Risk of Guillain-Barr¨¦ syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study

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• 作者：Jeffrey C Kwong ; Priya P Vasa ; Michael A Campitelli ; Steven Hawken ; Kumanan Wilson ; Laura C Rosella ; Therese A Stukel ; Natasha S Crowcroft ; Allison J McGeer ; Lorne Zinman ; Shelley L Deeks
• 刊名：The Lancet Infectious Diseases
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：13
• 期：9
• 页码：769-776
• 全文大小：152 K

文摘

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Summary

Background

The possible risk of Guillain-Barr¨¦ syndrome from influenza vaccines remains a potential obstacle to achieving high vaccination coverage. However, influenza infection might also be associated with Guillain-Barr¨¦ syndrome. We aimed to assess the risk of Guillain-Barr¨¦ 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-Barr¨¦ syndrome during the risk interval compared with the control interval.

Findings

We identified 2831 incident admissions for Guillain-Barr¨¦ syndrome; 330 received an influenza vaccine and 109 had an influenza-coded health-care encounter within 42 weeks before hospitalisation. The risk of Guillain-Barr¨¦ 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-Barr¨¦ 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-Barr¨¦ syndrome admissions per million vaccinations, compared with 17¡¤2 Guillain-Barr¨¦ syndrome admissions per million influenza-coded health-care encounters.

Interpretation

The relative and attributable risks of Guillain-Barr¨¦ syndrome after seasonal influenza vaccination are lower than those after influenza illness. Patients considering immunisation should be fully informed of the risks of Guillain-Barr¨¦ syndrome from both influenza vaccines and influenza illness.

Funding

Canadian Institutes of Health Research.