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Occurrences of the Guillain–Barré Syndrome (GBS) After Vaccinations with the 1976 Swine A/H1N1 Vaccine, and Evolution of the Concern for an Influenza Vaccine-GBS Association

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Influenza Vaccines for the Future

Part of the book series: Birkhäuser Advances in Infectious Diseases ((BAID))

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Abstract

Implementation of a public vaccination program with A/New Jersey (A/NJ) vaccines in 1976 led to the recognition of an increased risk among vaccinated persons of developing the neurological disorder known as Guillain–Barré Syndrome (GBS). The attributable risk was 8.8 among adults in the 6-week period after vaccination or about 1 case per 100,000 vaccinations. Skepticism of the statistically significant association was resolved with a subsequent careful assessment in two states in the USA that confirmed the association. Subsequent efforts to confirm an association between other influenza vaccines and occurrence of GBS have mostly failed to identify an association but a suggestion of about one case of GBS per one million vaccinations has been reported. GBS has been associated with various other infections, illnesses, vaccinations, and other disorders. Campylobacter jejuni infections are accepted as inducing a risk for GBS and evidence suggests antiganglioside immune responses that react with the nerve myelin sheath as the mechanism. To assess this possibility, A/NJ and some other influenza vaccines were all shown to induce antiganglioside antibodies in mice; however, a relation of this finding in mice to GBS in humans has not been provided.

More recently, reports have indicated a risk of GBS after clinical influenza that is greater than the risk after influenza vaccination, suggesting that influenza vaccination may actually protect against GBS. Influenza, influenza vaccinations, and their role in the occurrences of GBS are evolving subjects. At present, however, occurrence of GBS cannot be considered an inherent risk of influenza vaccination.

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References

  1. Sencer DJ, Millar JD (2006) Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis 12:29–33

    Article  PubMed  Google Scholar 

  2. Schonberger LB, Bregman DJ, Sullivan-Bolyal JZ, Keenlyside RA, Ziegler DW, Retailliau HF, Eddins DL, Bryan JA (1979) Guillain–Barre syndrome following vaccination in the National Influenza Immunization Program. United States, 1976-1977. Am J Epidemiol 110:105–122

    PubMed  CAS  Google Scholar 

  3. Johnson DE (1982) Guillain-Barre syndrome in the US Army. Arch Neurol 39:21–24

    Article  PubMed  CAS  Google Scholar 

  4. Beghi E, Kurland LT, Mulder DW, Wiederholt WC (1985) Guillain-Barre syndrome: clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol 42:1053–1057

    Article  PubMed  CAS  Google Scholar 

  5. Kurland LT, Wiederholt WC, Kirkpatrick JW, Potter HG, Armstrong P (1985) Swine influenza vaccine and Guillain-Barre syndrome. Epidemic or Artifact? Arch Neurol 42:1089–1092

    Article  PubMed  CAS  Google Scholar 

  6. Marks JS, Halpin TJ (1980) Guillain-Barre syndrome in recipients of A/New Jersey influenza vaccine. JAMA 243:2490–2494

    Article  PubMed  CAS  Google Scholar 

  7. Breman JG, Hayner NS (1984) Guillain-Barre syndrome and its relationship to swine influenza vaccination in Michigan, 1976-1977. Am J Epidemiol 119:880–889

    PubMed  CAS  Google Scholar 

  8. Safranek TJ, Lawrence DN, Kurland LT, Culver DH, Wiederholt WC, Hayner NS, Osterholm MT, O’Brien P, Hughes JM, Expert Neurology Group (1991) Reassessment of the association between Guillain-Barre syndrome and receipt of swine influenza vaccine in 1976-1977: Results of a two-state study. Am J Epidemiol 133:940–951

    Google Scholar 

  9. Asbury AK, Arnason BG, Karp HR, McFarlin DE (1978) Criteria for diagnosis of Guillain-Barre syndrome. Ann Neurol 3:565–566

    Article  Google Scholar 

  10. Asbury AK, Cornblath DR (2004) Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 27:S21–S24

    Article  Google Scholar 

  11. Sejvar J, Cornblath D, Hughes R, The Brighton Collaboration Guillain-Barre Syndrome Working Group. (2008) The Brighton Collaboration case definition for Guillain-Barre syndrome as an adverse event following immunization. Inflammatory Neuropathy Consortium Meeting, Paris, France, July 2008

