Where can I get more information? GBS can range from a very mild case with brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently. Fortunately, most people eventually recover from even the most severe cases of GBS. After recovery, some people will continue to have some degree of weakness.
It is preceded by upper respiratory or gastrointestinal infection in about two-thirds of cases and is associated with some viral infections, including influenza.
GBS has also been associated with the swine-influenza vaccine. Thereafter, some studies have shown a small increased risk of GBS following receipt of seasonal and H1N1 monovalent influenza vaccines.
Studies over the years have also shown an increased risk of GBS following influenza infection, and the magnitude of risk is several times greater than that following influenza vaccination. Because GBS is rare, and even rarer following vaccination, it is difficult to estimate precise risk. We try to shed light on the complex relationship of GBS and its association with influenza and influenza vaccines over the past 35 years.
Thirty-five years later we are still grappling with this increased risk; concerns continue that the risk observed in might surface again following administration of influenza vaccines, which have a change in the strain nearly every year [ 2 ]. In this review, we purport that there may be enough evidence in to be somewhat reassured to move past the fear that influenza vaccines can cause GBS of the same magnitude that was described in The Swine Flu Affair [ 3 ].
It results from damage to the peripheral nerves and nerve roots, presenting with progressive bilateral symmetric weakness of the lower limbs over a period of 12 hours and reaching a plateau at approximately 28 days.
The onset of symptoms in about two-thirds of the cases is preceded by an upper respiratory or gastrointestinal infection. The annual incidence of GBS is 0. In children and adolescents, the range is 0. GBS is thought to be immune-mediated, in which antibodies in response to an antigenic stimulus, such as a bacterial or viral infection, cross-react with nerve ending antigens; this is often referred to as molecular mimicry.
Several infectious agents have been shown to be associated with GBS, most notably Campylobacter jejuni [ 9—13 ]. Investigations revealed up to a 8-fold increased risk of GBS following receipt of the influenza vaccine; the risk was found to be highest 2—3 weeks after vaccination.
The attributable risk was estimated at 1 additional case of GBS for every doses administered [ 114 ]. As a result of this adverse outcome following vaccination, as well as the fact that the pandemic never materialized, the influenza vaccination program was halted [ 3 ]. Sinceseveral published studies have assessed risk of GBS following receipt of seasonal inactivated influenza vaccines.
Most studies did not demonstrate a significant association between seasonal influenza vaccine and GBS, and most point estimates were not significant Figure 1 [ 16—23 ]. However, 2 studies reporting positive findings garnered much attention.
InJuurlink et al studied the association of GBS with influenza vaccines administered during — in Canada; using a self-controlled case series design, they found a small but significant increased risk of GBS in the 6 weeks following receipt of influenza vaccine relative risk [RR] 1.
The other notable study used US data from the period — 2 influenza seasons and demonstrated an overall increased RR of 1.
The RR of 1. Based on evidence from these 2 studies, a risk estimate of 1 additional GBS case per 1 million persons vaccinated has been communicated to the public and found in the Advisory Committee on Immunization Practices recommendations and the Vaccine Information Statements for influenza vaccines [ 224 ].
More recently, GBS risk assessment following influenza vaccination once again came to the forefront.
During the H1N1 influenza pandemic, vaccine safety surveillance was heightened and critical to the unadjuvanted monovalent inactivated influenza A H1N1 pH1N1 vaccine vaccination program that began in October GBS was a particularly important component of the pandemic response, because the swine-origin influenza vaccine was associated with an increased risk of GBS and the H1N1 influenza virus was also of swine origin, and there was a high degree of public interest regarding the safety of pandemic H1N1 vaccines.
In the United States, several federal agencies enhanced, adapted, or created surveillance systems to monitor pH1N1 vaccine safety including assessing the risk of GBS following vaccination [ 26 ].
The results of surveillance from most of these systems are captured in Table 1. At the Centers for Disease Control and Prevention CDCactive GBS case-finding surveillance using a population catchment of nearly 45 million people was implemented as part of the Emerging Infections Program EIPa long-standing collaboration with the CDC, local health departments, academic institutions, healthcare providers, specialist networks, and clinical laboratories [ 27 ].
In Novemberprospective cohort analyses showed a small increased risk of GBS within the 6 weeks following vaccination and an attributable risk of approximately 1 additional case of GBS per million persons vaccinated [ 28 ].
Final analyses confirmed this small increased risk within 6 weeks of vaccination [ 2930 ]. To increase the power to assess an increased risk of this rare disease, a meta-analysis combined data on 23 million persons vaccinated from all the federal systems that participated in pH1N1 vaccine safety monitoring.
Consistent with previous studies assessing the seasonal influenza vaccine data from earlier years [ 2022 ], this pooled analysis found an attributable risk of 1—3 additional GBS cases per million persons vaccinated with pH1N1 [ 33 ] Table 1.
Findings from European studies assessing the risk of GBS following the pH1N1 vaccines somewhat differed from what was observed in the United States. Finally, a study from Quebec, Canada, found an attributable risk of 2 additional cases of GBS per million doses administered, similar to the US surveillance findings; however, Quebec primarily used adjuvanted H1N1 vaccines.
Results of these studies from the United States, Europe, Canada, and internationally gave mixed results but in general suggest an increased risk of GBS after either adjuvanted or unadjuvanted vaccine.The estimated annual incidence in the United States is to per , persons.
Guillain-Barré syndrome is believed to result from an aberrant immune response that attacks nerve tissue. Jul 06, · The NINDS conducts research on disorders including Guillain-Barré syndrome and funds research at major institutions and universities. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.
Suggest a Research Topic. SHARE ON. Open Supplemental Data. Original Research ARTICLE Guillain-Barre syndrome (GBS) is currently the most frequent cause of acute flaccid paralysis worldwide.
United States. Reviewed by: Eduardo Nobile-Orazio, Università degli Studi di Milano, Italy Raghav Govindarajan, University of Missouri, United States. Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A (H1N1) Monovalent Vaccine United States, Patient history is important in diagnosis of Guillain-Barré syndrome.
The progression of ascending paralysis is a typical presentation. About 50% of cases also include a history of a recent infection or illness like a sore throat, a cold, the flu, or diarrhea.
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