Guillain-Barré syndrome following influenza vaccination.
BACKGROUND
An unexplained increase in the risk of Guillain-Barre syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976-1977. Guillain-Barre syndrome remains the most frequent neurological condition reported after influenza vaccination to the Vaccine Adverse Events Reporting System (VAERS) since its inception in 1990.


OBJECTIVE
To evaluate trends of reports to VAERS of GBS following influenza vaccination in adults.


METHODS
VAERS is the US national spontaneous reporting system for adverse events following vaccination. Reports of GBS in persons 18 years or older following influenza vaccination were evaluated for each influenza season from July 1, 1990, through June 30, 2003. The number of people vaccinated was estimated from the National Health Interview Survey and US census data. Beginning in 1994, active follow-up was conducted to verify GBS diagnosis and obtain other clinical details.


METHODS
Reporting rates of GBS following influenza vaccination over time.


RESULTS
From July 1990 through June 2003, VAERS received 501 reports of GBS following influenza vaccination in adults. The median onset interval (13 days) was longer than that of non-GBS reports of adverse events after influenza vaccine (1 day) (P<.001). The annual reporting rate decreased 4-fold from a high of 0.17 per 100,000 vaccinees in 1993-1994 to 0.04 in 2002-2003 (P<.001). A GBS diagnosis was confirmed in 82% of reports. Preceding illness within 4 weeks of vaccination was identified in 24% of reported cases.


CONCLUSIONS
From 1990 to 2003, VAERS reporting rates of GBS after influenza vaccination decreased. The long onset interval and low prevalence of other preexisting illnesses are consistent with a possible causal association between GBS and influenza vaccine. These findings require additional research, which can lead to a fuller understanding of the causes of GBS and its possible relationship with influenza vaccine.
Haber
Penina
P
Immunization Safety Branch, Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA. PHaber@cdc.gov
DeStefano
Frank
F
Angulo
Fredrick J
FJ
Iskander
John
J
Shadomy
Sean V
SV
Weintraub
Eric
E
Chen
Robert T
RT
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D020275:Guillain-Barre Syndrome / Q000453:epidemiology / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects*; D008875:Middle Aged; D016012:Poisson Distribution; D014481:United States / Q000453:epidemiology
D007252:Influenza Vaccines