Guillain-Barré Syndrome and Vaccines: Time to Say Yes?

Douglas S. Paauw, MD

Disclosures

July 02, 2019

Go Ahead and Immunize

Historically, we've been taught to avoid influenza vaccine in patients who had a history of GBS, due to concerns about postvaccination reactivation. This concern ratcheted up following a reported increase in cases that occurred in the aftermath of a vigorous 1976 campaign to increase receipt of influenza vaccine. That year, amid concerns about the potential for widespread transmission of a new strain—so-called swine flu—pubic health officials launched an effort to immunize every "man, woman, and child in the United States."[1]

While it is questionable whether that year's vaccine formulation led to an increase in the number of GBS cases or whether the uptick was simply the result of better recognition, there is no question that the GBS cases that did occur during that influenza season were widely covered by the press. Federal health officials eventually decided that the possibility of an association of GBS with the vaccine, however small, necessitated stopping the immunization effort.[1]

In the years since, simply observing GBS incidence in the period following influenza vaccine season has found no increase in cases. Like many, however, I followed this recommendation and did not vaccinate my GBS patients. Intuitively, to me, the concerns about immune activation made sense.

Evidence over the past 10 years demonstrates that this concern was overblown. A survey[2] of 245 patients with a history of either GBS or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) asked about receipt of the influenza vaccine; 106 GBS patients reported having received influenza vaccine following their diagnosis (a total of 775 vaccinations). None had a recurrence of GBS.

A more recent retrospective chart review[3] of over 3 million individuals included in an insurance database identified approximately 500 cases of GBS occurring over 31 million person-years; six of these were confirmed as a GBS recurrence and only one had any vaccine exposure (a measles-mumps-rubella vaccine administered 4 months prior to onset). Another 279 patients in the database were found to have a history of GBS and to have received 989 vaccinations, including 405 trivalent influenza vaccinations. No cases of GBS occurred in this group.

Recent evidence on risk for recurrent GBS after vaccination confirms that, if GBS reoccurrence is associated with administration of influenza vaccine, it is not a common event. We don't know whether it really is an event at all. In fact, because influenza could potentially trigger GBS, avoiding immunization could potentially create risk for GBS.[4,5]

The GBS CIDP Foundation recommends avoiding any immunization that a GBS patient had received within 4-6 weeks prior to the development of their initial symptoms. I think that is fair enough. For the vast majority of GBS patients, that will not have been the case.

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