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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 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
In the citing paper
“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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Cites
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Time Lines of Infection and Disease in Human Influenza: A Review of Volunteer Challenge Studies
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GOODWIN, K., VIBOUD, C., & SIMONSEN, L. (2006) · Vaccine · doi:10.1016/j.vaccine.2005.08.105 · Cited by 1,064
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The spectrum of antecedent infections in Guillain-Barre syndrome
Jacobs, B. C., Rothbarth, P. H., van der Meché, F. G. A., Herbrink, P., Schmitz, P. I. M., de Klerk, M. A., & van Doorn, P. A. (1998) · Neurology · doi:10.1212/wnl.51.4.1110 · Cited by 824
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Tutorial in biostatistics: the self‐controlled case series method
Whitaker, H. J., Paddy Farrington, C., Spiessens, B., & Musonda, P. (2006) · Statistics in Medicine · doi:10.1002/sim.2302 · Cited by 719
The Guillain–Barré Syndrome and the 1992–1993 and 1993–1994 Influenza Vaccines
Lasky, T., Terracciano, G. J., Magder, L. S., Koski, C. L., Ballesteros, M., Nash, D., Clark, S., Haber, P., Stolley, P. D., Schonberger, L. B., et al. (1998) · New England Journal of Medicine · doi:10.1056/nejm199812173392501 · Cited by 501
Relative Incidence Estimation from Case Series for Vaccine Safety Evaluation
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Willison, H. J., Jacobs, B. C., & van Doorn, P. A. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00339-1 · Cited by 1,634
Shahrizaila, N., Lehmann, H. C., & Kuwabara, S. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00517-1 · Cited by 703
The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection
Sellers, S. A., Hagan, R. S., Hayden, F. G., & Fischer, W. A. (2017) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12470 · Cited by 455
Vaccine Safety: Myths and Misinformation
Geoghegan, S., O’Callaghan, K. P., & Offit, P. A. (2020) · Frontiers in Microbiology · doi:10.3389/fmicb.2020.00372 · Cited by 275
“However, concern about vaccine safety continues to be an important driver of decreased vaccine uptake in most contexts (Larson et al., 2014).”
BackgroundCOVID-19 and neuromuscular disorders
Guidon, A. C., & Amato, A. A. (2020) · Neurology · doi:10.1212/wnl.0000000000009566 · Cited by 283
Metadata
- 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 › Clinical 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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