title: Guillain-Barré syndrome and H1N1 (2009) pandemic influenza vaccination using an AS03 adjuvanted vaccine in the United Kingdom: self-controlled case series.
abstract: In 1976 a swine influenza vaccine was associated with an increased risk of Guillain-Barré syndrome (GBS). Although subsequent studies did not find an increased risk of GBS following seasonal influenza vaccine, there was concern that the monovalent H1N1 vaccines developed against the swine influenza pandemic of 2009 might increase the risk of GBS. In the UK a split-virion AS03 oil-in-water adjuvanted vaccine (Pandemrix™) was predominantly used. To determine whether the risk of GBS increased after Pandemrix administration, we sought GBS cases during the period of vaccine use from neurologists and a patient support group, and following the vaccination period from hospital episode statistics (HES) in England. We obtained cases' vaccination histories and illness onset dates from general practitioners. We determined the relative incidence of GBS in the 6 weeks after vaccination using the self-controlled case series method on the cases identified in HES. We included 327 GBS cases, of whom 37 received pandemic vaccine in the study period, nine of whom developed GBS within 6 weeks of vaccination (relative incidence 1.05 [95% confidence interval (CI) 0.37 to 2.24]). We found no evidence of an increased risk of GBS in the 6 weeks following pandemic influenza vaccination.
authors.affiliation: Statistics Modelling and Economics Department, Health Protection Services, Health Protection Agency, Colindale, London NW9 5EQ, United Kingdom. nick.andrews@hpa.org.uk
authors.forename: Nick
authors.initials: N
authors.lastname: Andrews
authors.forename: Julia
authors.initials: J
authors.lastname: Stowe
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000139:chemically induced / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D020275:Guillain-Barre Syndrome / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000009:adverse effects*; D007251:Influenza, Human / Q000517:prevention & control* / Q000821:virology; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines