Vaccines and Guillain-Barré Syndrome

Abstract

Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis in developed countries and is characterized by various degrees of weakness, sensory abnormalities and autonomic dysfunction. Although the underlying aetiology and pathophysiology of GBS are not completely understood, it is broadly believed that immune stimulation plays a role in its pathogenesis. Thus, since vaccines have an effect on the immune system it is biologically plausible that immunizations may be associated with subsequent GBS. The objective of this article is to review the current body of evidence that either supports or does not support a causal, rather than just temporal, association between various vaccines and GBS, and to provide an evidence-based review of this issue. The scope of the article includes published reports that, regardless of method of case ascertainment, appeared in peer-reviewed literature between 1950 and 2008. Our review indicates that, with rare exceptions, associations between vaccines and GBS have been only temporal. There is little evidence to support a causal association with most vaccines. The evidence for a causal association is strongest for the swine influenza vaccine that was used in 1976-77. Studies of influenza vaccines used in subsequent years, however, have found small or no increased risk of GBS. Older formulations of rabies vaccine cultured in mammalian brain tissues have been found to have an increased risk of GBS, but newer formulations of rabies vaccine, derived from chick embryo cells, do not appear to be associated with GBS at a greater than expected rate. In an earlier review, the Institute of Medicine concluded that the evidence favoured a causal association between oral polio vaccine and tetanus toxoid-containing vaccines and GBS. However, recent evidence from large epidemiological studies and mass immunization campaigns in different countries found no correlation between oral polio vaccine or tetanus toxoid-containing vaccines and GBS. Spontaneous reports to the US Vaccine Adverse Events Reporting System shortly after the introduction of quadrivalent conjugated meningococcal vaccine (MCV4) raised concerns of a possible association with GBS. Comparisons with expected rates of GBS, however, were inconclusive for an increased risk, and lack of controlled epidemiological studies makes it difficult to draw conclusions about a causal association. For other vaccines, available data are based on isolated case reports or very small clusters temporally related to immunizations, and no conclusion about causality can be drawn. There are certain circumstances in which immunizing individuals, particularly those with a prior history of GBS, may require caution. However, the benefit of vaccines in preventing disease and decreasing morbidity and mortality, particularly for influenza, needs to be weighed against the potential risk of GBS.

Surveillance for Adverse Events following Immunization from 2008 to 2011 in Zhejiang Province, China

“…Although an association between the influenza virus vaccine and GBS was observed in 1976 (23), assessment of current pH1N1 vaccines had found either no association or a higher rate of GBS with 0.85 per million vaccine doses in our study, which is consistent with estimates for seasonal influenza virus vaccine. This rate is also lower than the baseline incidence rate of 0.6 to 1.9 cases per 1 million population in European countries or the estimated risk of 1 case per 1 million doses of seasonal influenza virus vaccines given in the United States (24,25).…”

Guillain-Barré syndrome associated with H1N1 vaccination

“…Although infrequent, it also may happen as a neurologic adverse event following immunization. The pathophysiology of vaccination-related GBS is not completely understood and probably an immune stimulation plays a role in its pathogenesis 1,3 . Recent studies showed no conclusive result proving a causal relationship between influenza A vaccine and GBS, nor a possible increased risk for GBS after H1N1 imunnization 4,5 .…”

“…Guillain-Barré syndrome (GBS) has been described as adverse event following different types of vaccines, such as influenza, varicella, polio virus and hepatitis B 1 . Since 2009 with the emergence of the pandemic H1N1 influenza virus infection in humans, new vaccines have been developed for influenza A (H1N1) as a preventive strategy to reduce transmission, protect groups at increased risk of infection, and decrease complications and death 2 .…”

Cabale contre la vaccination anti-H1N1 : est-elle justifiée ?

“…Il en va de la responsabilité de chaque soignant de bien comprendre les enjeux de la vaccination, vis-à-vis de lui-même, de son entourage, et de ses patients [6]. Les populations prioritaires ont été définies par le gouvernement (circulaire du 28 octobre 2009) après avis du Haut conseil de santé publique [7] et sont les suivantes, par ordre décroissant de hiérarchisation : -personnel de santé de réanimation néonatale et pédiatrique, -personnels médical, paramédical et aide-soignant des établissements de santé, ainsi que médecins et infirmier(e)s du secteur ambulatoire exposés à des patients grippés ou en contact avec des patients porteurs de facteurs de risque, -femmes enceintes à partir du deuxième trimestre, -entourage des nourrissons de moins de 6 mois (famille et personnes assurant la garde de ces nourrissons), -professionnels chargés de l'accueil de la petite enfance (jusqu'à 3 ans), -nourrissons âgés de 6 à 23 mois révolus avec facteurs de risque (atteints de pathologies chroniques sévères), -sujets âgés de 2 à 64 ans avec facteurs de risque, -autres professionnels de santé, personnels de la chaîne de secours et transporteurs sanitaires, -nourrissons âgés de 6 à 23 mois révolus sans facteurs de risque, ou leur entourage si le vaccin non adjuvé est indisponible, -personnels d'accueil des pharmacies, -personnels des établissements médico-sociaux, Cependant, aucun lien épidémiologique n'a été mis en évidence [11,12]. On peut rappeler à cette occasion que le syndrome de Guillain-Barré a une incidence de 2,8 cas pour 100 000 habitants en population générale, et de 4 à 7 pour 1 000 000 habitants après une grippe naturelle.…”