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. 2022 Nov;29(11):3389-3394.
doi: 10.1111/ene.15516. Epub 2022 Aug 13.

Guillain-Barré syndrome following influenza vaccination: A 15-year nationwide population-based case-control study

Lotte Sahin Levison  1 , Reimar Wernich Thomsen  2 , Henning Andersen  1
Affiliations

Guillain-Barré syndrome following influenza vaccination: A 15-year nationwide population-based case-control study

Lotte Sahin Levison et al. Eur J Neurol. 2022 Nov.

Abstract

Background and purpose: Influenza vaccination may increase the risk of developing Guillain-Barré syndrome (GBS) due to an elicited immune response, but the exact magnitude and duration of risk is unclear and hence the aim of this study.

Methods: We conducted a retrospective nationwide population-based case-control study of prospectively collected data on all patients with first-time hospital-diagnosed GBS in Denmark between 2002 and 2016 and 10 age-, sex- and index date-matched population controls per case. The primary exposure was incident influenza vaccination 1 month prior to admission with GBS. We used medical registries to ascertain a complete hospital contact history of pre-existing morbidities. To examine duration of GBS risk, we repeated the analysis for five consecutive 1-month risk periods following vaccination.

Results: Of the 1295 GBS cases and 12,814 controls, 20 cases (1.5%) and 119 controls (0.9%) had received an influenza vaccination within the last month, yielding a comorbidity-adjusted odds ratio of 1.9 (95% confidence interval 1.1-3.2) for GBS. Stratified analyses by calendar time, gender and age showed similar results. The increased risk of GBS was largely confined to 1 month following influenza vaccination. The population-attributable fraction of GBS from influenza vaccination in Denmark was 0.4%.

Conclusions: Influenza vaccination was associated with a slightly elevated risk of GBS occurrence within 1 month after vaccination. However, only 1.5% of GBS cases in Denmark are associated with recent influenza vaccination. Thus, the benefit of influenza vaccines in preventing influenza infections and associated morbidity and mortality needs to be weighed against the small absolute risk of GBS.

Keywords: Guillain-Barré syndrome; epidemiology; neuropathy.

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Conflict of interest statement

None.

DATA AVAILABILITY STATEMENT

The study received approval from the Danish Data Protection Agency (file number 1–16–02‐817‐17). No ethical approval or informed consent is required to conduct register‐based studies in Denmark [14]. Data were based on Danish national registers, and individual‐level data cannot be shared. However, summary statistics, additional results may be provided on request [14].

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