Guillain-Barre and vaccine citations
Bryan, J.; Noble, G.R.; Guillain-Barré Syndrome after administration of killed
vaccines. Genf: Ref: IABS Symposium on Influenza Immunization 1.6-4.6.1977
Beghi E, et al. Guillain-Barre syndrome. Clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol. 1985 Nov;42(11):1053-7. PMID: 4051833; UI: 86024965.
JG, et al. Guillain-Barre syndrome and its relationship to swine influenza vaccination
in Michigan, 1976-1977. Am J Epidemiol. 1984 Jun;119(6):880-9. PMID: 6731430; UI:
Active surveillance to detect all patients with Guillain-Barre syndrome who had had onset of illness from July 1, 1976 through April 30, 1977 was undertaken in Michigan after indications that the syndrome might be associated with the National Influenza Immunization Program of 1976-1977. Hospital record room librarians, neurologists, and neurosurgeons reported the greatest number of cases; coded hospital discharge records were the best means of ascertaining case occurrence. This differed from national surveillance, which relied essentially on reports that neurologists and other clinicians sent to state epidemiologists and then to the Centers for Disease Control; hospital discharge lists were not systemically reviewed nationally. A total of 79 of the Michigan cases were in persons who had not received swine influenza vaccine, while 46 cases were in persons who had received it. For unvaccinated adults, the incidence of Guillain-Barre syndrome during the 10-month surveillance period was 0.36 cases per 10(6) person-weeks; for adults with onset within six weeks of vaccination, it was 2.31 cases per 10(6) person-weeks. After six weeks post-vaccination, the rate decreased to 0.17 cases per 10(6) person-weeks. The attributable risk for acquiring Guillain-Barre syndrome within six weeks after receiving swine influenza vaccine was 11.70 cases per 10(6) persons vaccinated.
OF, Shapiro ED, Spiegelman KN, Leicher CR, Breningstall GN, Khatri BO, Dobyns WB.
Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barre syndrome)
after immunization with Haemophilus influenzae type b conjugate vaccine. J Pediatr. 1989 Nov;115(5 Pt 1):743-6. No abstract available. PMID: 2809907
[PubMed - indexed for MEDLINE]
Elissa A. Laitin and Elise M. Pelletier. The Influenza A/New Jersey (Swine Flu) Vaccine and Guillain-Barré Syndrome: The Arguments for a Causal Association-----
W, et al. [Neurological complications after influenza vaccination]. MMW Munch Med
Wochenschr. 1977 May 20;119(20):705-10. German. PMID: 406554; UI: 77212853.
The clinical aspects and differential diagnosis of 11 neural complications following influenza vaccination (Guillain-Barre syndrome, serogenetic polyneuritis, encephalomyelitis) are discussed. Etiopathogenetically a hypersensitivity to components in the serum must be taken into consideration, as a case with anaphylactoid reaction shows. The incubation period of the remaining cases (beginning only after the 4th day post vaccination) is on the other hand consistent with the assumption of a pathomechanism rather like that of serum sickness. The number of influenza vaccinations previously administered in the individual case bears no relation to the neurological disturbances described. Vaccines of different manufacture can, in the same way, provoke these rare inoculation complications (frequency: 1 case per 0.7-1.3 mio vaccinations). The indication for influenza vaccinations is not limited by these occurrences.
JR. Guillain-Barre syndrome. Occurrence following combined mumps-rubella vaccine. Am J
Dis Child. 1973 Jun;125(6):834-5. No abstract available. PMID: 4350682; UI: 73187935.
Grond M, Gibbels E, Schadlich HJ, Haupt WF. [Polyneuropathies following administration of tetanus toxoid] Nervenarzt. 1988 May;59(5):309-12. German. PMID: 3405346 [PubMed - indexed for MEDLINE]
Grose C, et al. Guillain-Barre syndrome following administration of live measles vaccine. Am J Med. 1976 Mar;60(3):441-3. PMID: 1258890; UI: 76158140.
In a 19 month old girl and a 10 month old girl the Guillain-Barre syndrome developed within a week after they received, respectively, live measles-rubella vaccine and live measles vaccine. The older child was immune to the rubella at the time of vaccination, but both girls demonstrated a primary measles antibody response. Serum obtained during the acute and convalescent stages from the younger child was tested for antibodies against the herpes viruses (herpes simplex, Epstein-Barr virus, cytomegalovirus and varicella-zoster) and found to be negative.
