Risk of Guillain-Barre syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study.
Abstract
Background The possible risk of Guillain-Barré syndrome from influenza vaccines remains a potential obstacle to achieving high vaccination coverage. However, influenza infection might also be associated with Guillain-Barré syndrome. We aimed to assess the risk of Guillain-Barré syndrome after seasonal influenza vaccination and after influenza-coded health-care encounters.Methods We used the self-controlled risk interval design and linked universal health-care system databases from Ontario, Canada, with data obtained between 1993 and 2011. We used physician billing claims for influenza vaccination and influenza-coded health-care encounters to ascertain exposures. Using fixed-effects conditional Poisson regression, we estimated the relative incidence of hospitalisation for primary-coded Guillain-Barré syndrome during the risk interval compared with the control interval.Findings We identified 2831 incident admissions for Guillain-Barré syndrome; 330 received an influenza vaccine and 109 had an influenza-coded health-care encounter within 42 weeks before hospitalisation. The risk of Guillain-Barré syndrome within 6 weeks of vaccination was 52% higher than in the control interval of 9-42 weeks (relative incidence 1·52; 95% CI 1·17-1·99), with the greatest risk during weeks 2-4 after vaccination. The risk of Guillain-Barré syndrome within 6 weeks of an influenza-coded health-care encounter was greater than for vaccination (15·81; 10·28-24·32). The attributable risks were 1·03 Guillain-Barré syndrome admissions per million vaccinations, compared with 17·2 Guillain-Barré syndrome admissions per million influenza-coded health-care encounters.Interpretation The relative and attributable risks of Guillain-Barré syndrome after seasonal influenza vaccination are lower than those after influenza illness. Patients considering immunisation should be fully informed of the risks of Guillain-Barré syndrome from both influenza vaccines and influenza illness.Funding Canadian Institutes of Health Research.
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The attributable risk of Guillain-Barré syndrome admissions within 6 weeks was 1.03 per million influenza vaccinations, compared with 17.2 GBS admissions per million influenza-coded health-care encounters.
“The attributable risks of admissions for GBS within 6 weeks were 1⋅03 per million vaccinations, compared with 17⋅2 GBS admissions per million influenza-coded health-care encounters (Kwong et al., 2013).”
From Vaccine Safety: Myths and Misinformation (2020) · cites this paper as Kwong et al., 2013
The risk of Guillain-Barré syndrome within 6 weeks of influenza infection is greater than after influenza vaccination.
“The risk of GBS within 6 weeks of influenza infection is greater than after the vaccine.”
From Vaccine Safety: Myths and Misinformation (2020) · cites this paper as Kwong et al., 2013
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Update on Influenza Vaccines: Needs and Progress
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- Authors
- Kwong, J. C., Vasa, P. P., Campitelli, M. A., Hawken, S., Wilson, K., Rosella, L. C., Stukel, T. A., Crowcroft, N. S., McGeer, A. J., Zinman, L., & Deeks, S. L.
- Affiliations
- University Health Network (CA)
- St. Michael's Hospital (CA)
- Institute for Clinical Evaluative Sciences (CA)
- University of Ottawa (CA)
- University of Toronto (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Kwong, Jeffrey C
- ORCID
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 13
- Issue
- 9
- Pages
- 769-776
- ISSN
- 1473-3099 (ISSN-L)
- OpenAlex
- W2162677016
- Cited by
- 115
- References
- 31
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 7 · 2022: 6 · 2021: 14 · 2020: 13 · 2019: 12 · 2018: 6 · 2017: 7 · 2016: 8 · 2015: 11 · 2014: 10 · 2013: 1
- FWCI
- 6.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Ministry of Health and Long-Term Care
- Department of Family and Community Medicine, University of Toronto
- Institute for Clinical Evaluative Sciences
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- Guillain-Barré syndrome, seasonal influenza vaccination, influenza, vaccine adverse events, hospitalization, attributable risk, Ontario
- MeSH terms
- Adolescent, Adult, Aged, Canada, Female, Hospitalization, Humans, Influenza, Human, Influenza Vaccines, Male, Middle Aged, Risk Factors, Seasons, Vaccination, Vaccines, Inactivated, Incidence, Guillain-Barre Syndrome, Young Adult
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