toxin which is no longer being produced. This vaccine was licensed for the 2000-2001 flu season in Switzerland and then permanently withdrawn from the market upon detection of the facial nerve palsy caused by the vaccine 1. It was never used in the United States.

The 2012 report by the Institute of Medicine (IOM) 2, now called the National Academy of Medicine (NAM), described two studies with sufficient validity and precision that both reported no association between inactivated influenza vaccine and facial nerve palsy 3,4. The report also described one study assessing an association between acellular pertussis vaccination and facial nerve palsy 5; however, this study did not provide convincing evidence due to a lack of validity and precision 2. Most studies published since the 2012 IOM report have also reported no association between vaccination and facial nerve palsy 6-8; however, a 2017 self-controlled case-series analysis of a California cohort did find a temporal association between receipt of meningococcal conjugate vaccine concomitantly with other vaccines and facial nerve palsy 9. A 2017 South Korean nationwide cohort study found no associations between HPV vaccination and 33 predefined serious adverse events (including facial nerve palsy) 10. A 2020 systematic review and meta-analysis found no association between HPV vaccines and many autoimmune or other rare diseases (including facial nerve palsy) 11.

Analyses of safety surveillance data from the Vaccine Safety Datalink found no significant associations between mRNA COVID-19 vaccines and 23 serious health outcomes (including facial nerve palsy) 12. Two Israeli studies found no association between Comirnaty, the Pfizer-BioNTech COVID-19 vaccine, and facial nerve palsy 13,14. A Hong Kong case-control study found an increased risk of facial nerve palsy after vaccination with CoronaVac, an inactivated COVID-19 vaccine not used in the US (aOR:  2.4; 95% CI: 1.4-4.0), but found no significant association with Comirnaty (aOR:  1.8; 95% CI: 0.9-3.5) 15. A self-controlled case series using a national English database found an increased risk of facial nerve palsy 15-21 days after vaccination with ChAdOx1nCoV-19, a viral vector COVID-19 vaccine not used in the US (IRR: 1.29; 95% CI: 1.08-1.56), but found no significant association with Comirnaty 16.

Proposed Biological Mechanism

Known causes of facial nerve palsy include infections due to Borrelia burgdorferi, the agent of Lyme disease, and zoster virus in Ramsay-Hunt syndrome. Infections with Clostridium tetani or Corynebacterium diphtheria have been associated with facial nerve palsy as well, albeit very rarely 2. Although other viral infections such as herpes simplex virus (HSV) and varicella zoster virus (VZV) have also been associated with facial nerve palsy 17-20, the pathogenesis of facial nerve palsy remains poorly understood. Hypotheses include reactivation of latent viral infections in facial nerve ganglia 21 or an autoimmune mechanism possibly with segmental demyelination 22. Regarding the association of facial nerve palsy with Nasalflu®, an influenza vaccine adjuvanted with E. coli heat-labile toxin, the most likely hypothesis is that the E. coli enterotoxin resulted in inflammation and entrapment of the facial nerve in the facial canal 23,24.

The IOM concluded that the only mechanistic evidence for an association between facial nerve palsy and tetanus or diphtheria vaccines was knowledge about the natural infection, and that there was no mechanistic evidence for hepatitis A, hepatitis B and influenza vaccines causing facial nerve palsy 2.

* These conclusions do not necessarily consider vaccines recommended only for special populations in the United States such as Yellow Fever vaccine (international travelers) or Smallpox vaccine (military personnel), or vaccines no longer recommended to the public such as the Janssen (J&J) COVID-19 vaccine.


1.         Mutsch M, Zhou W, Rhodes P, Bopp M, Chen RT, Linder T, Spyr C, Steffen R. Use of the inactivated intranasal influenza vaccine and the risk of Bell’s palsy in Switzerland. The New England journal of medicine 2004; 350(9): 896-903.

2.         Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.

3.         Greene SK, Kulldorff M, Lewis EM, Li R, Yin R, Weintraub ES, Fireman BH, Lieu TA, Nordin JD, Glanz JM, Baxter R, Jacobsen SJ, Broder KR, Lee GM. Near real-time surveillance for influenza vaccine safety: Proof-of-concept in the vaccine safety datalink project. American Journal of Epidemiology 2010; 171(2): 177-88.

4.         Stowe J, Andrews N, Wise L, Miller E. Bell’s palsy and parenteral inactivated influenza vaccine. Hum Vaccin 2006; 2(3): 110-2.

5.         Yih WK, Nordin JD, Kulldorff M, Lewis E, Lieu TA, Shi P, Weintraub ES. An assessment of the safety of adolescent and adult tetanus-diphtheria-acellular pertussis (Tdap) vaccine, using active surveillance for adverse events in the Vaccine Safety Datalink. Vaccine 2009; 27(32): 4257-62.

6.         Lee GM, Greene SK, Weintraub ES, Baggs J, Kulldorff M, Fireman BH, Baxter R, Jacobsen SJ, Irving S, Daley MF, Yin R, Naleway A, Nordin JD, Li L, McCarthy N, Vellozzi C, Destefano F, Lieu TA. H1N1 and seasonal influenza vaccine safety in the vaccine safety datalink project. Am J Prev Med 2011; 41(2): 121-8.

7.         Rowhani-Rahbar A, Klein NP, Lewis N, Fireman B, Ray P, Rasgon B, Black S, Klein JO, Baxter R. Immunization and Bell’s palsy in children: a case-centered analysis. Am J Epidemiol 2012; 175(9): 878-85.

