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. 2013 May;28(5):433-44.
doi: 10.1007/s10654-013-9797-8. Epub 2013 Mar 31.

Risk of Guillain-Barré syndrome after 2010-2011 influenza vaccination

Francesca Galeotti  1 , Marco Massari, Roberto D'Alessandro, Ettore Beghi, Adriano Chiò, Giancarlo Logroscino, Graziella Filippini, Maria Donata Benedetti, Maura Pugliatti, Carmela Santuccio, Roberto Raschetti; ITANG study group
Collaborators, Affiliations

Risk of Guillain-Barré syndrome after 2010-2011 influenza vaccination

Francesca Galeotti et al. Eur J Epidemiol. 2013 May.

Abstract

Influenza vaccination has been implicated in Guillain Barré Syndrome (GBS) although the evidence for this link is controversial. A case-control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case-control analysis and a self-controlled case series analysis (SCCS). Case-control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.

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Figures

Fig. 1
Fig. 1
Diagram of the observation period for the self-controlled case-series (SCSS) method
Fig. 2
Fig. 2
Recruitment of participants in the study. The reasons for exclusion from the Brighton criteria were: alternative explanation of symptoms (11 cases), course not monophasic (11), nadir of symptoms not reached between 12 h and 28 days after symptoms onset (5), absence of bilateral limbs weakness (18), conservation of tendon stretching reflexes (4); missing data (4 patients)
Fig. 3
Fig. 3
Forest plot showing the results of the final conditional regression analysis. a ILI = Influenza-like illness; URI = Upper respiratory tract infections, b Any occurrence of chronic comorbidities among: malignancies, immunocompromised states (e.g. transplantation, use of immunosuppressants, HIV infection), autoimmune disorders (e.g. thyroiditis, diabetes type I, rheumatoid arthritis, vasculitis) and past surgical intervention
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