Hurwitz ES, et al. Guillain-Barre syndrome and the 1978-1979 influenza vaccine. N Engl J Med. 1981 Jun 25;304(26):1557-61. PMID: 7231501; UI: 81197565.
Hughes R, et al. Vaccines and Guillain-Barre syndrome. BMJ. 1996 Jun 8;312(7044):1475-6. No abstract available.PMID: 8664637; UI: 96257108.
Kakar A, Sethi PK. Guillain Barre syndrome associated with hepatitis B vaccination.Indian J Pediatr. 1997 Sep-Oct;64(5):710-2. No abstract available.PMID: 10771907 [PubMed - indexed for MEDLINE]
Kinnunen E, et al. Incidence of Guillain-Barre syndrome during a nationwide oral poliovirus vaccine campaign. Neurology. 1989 Aug;39(8):1034-6. PMID: 2788248; UI: 89344401.
Kinnunen E, et al. Nationwide oral poliovirus vaccination campaign and the incidence of Guillain-Barre Syndrome. Am J Epidemiol. 1998 Jan 1;147(1):69-73. PMID: 9440401; UI: 98103584.
RA, et al. Fatal Guillain-Barre syndrome after the national influenza immunization
program. Neurology. 1980 Sep;30(9):929-33. PMID: 6252515; UI: 81031247.
Fifty-eight fatal cases of Guillain-Barre syndrome (GBS) were reported during the 1976 to 1977 National Influenza Program: Thirty-two (58%) of these patients had received the A/New Jersey influenza vaccine. The mean interval from vaccination to onset was 3.9 weeks, and the incidence of preceding illness in vaccinated or unvaccinated patients was similar. Fifty-eight percent had at least one chronic disease before onset. The clinical features were similar in vaccinated and unvaccinated patients. Most deaths followed medical complications of respiratory paralysis: Fifteen had pneumonia, 29 (83%) died suddenly, 15 had sudden arrhythmias or hypotension, and 7 had myocardial infarction or pulmonary embolus.
Lasky T, et al. The Guillain-Barre syndrome and the 1992-1993 and 1993-1994 influenza vaccines. N Engl J Med. 1998 Dec 17;339(25):1797-802. PMID: 9854114; UI: 99061022.
Lorentz, IT, et al, "Post-Vaccinal Sensory Polyneuropathy with Myoclonus", Proc Aust Ass Neurol, 1969, 6:81-86.
AD, et al. An epidemiologic and clinical evaluation of Guillain-Barre syndrome
reported in association with the administration of swine influenza vaccines. Am J
Epidemiol. 1984 Jun;119(6):841-79. PMID: 6328974; UI: 84228447.
As a result of a court order, computerized summaries of approximately 1,300 cases reported as Guillain-Barre syndrome by state health departments to the Centers for Disease Control during the intensive national surveillance instituted following the swine influenza vaccination program in 1976-1977 became available for further study. Although the data were not uniformly adequate to confirm the diagnosis of Guillain-Barre syndrome, they were sufficient to enable classification according to extent of motor involvement. Vaccinated cases with "extensive" paresis or paralysis occurred in a characteristic epidemiologic pattern closely approximated by a lognormal curve, suggesting a causal relationship between the disease and the vaccine. Cases with "limited" motor involvement showed no such pattern, suggesting that this group included a substantial proportion of cases which were unrelated to the vaccine. The effect attributed to the vaccine lasted for at least six weeks and possibly for eight weeks but not longer. The relative risk of acquiring "extensive" disease over a six-week period following vaccination ranged from 3.96 to 7.75 depending on the particular baseline estimate of expected normal or endemic incidence that was chosen. Correspondingly, the number of cases that could be attributed to the vaccine over the six-week period ranged from 211 to 246, or very slightly higher over an eight-week period if the lowest baseline estimate was used. The total rate of Guillain-Barre syndrome cases attributed to prior use of the vaccine was 4.9 to 5.9 per million vaccinees.
Muhlebach-Sponer M, et al. Intrathecal rubella antibodies in an adolescent with Guillain-Barre syndrome after mumps-measles-rubella vaccination. Eur J Pediatr. 1995 Feb;154(2):166. No abstract available.PMID: 7720751; UI: 95237246.
