Risk of Guillain-Barré syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study

Kwong, Jeffrey C.; Vasa, Priya; Campitelli, Michael A.; Hawken, Steven; Wilson, Kumanan; Rosella, Laura; Stukel, Thérèse A.; Crowcroft, Natasha S.; McGeer, Allison; Zinman, Lorne; Deeks, Shelley L.

doi:10.1016/s1473-3099(13)70104-x

Cited by 98 publications

(77 citation statements)

References 28 publications

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“…The Institute of Medicine stated in 2011 that "an association cannot be confidently ruled out, particularly for future vaccine strains" [7]. Indeed, several cases describing a possible association have previously been reported [8,9], and their conclusions are consistent with a number of recent studies [10][11][12] and meta-analysis [13], which suggest the presence of a very small but quantifiable attributable risk (approximately 1 -2 excess cases per one million vaccinated individuals).…”

Section: Discussionmentioning

confidence: 77%

Guillain-Barre Syndrome Following Seasonal Influenza Vaccination

Mak¹

2017

J Neurol Res

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A 77-year-old man with a background of intracranial hemorrhage and hemophilic arthropathy presented with progressive weakness of all four limbs. His symptoms started acutely 8 days after a seasonal influenza vaccination. Physical examination revealed symmetrical proximal muscle weakness and generalized areflexia. Common infectious triggers of Guillain-Barre syndrome (GBS) were ruled out. Neurophysiological studies demonstrated features consistent with GBS. The patient's hospital stay was extensive and complicated by various comorbidities. Despite intravenous immunoglobulin (IVIG) treatment, the symptoms progressed to involve respiratory muscles and the patient was admitted to the intensive care unit. The patient's condition gradually improved after a further course of IVIG, and he was discharged 15 weeks post-admission with ongoing community rehabilitation. The temporal relationship between influenza vaccination and GBS development in this case was suggestive of a vaccineinduced cause, and the clinical implications of this association warrant further research.

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Section: Discussionmentioning

confidence: 77%

Guillain-Barre Syndrome Following Seasonal Influenza Vaccination

Mak¹

2017

J Neurol Res

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“…30 In addition, the high positive predictive value and spec- ificity suggests that the database can accurately identify patients who have truly undergone vaccination, allowing these data to be used to study influenza vaccine safety using self-controlled study designs. 32 In the absence of a vaccination registry in Ontario, administrative data represent the best available data source to study influenza vaccines at a population level. However, we fully support the creation of a registry in Ontario to permit optimal evaluations of our publicly funded vaccination programs, particularly since vaccinations given at public health and workplace clinics are not captured by physician billing claims data.…”

Section: Resultsmentioning

confidence: 99%

Using physician billing claims from the Ontario Health Insurance Plan to determine individual influenza vaccination status: an updated validation study

et al. 2016

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“…For example, GBS is a rare event which is consistently reported in post-marketing surveillance of influenza vaccines, including in Ontario where there were three reports of GBS following influenza vaccine over three years. While the evidence considering influenza vaccination and GBS is inadequate to accept or reject a causal association (35), the absolute risk of approximately one excess case per one million vaccines (36)(37)(38) is much lower than that associated with influenza disease (39,40). Of note, there were two reports of bilateral panuveitis during this time period which have been described in more detail by Manusow and colleagues (41).…”

Section: Discussionmentioning

confidence: 99%