Guillain-Barré Syndrome and Vaccines
Guillain-Barré syndrome (GBS) is a rare disorder where the body’s immune system damages nerve. The damage to the nerves causes muscle weakness and sometimes paralysis. While its cause is not fully understood, the syndrome often follows infection with a virus or bacteria. Each year in the United States, an estimated 3,000 to 6,000 people develop GBS. Most people fully recover from GBS, but some have permanent nerve damage.
Anyone can develop GBS, but people older than 50 are at greatest risk. About two-thirds of people with GBS were sick with diarrhea or respiratory illness days or weeks before developing symptoms. 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 compares the usual rate of GBS to the observed rate of GBS in vaccinated people. This helps to determine whether a vaccine could be causing more cases.
GBS and the link to flu vaccine
In response to a potential pandemic strain of a flu virus in 1976, there was a national campaign for people to get the swine flu vaccination. Over 45 million people were vaccinated and there were increased reports of GBS following vaccination. Those who received the 1976 swine flu vaccine had a slight increased risk for developing GBS of 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.
CDC monitors GBS cases during each flu season. From data collected, the association between seasonal flu vaccine and GBS has been found to vary 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.
Additional studies have been conducted on the risk of GBS following flu vaccination. Results of these 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 flu infection can potentially cause severe illness and death. The best way to prevent flu infection and its complications is to get the flu vaccine.
CDC and the Food and Drug Administration (FDA) are committed to ensuring that all vaccines are as safe as possible. Once vaccines are licensed in the United States, they are continuously monitored through several safety systems and programs. Learn more about the nation’s vaccine safety efforts.
Myers TR, McCarthy NL, Panagiotakopoulos L, Omer SB. Estimation of the incidence of Guillain-Barré Syndrome during pregnancy in the United Statesexternal icon Open Forum Infect Dis. 2019 Mar; 6(3):ofz071. Epub 2019 Mar.
Gee J, Sukumaran L, Weintraub E, the Vaccine Safety Datalink team. Risk of Guillain-Barré syndrome following quadrivalent human papillomavirus vaccine in the Vaccine Safety Datalinkexternal icon Vaccine. 2017; 35(43):5756-5758. Epub 2017 Sept 19.
Andrews N, Stowe J, Miller E. No increased risk of Guillain-Barré syndrome after human papillomavirus vaccine: a self-controlled case-series study in Englandexternal icon Vaccine. 2017; 35(13):1729-1732. Epub 2017 Feb 27.
Martin Arias LH, Sanz R, Sainz M, Treceno C, Carvajal A. Guillain-Barre syndrome and influenza vaccines: a meta-analysisexternal icon Vaccine. 2015 Jul17;33:3773-3778. Epub 2015 May 18.
Kawai AT, Li L, Kulldorff M, Vellozzi C, Weintraub E, Baxter R, Belongia EA, Daley MF, Jacobsen SJ, Naleway A, Nordin JD, Lee GM. Absence of associations between influenza vaccines and increased risks of seizures, Guillain-Barré syndrome, encephalitis, or anaphylaxis in the 2012-2013 seasonexternal icon Pharmacoepidemiol Drug Saf. 2014 May;23(5):548-53. Epub 2014 Feb 4.
Nordin JD, Kharbanda EO, Vazquez-Benitez G, Lipkind H, Lee GM, Naleway AL. Monovalent H1N1 influenza vaccine safety in pregnant women, risks for acute adverse eventsexternal icon Vaccine. 2014 Sep 3;32(39):4985-92. Epub 2014 Jul 18.
Greene SK, Rett MD, Vellozzi C, L, Kulldorff M, Marcy SM, Daley MF, Belongia EA, Baxter R, Fireman BH, Jackson ML, Omer SB, Nordin JD, Jin R, Weintraub ES, Vijayadeva V, Lee GM. Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009-2011external icon PLoS One. 2013 Jun 26;8(6):e67185.