Mader R, et
al. Systemic vasculitis following influenza vaccination--report of 3 cases and
literature review. J Rheumatol. 1993 Aug;20(8):1429-31. Review. PMID: 8230034; UI:
Influenza vaccination is a widely accepted practice particularly among the elderly and high risk individuals. Minor and transitory
side effects following the vaccination are common while systemic complications are infrequently reported. We describe 3 patients who developed systemic vasculitis following influenza vaccination. With increasing use of influenza vaccination, attention should be drawn to the possible expression of systemic adverse effects such as vasculitis.
Morris K, et al. Guillain-Barre syndrome after measles, mumps, and rubella vaccine. Lancet. 1994 Jan 1;343(8888):60. No abstract available.PMID: 7905077; UI: 94125719.
Nejmi SE, Tajri M, Laraki M, Sadraoui A. [Guillain-Barre syndrome following immunization against Haemophilus influenzae type b] Arch Pediatr. 2001 Aug;8(8):894-5. French. No abstract available. PMID: 11524923 [PubMed - indexed for MEDLINE]
Newton N Jr, et al. [See Related Articles] Guillain-Barre syndrome after vaccination with purified tetanus toxoid. South Med J. 1987 Aug;80(8):1053-4. PMID: 3616707; UI: 87292322.
[No authors listed] [Vaccination and the Guillan-Barre syndrome]. Ned Tijdschr Geneeskd. 1978 Nov 11;122(45):1780. Dutch. No abstract available.PMID: 703884; UI: 79032243.
PE. Guillain-Barre syndrome after measles. Br Med J. 1972 Oct 7;4(831):50. No abstract
PMID: 5078428; UI: 73022045.
C . Neurological complications of swine influenza vaccination. Acta
Neurol Scand 1982 Oct;66(4):413-31
The emphasis upon the remarkably large number of cases of Guillain-Barre syndrome which resulted from the 1976 National Swine Influenza immunization program in the U.S.A. has obscured the fact that other neurological complications, involving the central nervous system also occurred. The anatomical distribution of lesions is almost identical with that seen following other types of vaccination: involvement of the brain, cerebellum, optic nerve, cranial nerves and spinal cord occurred with approximately the same frequency. 5 instances of the very rare subacute or chronic, progressive, post-vaccinal encephalopathy are described, a situation which is identical to the subacute and chronic forms of polyradiculoneuropathy. In a number of cases, in particular the myelopathies, a subclinical involvement of peripheral nerves was demonstrated by means of electrodiagnostic studies, illustrating the often overlooked fact that central nervous system involvement will mask peripheral nerve lesions. The etiological significance of the swine influenza vaccination was overlooked and completely erroneous diagnoses were established in a surprisingly large number of the 26 new cases reported here. PMID: 6128862, UI: 83070654
J, et al. Guillain-Barre syndrome after measles, mumps,
and rubella vaccine. Lancet. 1994 Mar 19;343(8899):733. No abstract available.PMID:
7907701; UI: 94180642.
Retailliau HF, et al. Illness after influenza vaccination reported through a nationwide surveillance system, 1976-1977. Am J Epidemiol. 1980 Mar;111(3):270-8. PMID: 7361749; UI: 80150827.
In 1976, the Center for Disease Control coordinated nationwide surveillance for illnesses after influenza vaccination as part of an effort to vaccinate the nation against influenza A/New Jersey/76. For the 48,161,019 persons vaccinated in 1976, a total of 4733 reports of illness were received which included reports of 223 deaths. When Guillain-Barre syndrome was reported in vaccine recipients, an investigation was begun to examine this possible association. Other than the Guillain-Barre syndrome and rare cases of anaphylaxis, no serious illnesses were causally associated with influenza vaccination by this type of surveillance. Widespread underreporting of illness and death in the passive phase of this surveillance system, however, impaired the ability to draw conclusions about reactions to vaccine from the reports of illness received.
da Silveira CM, et al. Measles vaccination and Guillain-Barre syndrome. Lancet. 1997 Jan 4;349(9044):14-6. PMID: 8988116; UI: 97141866.
M, et al. [Central nervous system infection caused by mumps virus]. Nippon Rinsho.
1997 Apr;55(4):870-5. Review. Japanese. PMID: 9103886; UI: 97257339.
Central nervous system infection caused by mumps virus is reviewed. Aseptic meningitis, acute encephalitis, chronic encephalitis, hydrocephalus, ataxia, transverse myelitis, Guillain-Barre syndrome and deafness are noted as central nervous system complications of mumps. Among these complications, acute and chronic encephalitis, hydrocephalus, transverse myelitis and deafness occasionally result in severe sequelae. Aseptic meningitis due to mumps vaccine strain increased significantly after the introduction of trivalent measles, mumps and rubella vaccination in Japan. Recently, a differentiation method of mumps vaccine strain from wild viruses has been established using molecular analysis. Mumps virus infection is still one of the most common communicable viral infections, although it is preventable by vaccination.
