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Eiffert SR, Kinlaw AC, Sleath BL, Thorpe CT, Traub R, Raman SR, Stürmer T. Vaccine patterns among older adults with Guillain-Barré syndrome and matched comparators, 2006-2019. J Am Geriatr Soc 2024. [PMID: 39090827 DOI: 10.1111/jgs.19110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/23/2024] [Accepted: 06/30/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Some vaccines have a small risk of triggering Guillain-Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-containing vaccine (GBS occurring within 42 days following vaccination). METHODS We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee-for-service Medicare enrollees. We defined the index date as an ICD-9-CM or ICD-10-CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non-GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC). RESULTS We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non-GBS comparators (95% CI -44, -38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine. CONCLUSIONS GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations.
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Affiliation(s)
- Samantha R Eiffert
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Carolyn T Thorpe
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Rebecca Traub
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sudha R Raman
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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2
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Kiely M, Tadount F, Lo E, Sadarangani M, Wei SQ, Rafferty E, Quach C, MacDonald SE. Sex differences in adverse events following seasonal influenza vaccines: a meta-analysis of randomised controlled trials. J Epidemiol Community Health 2023; 77:791-801. [PMID: 37734937 PMCID: PMC10646905 DOI: 10.1136/jech-2023-220781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Despite being a vaccine-preventable disease, influenza remains a major public health threat with vaccine safety concerns reducing vaccine acceptability. Immune responses to vaccines and adverse events may differ between males and females, but most studies do not report results by sex. Using data from clinical trials, we explored sex differences in adverse events following seasonal influenza vaccines. METHODS We obtained data for phase III randomised controlled trials identified through a systematic review and clinical trials registries, and performed a two-stage meta-analysis. Risk ratios (RR) and 95% confidence intervals (95% CI) comparing solicited reactions in females versus males were pooled using the Mantel-Haenszel method and a random-effects model. We used the ROBINS-I tool to assess risk of bias and the I2 statistic for heterogeneity. Main analysis was stratified by age: 18-64 years and ≥65 years. RESULTS The dataset for this analysis included 34 343 adults from 18 studies (12 with individual-level data and 6 with aggregate data). There was a higher risk of injection site reactions in females compared with males for both younger and older participants, with RRs of 1.29 (95% CI 1.21 to 1.37) and 1.43 (95% CI 1.28 to 1.60), respectively. Higher risk in females was also observed for systemic reactions, with RRs of 1.25 (95% CI 1.20 to 1.31) and 1.27 (95% CI 1.20 to 1.34) for younger and older participants, respectively. We also observed elevated risks of severe reactions in females, with a higher RR in younger versus older participants for systemic reactions (RRs 2.12 and 1.48, p=0.03, I2=79.7%). RRs were not found to vary between quadrivalent and trivalent vaccines. CONCLUSION This meta-analysis suggested a higher risk of solicited reactions following influenza vaccines for females compared with males, irrespective of age and vaccine type. Transparent communication of this risk could increase the trust in vaccines and limit vaccine hesitancy. Future studies should report results stratified by sex and explore the role of gender in the occurrence of adverse events.
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Affiliation(s)
- Marilou Kiely
- Department of Microbiology, Infectiology, immunology & Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Fazia Tadount
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Ernest Lo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University if British Columbia, Vancouver, British Columbia, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | | | - Caroline Quach
- Department of Microbiology, Infectiology, immunology & Pediatrics, University of Montreal, Montreal, Quebec, Canada
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Eiffert SR, Stürmer T, Thorpe CT, Traub R, Raman SR, Pate V, Kinlaw AC. Vaccine patterns among patients diagnosed with Guillain-Barré Syndrome and matched counterparts in a Medicare supplemental population, 2000-2020. Vaccine 2023; 41:5763-5768. [PMID: 37573203 PMCID: PMC10528847 DOI: 10.1016/j.vaccine.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
Some vaccines have a small risk of Guillain-Barré Syndrome (GBS), a rare autoimmune disorder characterized by paralysis if untreated. The CDC's Advisory Committee on Immunization Practices (ACIP) guidelines do not consider GBS a precaution for future vaccines unless GBS developed within six weeks after a tetanus-toxoid-containing vaccine or influenza vaccine. Our goal was to describe vaccine patterns before and after GBS diagnosis. We matched each of 709 patients diagnosed with GBS from 2002 to 2020 with Medicare supplemental insurance to 10 counterparts without GBS (1:10) on age and sex. Propensity score-based weighting balanced covariates between groups, and we estimated weighted mean cumulative counts (wMCC) of vaccines/person before and after GBS diagnosis. Among patients with GBS, 7% were diagnosed within 42 days after a vaccine. Prior to GBS diagnosis, the wMCC of vaccines per person was similar between GBS cases and matched counterparts, but after two years of follow-up, GBS patients received 21 fewer vaccines/100 people than counterparts (wMCC difference -0.21 vaccines/person, 95% CI -0.24 to -0.18); GBS patients received 16 vaccines/100 people while matched counterparts received 36/100. Vaccine use was reduced following GBS diagnosis despite no ACIP precaution for most (93%) patients in this study. The observed drop in vaccines after GBS diagnosis indicates a disconnect between clinical practice and current recommendations.
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Affiliation(s)
- Samantha R Eiffert
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, USA.