DA Salmon, M Proschan, R Forshee, Gargiullo P, Bleser W, Burwen DR, Cunningham F, Garman P, Greene SK, Lee GM, Vellozzi C, Yih WK, Gellin B, Lurie N, H1N1 GBS Meta-Analysis Working Group. Association between Guillain-Barre syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysisexternal icon Lancet. 2013 Apr 27;381(9867):1461-1468. Epub 2013 Mar 13.
Nelson KE. Invited commentary: Influenza vaccine and Guillain-Barre syndrome–is there a risk?external icon Am J Epidemiol. 2012 Jun 1;175(11):1129-32.
Greene SK, Rett M, Weintraub ES, Li L, Yin R, Amato AA, Ho DT, Sheikh SI, Fireman BH, Daley MF, Belongia EA, Jacobsen SJ, Baxter R, Lieu TA, Kulldorf M, Vellozzi C, Lee GM. Risk of confirmed Guillain-Barre syndrome following receipt of monovalent inactivated influenza A (H1N1) and seasonal influenza vaccines in the Vaccine Safety Datalink Project, 2009-2010external icon Am J Epidemiol. 2012 Jun 1;175(11):1100-9. Epub 2012 May 11.
JI Tokars, P Lewis, F DeStefano, Wise M, Viray M, Morgan O, Gargiullo P, Vellozzi C. The risk of Guillain-Barre syndrome associated with influenza A (H1N1) 2009 monovalent vaccine and 2009-2010 seasonal influenza vaccines: results from self-controlled analysesexternal icon Pharmacoepidemiol Drug Saf. 2012 May;21(5):546-552. Epub 2012 Mar 8.
Baxter R, Lewis N, Bakshi N, Vellozzi C, Klein NP, CISA Network. CISA Network: Recurrent Guillain-Barre syndrome following vaccinationexternal icon Clin Infect Dis. 2012 Mar;54(6):800-804. Epub 2012 Jan 19.
Wise ME, Viray M, Sejvar JJ, Lewis P, Baughman AL, Connor W, Danila R, Giambrone GP, Hale C, Hogan BC, Meek JI, Murphee R, Oh JY, Reingold A, Tellman N, Conner SM, Singleton JA, Lu PJ, DeStefano F, Fridkin SK, Vellozzi C, Morgan OW. Guillain-Barre syndrome during the 2009-2010 H1N1 influenza vaccination campaign: population-based surveillance among 45 million Americansexternal icon Am J Epidemiol. 2012 Jun 1;175(11):1110-1119. Epub 2012 May 11.
Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T Duran MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphael JC, Gaillard JL, Gault E. Guillain-Barre syndrome and influenza virus infectionexternal icon Clin Infect Dis. 2009 Jan 48(1):48-56 2009.
Juurlink DN, Stukel TA, Kwong J, Kopp A, McGeer A, Upshur RE, Manuel DG, Moineddin R, Wilson K. Guillain-Barre syndrome after influenza vaccination in adults: a population-based studyexternal icon Arch Intern Med. 2006 Nov 13;166(20):2217-2221.
Hughes RA, Charlton J, Latinovic R, Guilliford MC. No association between immunization and Guillain-Barre syndrome in the United Kingdom, 1992 to 2000external icon Arch Intern Med. 2006 Jun 26;166(12):1301-1304.
Haber P, DeStefano F, Angulo FJ, Iskander J, Shadomy SV, Weintraub E, Chen RT. Guillain-Barre syndrome following influenza vaccinationexternal icon JAMA. 2004 Nov 24;292(20):2478-2481.
Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash B, Clark S, Haber P, Stolley PD. The Guillain-Barre syndrome and the 1992-1993 and 1993-1994 influenza vaccinesexternal icon N Engl J Med. 1998 Dec 17;339(25):1797-1802.
Kaplan JE, Katona P, Hurwitz ES, Schonberger LB. Guillain-Barre syndrome in the United States, 1979-1980 and 1980-1981. Lack of an association with influenza vaccinationexternal icon JAMA. 1982 Aug 13;248(6):698-700.
Hurwitz ES, Schonberger LB, Nelson, DB, Homan RC. Guillain-Barre syndrome and the 1978-1979 influenza vaccineexternal icon N Engl J Med. 1981 Jun 25;304(26):1557-1561.