    Google Scholar 

  12. Kennedy RH, Danielson MA, Mulder DW, Kurland LT (1978) Guillain-Barre Syndrome. A 42-year epidemiologic and clinical study. Mayo Clin Proc 53:93–99

    PubMed  CAS  Google Scholar 

  13. van Doorn PA, Ruts L, Jacobs BC (2008) Clinical features, pathogenesis, and treatment of Guillain-Barre syndrome. Lancet Neurol 7:939–950

    Article  PubMed  Google Scholar 

  14. Leneman F (1966) The Guillain-Barre syndrome. Arch Intern Med 118:139–144

    Article  PubMed  CAS  Google Scholar 

  15. Melnick SC, Flewett TH (1964) Role of infection in the Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry 27:385–407

    Article  Google Scholar 

  16. Langmuir AD (1979) Guillain-Barre syndrome: the swine influenza virus vaccine incident in the United States of America, 1976-77: preliminary communication. J R Soc Med 72:660–669

    PubMed  CAS  Google Scholar 

  17. Schonberger LB, Hurwitz ES, Katona P, Holman RC, Bregman DJ (1981) Guillain-Barre syndrome: its epidemiology and associations with influenza vaccination. Ann Neurol 9:31–38

    Article  PubMed  Google Scholar 

  18. Black S, Eskola J, Siegrist C-A, Halsey N, MacDonald N, Law B, Miller E, Andrews N, Stowe J, Salmon D et al (2009) Importance of background rates of disease in assessment of vaccine safety during mass immunization with pandemic H1N1 influenza vaccines. Lancet 374(9707):2115–2122

    Article  PubMed  Google Scholar 

  19. Sliman NA (1978) Outbreak of Guillain-Barre syndrome associated with water pollution. Br Med J 1:751–752

    Article  PubMed  CAS  Google Scholar 

  20. Haymaker W, Kernohan JW (1949) The Landry-Guillain-Barre syndrome: a clinical pathologic report of 50 fatal cases and a review of the literature. Medicine 28:59–141

    PubMed  CAS  Google Scholar 

  21. Zhu J, Mix E, Link H (1998) Cytokine production and the pathogenesis of experimental autoimmune neuritis and Guillain-Barre syndrome. J Neuroimmunol 84:40–52

    Article  PubMed  CAS  Google Scholar 

  22. Ariga T, Miyatake T, Yu RK (2001) Recent studies on the roles of antiglycosphingolipids in the pathogenesis of neurological disorders. J Neurosci Res 65:363–370

    Article  PubMed  CAS  Google Scholar 

  23. McCarthy N, Giesecke J (2001) Incidence of Guillain-Barre syndrome following infection with Campylobacter jejuni. Am J Epidemiol 153:610–614

    Article  PubMed  CAS  Google Scholar 

  24. Yuki N (2001) Infectious origins of, and molecular mimicry in, Guillain-Barre and Fisher syndromes. Lancet Infect Dis 1:29–37

    Article  PubMed  CAS  Google Scholar 

  25. Rees JH, Soudain SE, Gregson NA, Hughes RAC (1995) Campylobacter jejuni infection and Guillain-Barre syndrome. BMJ 333:1374–1379

    CAS  Google Scholar 

  26. Bereswill S, Kist M (2003) Recent developments in Campylobacter pathogenesis. Curr Opin Infect Dis 16:487–491

    Article  PubMed  Google Scholar 

  27. Nachamkin I, Shadomy SV, Moran AP, Cox N, Fitzgerald C, Ung H, Corcoran AT, Iskander JK, Schonberger LB, Chen RT (2008) Anti-ganglioside antibody induction by swine (A/NJ/19976/H1N1) and other influenza vaccines: Insights into vaccine-associated Guillain-Barre syndrome. J Infect Dis 198:226–233

    Article  PubMed  CAS  Google Scholar 

  28. Hurwitz ES, Schonberger LB, Nelson DB, Holman RC (1981) Guillain-Barre syndrome and the 1978-1979 influenza vaccine. New Engl J Med 304:1557–1561

    Article  PubMed  CAS  Google Scholar 

  29. Kaplan JE, Katona P, Hurwitz ES, Schonberger LB (1982) Guillain-Barre syndrome in the United States, 1979-1980 and 1980-1981. JAMA 248:698–700

