title: Recurrent Guillain-Barre syndrome following vaccination.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is an acute polyradiculopathy, thought to be autoimmune, which has been reported following vaccinations. The Advisory Committee on Immunization Practices recommends not administering influenza vaccine to individuals who have had a history of GBS within 6 weeks of a prior influenza vaccination if they are not at high risk of severe complications from influenza illness.
  
  
  METHODS
  We identified GBS cases from the Kaiser Permanente Northern California databases from 1995 into 2006 using hospital discharge codes; each medical record was neurologist-reviewed and only GBS-confirmed cases were included for follow-up. We followed confirmed cases through 2008 for vaccinations and recurrent GBS.
  
  
  RESULTS
  We identified 550 cases of GBS over 33 million person-years. Following their GBS diagnoses, 989 vaccines were given to 279 of these individuals, including 405 trivalent inactivated influenza vaccines (TIV) administered to 107 individuals with a prior diagnosis of GBS. Among the 550 total cases of GBS, 18 initially had onset within 6 weeks of TIV; of these, 2 were revaccinated with TIV without a recurrence of GBS. Only 6 individuals of 550 (1.1%) had a second (recurrent) diagnosis of GBS. Among these 6 individuals, none had any vaccine exposure at all in the 2 months prior to the second onset of GBS.
  
  
  CONCLUSIONS
  In our population of over 3 million members, during an 11-year period, risk of GBS recurrence was low. There were no cases of recurrent GBS after influenza vaccination and none within 6 weeks after any vaccine.
authors.affiliation: Kaiser Permanente Vaccine Study Center, Oakland, California 94612, USA. roger.baxter@kp.org
authors.forename: Roger
authors.initials: R
authors.lastname: Baxter
authors.forename: Ned
authors.initials: N
authors.lastname: Lewis
authors.forename: Nandini
authors.initials: N
authors.lastname: Bakshi
authors.forename: Claudia
authors.initials: C
authors.lastname: Vellozzi
authors.forename: Nicola P
authors.initials: NP
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D014612:Vaccines / Q000009:adverse effects; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000009:adverse effects; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D007252:Influenza Vaccines; D014612:Vaccines; D014613:Vaccines, Attenuated; D015164:Vaccines, Inactivated