Cited by 115Peripheral Neuropathies and DisordersInfluenza Virus Research StudiesPharmacovigilance and Adverse Drug Reactions

Risk of Guillain-Barre syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study.

Kwong, Jeffrey C, Vasa, Priya P, Campitelli, Michael A, Hawken, Steven, Wilson, Kumanan, Rosella, Laura C, Stukel, Therese A, Crowcroft, Natasha S +3 more·2013·The Lancet Infectious Diseases

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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Crossref · 10.1016/s1473-3099(13)70104-x

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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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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
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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