The New England Journal of Medicine
e-mail icon  FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |    Advanced Search
Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe
 
Original Article
Volume 339:1797-1802 December 17, 1998 Number 25
NextNext

The Guillain–Barré Syndrome and the 1992–1993 and 1993–1994 Influenza Vaccines
Tamar Lasky, Ph.D., Gina J. Terracciano, D.O., Laurence Magder, Ph.D., Carol Lee Koski, M.D., Michael Ballesteros, M.S., Denis Nash, M.P.H., Shelley Clark, M.S., Penina Haber, M.P.H., Paul D. Stolley, M.D., Lawrence B. Schonberger, M.D., and Robert T. Chen, M.D.

 Sign up for free e-toc
 

This Article
-Full Text
- PDF

Commentary
-Editorial
by Ropper, A. H.

Tools and Services
-Add to Personal Archive
-Add to Citation Manager
-Notify a Friend
-E-mail When Cited

More Information
-PubMed Citation
ABSTRACT

Background The number of reports of influenza-vaccine–associated Guillain–Barré syndrome to the national Vaccine Adverse Event Reporting System increased from 37 in 1992–1993 to 74 in 1993–1994, arousing concern about a possible increase in vaccine-associated risk.

Methods Patients given a diagnosis of the Guillain–Barré syndrome in the 1992–1993 and 1993–1994 influenza-vaccination seasons were identified in the hospital-discharge data bases of four states. Vaccination histories were obtained by telephone interviews during 1995–1996 and were confirmed by the vaccine providers. Disease with an onset within six weeks after vaccination was defined as vaccine-associated. Vaccine coverage in the population was measured through a random-digit–dialing telephone survey.

Results We interviewed 180 of 273 adults with the Guillain–Barré syndrome; 15 declined to participate, and the remaining 78 could not be contacted. The vaccine providers confirmed influenza vaccination in the six weeks before the onset of Guillain–Barré syndrome for 19 patients. The relative risk of the Guillain–Barré syndrome associated with vaccination, adjusted for age, sex, and vaccine season, was 1.7 (95 percent confidence interval, 1.0 to 2.8; P=0.04). The adjusted relative risks were 2.0 for the 1992–1993 season (95 percent confidence interval, 1.0 to 4.3) and 1.5 for the 1993–1994 season (95 percent confidence interval, 0.8 to 2.9). In 9 of the 19 vaccine-associated cases, the onset was in the second week after vaccination, all between day 9 and day 12.

Conclusions There was no increase in the risk of vaccine-associated Guillain–Barré syndrome from 1992–1993 to 1993–1994. For the two seasons combined, the adjusted relative risk of 1.7 suggests slightly more than one additional case of Guillain–Barré syndrome per million persons vaccinated against influenza.


Source Information

From the Department of Epidemiology and Preventive Medicine (T.L., L.M., M.B., D.N., S.C., P.D.S.) and the Department of Neurology (C.L.K.), School of Medicine, University of Maryland, Baltimore; the Vaccine Safety and Development Activity, Epidemiology and Surveillance Division, National Immunization Program (G.J.T., P.H., R.T.C.), and the Division of Viral and Rickettsial Diseases (L.B.S.), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta.

Address reprint requests to Dr. Lasky at the Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, 660 West Redwood St., Baltimore, MD 21201.

Full Text of this Article


This article has been cited by other articles:


HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  HELP  |  beta.nejm.org

Comments and questions? Please contact us.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.