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Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is a rare disorder where the body’s immune system damages nerve cells, causing muscle weakness and sometimes paralysis. While its cause is not fully understood, the syndrome often follows infection with a virus or bacteria. In the United States, an estimated 3,000 to 6,000 people develop GBS each year. Most people recover fully from GBS, but some have permanent nerve damage.

GBS is rare.

Anyone can develop GBS but people older than 50 are at greatest risk. In addition, about two-thirds of people who get GBS do so several days or weeks after they have been sick with diarrhea or a lung or sinus illness. Infection with the bacteria Campylobacter jejuni, which causes gastroenteritis (including symptoms of nausea, vomiting and diarrhea), is one of the most common risk factors for GBS. People also can develop GBS after having the flu or other infections such as cytomegalovirus and Epstein Barr virus. On very rare occasions, people develop GBS in the days or weeks after getting a vaccination.

To study whether a new vaccine might be causing GBS, CDC would compare the usual rate of GBS to the observed rate of GBS in persons getting vaccinated. This helps to determine whether a vaccine could be causing more cases.

GBS and the link to flu vaccine

In 1976, there was a small increased risk of GBS after swine flu vaccination, which was a special flu vaccine for a potential pandemic strain of flu virus. The Institute of Medicine (IOM) conducted a scientific review of this issue in 2003 and found that people who received the 1976 swine flu vaccine had an increased risk for developing GBS. The increased risk was approximately one additional case of GBS for every 100,000 people who got the swine flu vaccine. Scientists have several theories about the cause, but the exact reason for this link remains unknown.

There have been several studies of the risk of GBS after flu vaccine and CDC monitors for GBS during each flu season. The data on an association between seasonal influenza vaccine and GBS have been variable from season-to-season. When there has been an increased risk, it has consistently been in the range of 1-2 additional GBS cases per million flu vaccine doses administered.

Studies suggest that it is more likely that a person will get GBS after getting the flu than after vaccination. It is important to keep in mind that severe illness and death are associated with flu, and getting vaccinated is the best way to prevent flu infection and its complications.

CDC and FDA closely monitor the safety of all vaccines.

Tracking vaccine safety is a high priority for CDC. Several systems are in place to monitor vaccine safety. One of these systems is the Vaccine Adverse Event Reporting System (VAERS).

CDC and the U.S. Food and Drug Administration (FDA) co-manage VAERS, which serves as an early warning system to detect possible health problems that people experience following vaccinations. Anyone can report a suspected health problem after vaccination to VAERS. CDC and FDA scientists regularly review reports to detect new, unusual, or rare health events that could be linked to vaccines.

Another system is the Vaccine Safety Datalink (VSD). The VSD is a collaborative project between CDC’s Immunization Safety Office and eight integrated healthcare organizations. CDC conducts near real-time monitoring of influenza vaccine safety in the VSD each influenza season.

Related Scientific Articles

Kawai AT, Li L, Kulldorff M, Vellozzi C, et al. Absence of associations between influenza vaccines and increased risks of seizures, Guillain-Barré syndrome, encephalitis, or anaphylaxis in the 2012-2013 season. Pharmacoepidemiol Drug Saf. 2014 May;23(5):548-53. https://www.ncbi.nlm.nih.gov/pubmed/24497128

Nordin JD, Kharbanda EO, Vazquez-Benitez G, et al. Monovalent H1N1 influenza vaccine safety in pregnant women, risks for acute adverse events. Vaccine. 2014 Sep 3;32(39):4985-92. https://www.ncbi.nlm.nih.gov/pubmed/25045808

Greene SK, Rett MD, Vellozzi C, et al. Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009-2011. PLoS One. 2013 Jun 26;8(6):e67185. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067185

Nelson KE. Invited commentary: Influenza vaccine and Guillain-Barre syndrome–is there a risk? Am J Epidemiol. 2012 Jun 1;175(11):1129-32. https://www.ncbi.nlm.nih.gov/pubmed/22582208

Greene SK, Rett M, Weintraub ES, et al. Risk of confirmed Guillain-Barre syndrome following receipt of monovalent inactivated influenza A (H1N1) and seasonal influenza vaccines in the Vaccine Safety Datalink Project, 2009-2010. Am J Epidemiol. 2012 Jun 1;175(11):1100-9. https://www.ncbi.nlm.nih.gov/pubmed/22582210

DA Salmon, M Proschan, R Forshee, et al.: Association between Guillain-Barre syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis. Lancet 2013. 381:1461-1468. https://www.ncbi.nlm.nih.gov/pubmed/23498095

JI Tokars, P Lewis, F DeStefano, et al.: The risk of Guillain-Barre syndrome associated with influenza A (H1N1) 2009 monovalent vaccine and 2009-2010 seasonal influenza vaccines: results from self-controlled analyses. Pharmacoepidemiol Drug Saf.2012, 21:546-552. https://www.ncbi.nlm.nih.gov/pubmed/22407672

R Baxter, N Lewis, N Bakshi, et al.CISA Network: Recurrent Guillain-Barre syndrome following vaccination. Clin Infect Dis.2012. 54:800-804 https://www.ncbi.nlm.nih.gov/pubmed/22267712

ME Wise, M Viray, JJ Sejvar, et al.: Guillain-Barre syndrome during the 2009-2010 H1N1 influenza vaccination campaign: population-based surveillance among 45 million Americans. Am J Epidemiol.2012. 175:1110-1119. https://www.ncbi.nlm.nih.gov/pubmed/22582209

V Sivadon-Tardy, D Orlikowski, R Porcher, et al.: Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis. 48:48-56 2009 https://www.ncbi.nlm.nih.gov/pubmed/19025491

DN Juurlink, TA Stukel, J Kwong, et al.: Guillain-Barre syndrome after influenza vaccination in adults: a population-based study. Arch Intern Med.2006. 166:2217-2221. https://www.ncbi.nlm.nih.gov/pubmed/17101939

RA Hughes, J Charlton, R Latinovic, et al.: No association between immunization and Guillain-Barre syndrome in the United Kingdom, 1992 to 2000. Arch Intern Med.2006. 166:1301-1304. https://www.ncbi.nlm.nih.gov/pubmed/16801513

P Haber, F DeStefano, FJ Angulo, et al.: Guillain-Barre syndrome following influenza vaccination. JAMA. 292:2478-2481 2004 https://www.ncbi.nlm.nih.gov/pubmed/15562126

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JE Kaplan, P Katona, ES Hurwitz, et al.: Guillain-Barre syndrome in the United States, 1979-1980 and 1980-1981. Lack of an association with influenza vaccination. JAMA 1982. 248:698-700. https://www.ncbi.nlm.nih.gov/pubmed/7097920

ES Hurwitz, LB Schonberger, DB Nelson, et al.: Guillain-Barre syndrome and the 1978-1979 influenza vaccine. N Engl J Med 1981. 304:1557-1561. https://www.ncbi.nlm.nih.gov/pubmed/7231501

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