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Guillain-Barré Syndrome After Influenza Vaccination in Adults
A Population-Based Study
David N. Juurlink, MD, PhD;
Therese A. Stukel, PhD;
Jeffrey Kwong, MD, MSc;
Alexander Kopp, BA;
Allison McGeer, MD, MSc;
Ross E. Upshur, MD, MSc;
Douglas G. Manuel, MD, MSc;
Rahim Moineddin, PhD;
Kumanan Wilson, MD, MSc
Arch Intern Med. 2006;166:2217-2221.
Background Whether influenza vaccination is associated with Guillain-Barré syndrome (GBS) remains uncertain.
Methods We conducted 2 studies using population-based health care data from the province of Ontario, Canada. In the first study, we used the self-matched case-series method to explore the temporal association between probable influenza vaccination (adults vaccinated during October and November) and subsequent hospitalization because of GBS. In the second study, we used time-series analysis to determine whether the institution of a universal influenza immunization program in October 2000 was associated with a subsequent increase in hospital admissions because of GBS at the population level.
Results From April 1, 1992, to March 31, 2004, we identified 1601 incident hospital admissions because of GBS in Ontario. In 269 patients, GBS was diagnosed within 43 weeks of vaccination against influenza. The estimated relative incidence of GBS during the primary risk interval (weeks 2 through 7) compared with the control interval (weeks 20 through 43) was 1.45 (95% confidence interval, 1.05-1.99; P = .02). This association persisted in several sensitivity analyses using risk and control intervals of different durations. However, a separate time-series analysis demonstrated no evidence of seasonality and revealed no statistically significant increase in hospital admissions because of GBS after the introduction of the universal influenza immunization program.
Conclusion Influenza vaccination is associated with a small but significantly increased risk for hospitalization because of GBS.
Author Affiliations: Institute of Clinical Evaluative Sciences (Drs Juurlink, Stukel, Kwong, and Manuel and Mr Kopp), Primary Care Research Unit (Dr Upshur), Sunnybrook and Women's College Health Sciences Centre, and Departments of Medicine (Drs Juurlink, McGeer, Moineddin, and Wilson), Health Policy Management and Evaluation (Drs Juurlink, McGeer, and Wilson), Public Health Sciences (Dr Upshur), and Microbiology, Mount Sinai Hospital (Dr McGeer), University of Toronto; and Toronto General Research Institute, Toronto General Hospital (Dr Wilson), Toronto, Ontario.
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