Fear the Flu, Not the Shot: Influenza Vaccination and Guillain-Barré Syndrome

Angela L. Hewlett, MD


November 13, 2013

Editorial Collaboration

Medscape &


These studies have many limitations as well as different designs. Notable limitations include the possibility of Guillain-Barré syndrome misdiagnosis and inappropriate or incomplete medical coding. Mild cases of influenza that did not come to medical attention and patients who sought influenza vaccination outside of the systems used for review would not have been included. Furthermore, it is often difficult to accurately document a history of respiratory or gastrointestinal illness, a known risk factor for Guillain-Barré syndrome. One strength of all 3 studies was the use of population databases to capture large numbers of Guillain-Barré syndrome cases.

Baxter and colleagues did not demonstrate an increased risk for Guillain-Barré syndrome with any vaccine; however, the other studies documented a slight increase in risk. The elevated Guillain-Barré syndrome risk following H1N1 monovalent vaccination demonstrated by Polakowski and colleagues was not significant when a stricter case definition of Guillain-Barré syndrome was applied. Moreover, Kwong and colleagues found the risk for postvaccination Guillain-Barré syndrome to be much lower than the risk for an influenza infection, which is consistent with previous studies.

On the basis of these results, we should feel comfortable reassuring our patients and healthcare workers that the risk for Guillain-Barré syndrome from influenza vaccine is exceedingly low. It is also useful to have data suggesting that Guillain-Barré syndrome rates are higher after influenza illness than after receipt of the seasonal influenza vaccine, putting the vaccine risk into clinical/risk context. These studies supply more data affirming the conclusion that seasonal influenza vaccine is the safest and most effective way to prevent the spread of influenza in the healthcare setting as well as in the community.


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