    Article  PubMed  CAS  Google Scholar 

  30. Kaplan JE, Schonberger LB, Hurwitz ES, Katona P (1983) Guillain-Barre syndrome in the United States, 1978-1981: Additional observations from the national surveillance system. Neurology 33:633–637

    Article  PubMed  CAS  Google Scholar 

  31. Lasky T, Terracciano GJ, Magder I, Koski CL, Ballesteros M, Nash D, Clark S, Haber P, Stolley PD, Schonberger LB et al (1998) The Guillain-Barre syndrome and the 1992-1993 and 1993-1994 influenza vaccines. New Engl J Med 339:1797–1802

    Article  PubMed  CAS  Google Scholar 

  32. Stowe J, Andrews N, Wise L, Miller E (2009) Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom general practice research database. Am J Epidemiol 169:382–388

    Article  PubMed  Google Scholar 

  33. Roscelli JD, Bass JW, Pang L (1991) Guillain-Barre syndrome and influenza vaccination in the US Army, 1980-1988. Am J Epidemiol 133:952–955

    PubMed  CAS  Google Scholar 

  34. Centers for Disease Control and Prevention (2003) Surveillance Summaries, January 24, 2003. Surveillance for Safety after immunization: vaccine adverse event reporting system (VAERS) – United States, 1991–2001. MMWR 52 (No. SS-1)

    Google Scholar 

  35. Geier MR, Geier DA, Zahalsky AC (2003) Influenza vaccination and Guillain Barre syndrome. Clin Immunol 107:116–121

    Article  PubMed  CAS  Google Scholar 

  36. Haber P, DeStefano F, Angulo FJ, Iskander J, Shadomy SV, Weintraub E, Chen RT (2004) Guillain-Barre syndrome following influenza vaccination. JAMA 292:2478–2481

    Article  PubMed  CAS  Google Scholar 

  37. Souayah N, Nasar A, Fareed M, Suri K, Qureshi AI (2007) Guillain-Barre syndrome after vaccination in United States. A report from the CDC/FDA vaccine adverse event reporting system. Vaccine 25:5253–5255

    Article  PubMed  Google Scholar 

  38. Juurlink DN, Stukel TA, Kwong J, Kopp A, McGeer A, Upshur RE, Manuel DG, Moineddin R, Wilson K (2006) Guillain-Barre syndrome after influenza vaccination in adults. Arch Intern Med 166:2217–2221

    Article  PubMed  Google Scholar 

  39. Haber P, Slade B, Iskander J (2007) Letter to the editor. Vaccine 25:8101

    Article  PubMed  Google Scholar 

  40. Tam CC, O’Brien SJ, Petersen I, Islam A, Hayward A, Rodrigues LC (2007) Guillain-Barre syndrome and preceding infection with Campylobacter, influenza and Epstein-Barr virus in the general practice research database. PLoS ONE 2(4):e344. doi:10.1371/journal.pone.0000344

    Article  PubMed  Google Scholar 

  41. Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand M-C, Enouf V, Rozenberg F, Caudie C, Annane D, van der Wert S et al (2009) Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis 48:48–56

    Article  PubMed  Google Scholar 

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Acknowledgments

Financial support: Research performed by the authors and summarized in this report was supported by Public Health Service Contract NO1-AI-30039 from the National Institute of Allergy and Infectious Diseases.

The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

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Authors and Affiliations

  1. Department of Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM280, Houston, TX, 77030, USA

    Robert B. Couch

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  1. Robert B. Couch
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Correspondence to Robert B. Couch .

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Editors and Affiliations

  1. Novartis Vaccines & Diagnostics S.r.l., Via Fiorentina 1, Siena, 53100, Italy

    Rino Rappuoli

  2. Novartis Vaccines & Diagnostics S.r.l., Via Fiorentina 1, Siena, 53100, Italy

    Giuseppe Del Giudice

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Couch, R.B. (2011). Occurrences of the Guillain–Barré Syndrome (GBS) After Vaccinations with the 1976 Swine A/H1N1 Vaccine, and Evolution of the Concern for an Influenza Vaccine-GBS Association. In: Rappuoli, R., Del Giudice, G. (eds) Influenza Vaccines for the Future. Birkhäuser Advances in Infectious Diseases. Springer, Basel. https://doi.org/10.1007/978-3-0346-0279-2_16

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