LB, et al. Guillain-Barre syndrome following vaccination in the National Influenza
Immunization Program, United States, 1976--1977. Am J Epidemiol. 1979
Aug;110(2):105-23. PMID: 463869; UI: 79228981.
Because of an increase in the number of reports of Guillian-Barre syndrome (GBS) following A/New Jersey influenza vaccination, the National Influenza Immunization Program was suspended December 16, 1976 and nationwide surveillance for GBS was begun. This surveillance uncovered a total of 1098 patients with onset of GBS from October 1, 1976, to January 31, 1977, from all 50 states, District of Columbia, and Puerto Rico. A total of 532 patients had recently received an A/New Jersey influenza vaccination prior to their onset of GBS (vaccinated cases), and 15 patients received a vaccination after their onset of GBS. Five hundred forty-three patients had not been recently vaccinated with A/New Jersey influenza vaccine and the vaccination status for 8 was unknown. Epidemiologic evidence indicated that many cases of GBS were related to vaccination. When compared to the unvaccinated population, the vaccinated population had a significantly elevated attack rate in every adult age group. The estimated attributable risk of vaccine-related GBS in the adult population was just under one case per 100,000 vaccinations. The period of increased risk was concentrated primarily within the 5-week period after vaccination, although it lasted for approximately 9 or 10 weeks.
Udawat H, Chaudhary HR, Goyal RK, Chaudhary VK, Mathur R. Guillain-Barre syndrome following antirabies semple vaccine--a report of six cases. J Assoc Physicians India. 2001 Mar;49:384-5. No abstract available. PMID: 11291988 [PubMed - indexed for MEDLINE]
Richard Hughes, Jeremy Rees, Nigel Smeeton, John Winer
EDITOR,--Three cases of Guillain-Barre syndrome were reported to the Committee on Safety of Medicines in Britain during a recent programme which immunised just under 8 million children with measles/rubella vaccine (DM Salisbury, Department of Health, personal communication). This low figure might be due to underreporting but is reassuringly less than the background risk of developing the syndrome (which would have been expected to be about 7.6 cases in the month after immunisation in the United Kingdom, based on the typical reported annual incidence of 1/100 000).1
We questioned 103 patients with Guillain-Barre or Miller Fisher syndrome, 98 household controls, and 93 hospital controls in south east England in 1992-4 (before the measles/rubella immunisation programme).2 Thirteen patients, and nine household and five hospital controls reported being immunised within 12 weeks before onset of neuropathy in the index case. The immunisations were for influenza in 10 patients and eight household and three hospital controls, typhoid/cholera in one patient and one household control, typhoid alone in one patient, tetanus toxoid booster in one patient, diphtheria/tetanus/pertussis in one hospital control, and human immune globulin in one hospital control. The median intervals between immunisation and neuropathy onset in the index case were 44 (range 3-64) days in patients, 44 (7-64) days in household controls, and 36 (14-62) days in hospital controls. The differences in proportions immunised between the patients and either of the control groups are not significant but the confidence intervals for the odds ratios are wide. A matched analysis shows that the odds ratio of cases having been immunised was 4.0 (95% confidence interval 0.4 to 197) in comparison to household controls and 2.2 (0.7 to 8.1) in comparison to hospital controls. A similar study in 1983-4 also failed to show an increase in risk since 6/100 patients and 5/100 hospital controls had been immunised in the previous 12 weeks.3 The odds ratio for the two series combined was 1.8 (0.7 to 4.4).
Our case-control studies and the literature do not suggest any increased risk of Guillain-Barre syndrome after vaccines currently used in the United Kingdom. However, obtaining the number of individuals required to detect or exclude a small increase in absolute risk would require an active surveillance programme or classification of Guillain-Barre syndrome as a notifiable disease. At present we rely on diligent reporting to the Committee on Safety of Medicines of cases of the syndrome after vaccination.
Professor of neurology MRC clinical research fellow Department of Neurology, United Medical and Dental Schools, Guy's Hospital, London SE1 9RT
Lecturer in medical statistics Department of Public Health Medicine, Guy's Hospital
Consultant neurologist Queen Elizabeth Hospital, Birmingham B29 6JD