title: Guillain-Barré syndrome after influenza vaccination in adults: a population-based study.
abstract: BACKGROUND
  Whether influenza vaccination is associated with Guillain-Barré syndrome (GBS) remains uncertain.
  
  
  METHODS
  We conducted 2 studies using population-based health care data from the province of Ontario, Canada. In the first study, we used the self-matched case-series method to explore the temporal association between probable influenza vaccination (adults vaccinated during October and November) and subsequent hospitalization because of GBS. In the second study, we used time-series analysis to determine whether the institution of a universal influenza immunization program in October 2000 was associated with a subsequent increase in hospital admissions because of GBS at the population level.
  
  
  RESULTS
  From April 1, 1992, to March 31, 2004, we identified 1601 incident hospital admissions because of GBS in Ontario. In 269 patients, GBS was diagnosed within 43 weeks of vaccination against influenza. The estimated relative incidence of GBS during the primary risk interval (weeks 2 through 7) compared with the control interval (weeks 20 through 43) was 1.45 (95% confidence interval, 1.05-1.99; P = .02). This association persisted in several sensitivity analyses using risk and control intervals of different durations. However, a separate time-series analysis demonstrated no evidence of seasonality and revealed no statistically significant increase in hospital admissions because of GBS after the introduction of the universal influenza immunization program.
  
  
  CONCLUSIONS
  Influenza vaccination is associated with a small but significantly increased risk for hospitalization because of GBS.
authors.affiliation: Institute of Clinical Evaluative Sciences, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Therese A
authors.initials: TA
authors.lastname: Stukel
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kwong
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.forename: Ross E
authors.initials: RE
authors.lastname: Upshur
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007252:Influenza Vaccines / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D016012:Poisson Distribution; D011159:Population Surveillance; D012044:Regression Analysis; D012621:Seasons
chemical_list: D007252:Influenza Vaccines