Influenza vaccination and Guillain Barre syndrome small star,
filled.
Geier MR, Geier DA, Zahalsky AC.
The Genetic Centers of America, 14 Redgate Court, 20905, Silver Spring, MD, USA
Acute and severe Guillain Barre Syndrome (GBS) cases reported following
influenza vaccine to the Vaccine Adverse Events Reporting System (VAERS)
database from 1991 through 1999 were examined. Endotoxin concentrations were
measured using the Limulus amebocyte lysate assay in influenza vaccines. There
were a total of 382 cases of GBS reported to the VAERS database following
influenza vaccination (male/female ratio, 1.2). The median onset of GBS
following influenza vaccine was 12 days (interquartile range, 7 days to 21
days). There was an increased risk of acute GBS (relative risk, 4.3; 95%
confidence interval, 3.0 to 6.4) and severe GBS (relative risk, 8.5; 95%
confidence interval, 3.7 to 18.9) in comparison to an adult tetanus-diphtheria
(Td) vaccine control group. There were maximums in the incidence of GBS
following influenza vaccine that occurred approximately every third year (1993,
1996, and 1998) and statistically significant variation in the incidence of GBS
among different influenza manufacturers. Influenza vaccines contained from a
125- to a 1250-fold increase in endotoxin concentrations in comparison to an
adult Td vaccine control and endotoxin concentrations varied up to 10-fold among
different lots and manufacturers of influenza vaccine. The biologic mechanism
for GBS following influenza vaccine may involve the synergistic effects of
endotoxin and vaccine-induced autoimmunity. There were minimal potential
reporting biases in the data reported to the VAERS database in this study.
Patients should make an informed consent decision on whether to take this
optional vaccine based upon its safety and efficacy and physicians should
vigilantly report GBS following influenza vaccination to the VAERS in the United
States so that continued evaluation of the safety of influenza vaccine may be
undertaken.
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