8.         Wijnans L, Dodd CN, Weibel D, Sturkenboom M. Bell’s palsy and influenza(H1N1)pdm09 containing vaccines: A self-controlled case series. PloS one 2017; 12(5): e0175539.

9.         Tseng HF, Sy LS, Ackerson BK, Hechter RC, Tartof SY, Haag M, Slezak JM, Luo Y, Fischetti CA, Takhar HS, Miao Y, Cunnington M, Solano Z, Jacobsen SJ. Safety of Quadrivalent Meningococcal Conjugate Vaccine in 11- to 21-Year-Olds. Pediatrics 2017; 139(1).

10.       Yoon D, Lee JH, Lee H, Shin JY. Association between human papillomavirus vaccination and serious adverse events in South Korean adolescent girls: nationwide cohort study. BMJ (Clinical research ed) 2021; 372: m4931.

11.       Willame C, Gadroen K, Bramer W, Weibel D, Sturkenboom M. Systematic Review and Meta-analysis of Postlicensure Observational Studies on Human Papillomavirus Vaccination and Autoimmune and Other Rare Adverse Events. The Pediatric infectious disease journal 2020; 39(4): 287-93.

12.       Klein NP, Lewis N, Goddard K, Fireman B, Zerbo O, Hanson KE, Donahue JG, Kharbanda EO, Naleway A, Nelson JC, Xu S, Yih WK, Glanz JM, Williams JTB, Hambidge SJ, Lewin BJ, Shimabukuro TT, DeStefano F, Weintraub ES. Surveillance for Adverse Events After COVID-19 mRNA Vaccination. Jama 2021; 326(14): 1390-9.

13.       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 otolaryngology– head & neck surgery 2021; 147(8): 739-43.

14.       Shasha D, Bareket R, Sikron FH, Gertel O, Tsamir J, Dvir D, Mossinson D, Heymann AD, Zacay G. Real-world safety data for the Pfizer BNT162b2 SARS-CoV-2 vaccine: historical cohort study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2022; 28(1): 130-4.

15.       Wan EYF, Chui CSL, Lai FTT, Chan EWY, Li X, Yan VKC, Gao L, Yu Q, Lam ICH, Chun RKC, Cowling BJ, Fong WC, Lau AYL, Mok VCT, Chan FLF, Lee CK, Chan LST, Lo D, Lau KK, Hung IFN, Leung GM, Wong ICK. Bell’s palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study. The Lancet Infectious diseases 2022; 22(1): 64-72.

16.       Patone M, Handunnetthi L, Saatci D, Pan J, Katikireddi SV, Razvi S, Hunt D, Mei XW, Dixon S, Zaccardi F, Khunti K, Watkinson P, Coupland CAC, Doidge J, Harrison DA, Ravanan R, Sheikh A, Robertson C, Hippisley-Cox J. Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nature medicine 2021; 27(12): 2144-53.

17.       Ravin LC. Facial paralysis as a complication of chickenpox. American journal of ophthalmology 1961; 52: 723-4.

18.       Peitersen E, Caunt AE. The incidence of herpes zoster antibodies in patients with peripheral facial palsy. The Journal of laryngology and otology 1970; 84(1): 65-70.

19.       Tomita H, Hayakawa W. Varicella-Zoster virus in idiopathic facial palsy. Archives of otolaryngology (Chicago, Ill : 1960) 1972; 95(4): 364-8.

20.       McCormick DP. Herpes-simplex virus as a cause of Bell’s palsy. Lancet 1972; 1(7757): 937-9.

21.       Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Annals of internal medicine 1996; 124(1 Pt 1): 27-30.

22.       Manos-Pujol M, Nogues J, Ros A, Dicenta M, Mestre M, Buendia E. Etiopathogenesis of Bell’s palsy: an immune-mediated theory. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery 1994: S445-6.

23.       Halsey NA, Talaat KR, Greenbaum A, Mensah E, Dudley MZ, Proveaux T, Salmon DA. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2015; 33 Suppl 5: F1-f67.

24.       Lewis DJ, Huo Z, Barnett S, Kromann I, Giemza R, Galiza E, Woodrow M, Thierry-Carstensen B, Andersen P, Novicki D, Del Giudice G, Rappuoli R. Transient facial nerve paralysis (Bell’s palsy) following intranasal delivery of a genetically detoxified mutant of Escherichia coli heat labile toxin. PloS one 2009; 4(9): e6999.

Talking Points

Talking Points

Step 1: Establish empathy and credibility
·         As your doctor, I know that you want to make the best choices about vaccines for you and your family.

·         I also know there is a lot of information out there, and it is difficult to figure out who to trust.

·         Would it be okay if I share with you what I have learned from my experience, and what I share with my patients, my family and my friends about facial nerve palsy?

Step 2: Briefly address specific concerns, if any
·         Based on the best available science, it does not appear that vaccines cause facial nerve palsy.

·         The chicken pox and Tdap vaccines actually prevent facial nerve palsy.

Step 3: Pivot to disease risk
·         Vaccine-preventable diseases are real and have very real dangers associated with them, including illness, and even death. They are also equal opportunity diseases, as they can infect anyone at any time.
Step 4: Convey vaccine effectiveness
·         Vaccines are highly effective at protecting you and your family from vaccine-preventable diseases.
Step 5: Give a strong and personalized recommendation
·         You and I have the same goal: to keep you and your family healthy.

·         You have the power to protect yourself and your family from these diseases through vaccination.

·         I strongly recommend vaccination to my patients, my family, and my friends.