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. 2012 Jun 1;175(11):1110-9.
doi: 10.1093/aje/kws196. Epub 2012 May 11.

Guillain-Barre syndrome during the 2009-2010 H1N1 influenza vaccination campaign: population-based surveillance among 45 million Americans

Matthew E Wise  1 , Melissa Viray, James J Sejvar, Paige Lewis, Andrew L Baughman, Walter Connor, Richard Danila, Greg P Giambrone, Christa Hale, Brenna C Hogan, James I Meek, Rendi Murphree, John Y Oh, Arthur Reingold, Norisse Tellman, Susan M Conner, James A Singleton, Peng-Jun Lu, Frank DeStefano, Scott K Fridkin, Claudia Vellozzi, Oliver W Morgan
Affiliations

Guillain-Barre syndrome during the 2009-2010 H1N1 influenza vaccination campaign: population-based surveillance among 45 million Americans

Matthew E Wise et al. Am J Epidemiol. .

Abstract

Because of widespread distribution of the influenza A (H1N1) 2009 monovalent vaccine (pH1N1 vaccine) and the prior association between Guillain-Barré syndrome (GBS) and the 1976 H1N1 influenza vaccine, enhanced surveillance was implemented to estimate the magnitude of any increased GBS risk following administration of pH1N1 vaccine. The authors conducted active, population-based surveillance for incident cases of GBS among 45 million persons residing at 10 Emerging Infections Program sites during October 2009-May 2010; GBS was defined according to published criteria. The authors determined medical and vaccine history for GBS cases through medical record review and patient interviews. The authors used vaccine coverage data to estimate person-time exposed and unexposed to pH1N1 vaccine and calculated age- and sex-adjusted rate ratios comparing GBS incidence in these groups, as well as age- and sex-adjusted numbers of excess GBS cases. The authors received 411 reports of confirmed or probable GBS. The rate of GBS immediately following pH1N1 vaccination was 57% higher than in person-time unexposed to vaccine (adjusted rate ratio = 1.57, 95% confidence interval: 1.02, 2.21), corresponding to 0.74 excess GBS cases per million pH1N1 vaccine doses (95% confidence interval: 0.04, 1.56). This excess risk was much smaller than that observed during the 1976 vaccine campaign and was comparable to some previous seasonal influenza vaccine risk assessments.

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Figures

Figure 1.
Figure 1.
Weekly numbers of confirmed and probable Guillain-Barré syndrome (GBS) cases according to week of symptom onset (n = 411) and cumulative pH1N1 vaccine coverage, by age group, Emerging Infections Program catchment area, October 1, 2009–May 31, 2010.
Figure 2.
Figure 2.
Interval between receipt of pH1N1 vaccine and onset of Guillain-Barré syndrome (GBS) in weeks (n = 42), by age group, Emerging Infections Program catchment area, October 1, 2009–May 31, 2010. The chart is limited to cases with an interval of 1–84 days; 4 additional cases developed GBS prior to receiving pH1N1 vaccine, and 21 cases developed GBS more than 84 days after receiving pH1N1 vaccine.
Figure 3.
Figure 3.
Monthly cumulative pH1N1 vaccine coverage in the Emerging Infections Program catchment area, by age group, October 2009–May 2010.
See this image and copyright information in PMC

Comment in

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