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carolyn T Thorpe
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, USA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rebecca Traub
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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4
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Goetz V, Yang DD, Abid H, Roux CJ, Levy R, Kossorotoff M, Desguerre I, Angoulvant F, Aubart M. Neurological features related to influenza virus in the pediatric population: a 3-year monocentric retrospective study. Eur J Pediatr 2023:10.1007/s00431-023-04901-9. [PMID: 36947244 DOI: 10.1007/s00431-023-04901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Abstract
Influenza virus is generally characterized by fever, myalgia, and respiratory symptoms. Neurological entities have already been described, such as acute necrotizing encephalitis (ANE). We aimed to highlight the non-exceptional nature and explore the clinical spectrum and evolution of neurological features related to influenza virus in children. This monocentric observational study included patients under 18 years old, positive for influenza virus, between January 2017 and April 2019 in a pediatric university hospital. Patients were classified into two groups: those with or without a previous significant neurological or metabolic disorder. Two hundred eighty-nine children were identified with influenza infection. Thirty seven had a neurological manifestation: 14 patients who had previous significant neurological or metabolic disorder and 23 patients with no medical history. We identified several clinical patterns: 22 patients had seizures, 7 behavior disorders, 5 disturbances of consciousness, and 3 motor deficits. Four were diagnosed with a known influenza-associated neurological syndrome: 1 ANE, 1 cytotoxic lesion of the corpus callosum, 1 hemiconvulsion-hemiplegia-epilepsia syndrome, and 1 recurrent encephalitis in the context of a RANBP2 mutation. The neurological outcome was favorable in most cases. None of the patients with previous significant disorder retained sequalae or had a recurrence. Two patients had a fatal outcome, and both had a predisposing disorder. CONCLUSION Various neurological manifestations can be associated with influenza virus. Certain entities led to a poor prognosis, but in most cases, symptoms improved within a few days. The severity of the neurological manifestations correlated with previous neurological or metabolic disorders. WHAT IS KNOWN • Influenza viruses are well known pathogens with a seasonal epidemic evolution, particularly affecting children. These viruses cause acute fever with respiratory symptoms, associated with myalgia and headaches. Neurological presentation in influenza-virus infection is a well-established possibility as influenza virus is considered to be responsible for 27 to 36% of childhood encephalitis. Some specific and severe entity as acute necrotizing encephalitis, cytotoxic lesion of the corpus callosum, or Hemiconvulsion-hemiplegia-epilepsy syndrome are well described. WHAT IS NEW • In a French monocentric cohort of 37 children with influenza-related neurologic manifestations, the majority of these manifestations, including seizure, drowsiness, motor deficiency, hallucination… are self limiting and do not lead to after-effects. In rare cases (4/37), they may reveal severe encephalitis requiring rapid and appropriate treatment. Otherwise, comparison of a group of 14 children with underlying neurological or metabolic disorder with a group of 23 children free of any significant disorder show that the severity of the neurological manifestations was largely related to previous neurological or metabolic disorders highlighting the importance of vaccination in this population.
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Affiliation(s)
- Violette Goetz
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - David-Dawei Yang
- Pediatric Emergency Department, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France
| | - Hanene Abid
- Virology Laboratory, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France
| | - Charles-Joris Roux
- Paediatric Radiology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Raphael Levy
- Paediatric Radiology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - François Angoulvant
- Pediatric Emergency Department, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France.
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.
| | - Mélodie Aubart
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France.
- INSERM U1163 Institut HU Imagine, Laboratory of Human Genetics of Infectious Disease, Paris, France.
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5
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Zhai Q, Guo C, Xue F, Qiang J, Li C, Guo L. Guillain-Barré Syndrome in Northern China: A Retrospective Analysis of 294 Patients from 2015 to 2020. J Clin Med 2022; 11:jcm11216323. [PMID: 36362550 PMCID: PMC9658830 DOI: 10.3390/jcm11216323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Acute motor axonal neuropathy (AMAN) was first reported to be the main subtype of Guillain−Barré syndrome (GBS) in northern China in the 1990s. About 30 years has passed, and it is unknown whether the disease spectrum has changed over time in northern China. We aimed to study the epidemiological, clinical, and electrophysiological features of GBS in northern China in recent years. Methods: We retrospectively analyzed the medical records of GBS patients admitted to the Second Hospital of Hebei Medical University in northern China from 2015 to 2020. Results: A total of 294 patients with GBS were enrolled, with median age 53 years and 60.5% of participants being male, and a high incidence in summer and autumn. AMAN was still the predominant subtype in northern China (40.1%). The AMAN patients had shorter time to nadir, longer hospitalization time, and a more severe HFGS score at discharge than acute inflammatory demyelinating polyneuropathies (AIDP) (p < 0.05). With SPSS multivariable logistic regression analysis, we found the GBS disability score (at admission), dysphagia, and dysautonomia were independent risk factors for GBS patients requiring MV (p < 0.05). In comparison with other regions, the proportion of AMAN in northern China (40.1%) was higher than in eastern (35%) and southern (19%) China. Conclusions: AMAN is still the predominant subtype in northern China after 30 years, but there have been changes over time in the GBS spectrum since the 1990s. There are regional differences in GBS in China.
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Affiliation(s)
- Qiongqiong Zhai
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Cheng Guo
- Department of Pediatrics, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Jing Qiang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Chaonan Li
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
- Correspondence:
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6
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Wang F, Wang D, Wang Y, Li C, Zheng Y, Guo Z, Liu P, Zhang Y, Wang W, Wang Y, Hou H. Population-Based Incidence of Guillain-Barré Syndrome During Mass Immunization With Viral Vaccines: A Pooled Analysis. Front Immunol 2022; 13:782198. [PMID: 35185881 PMCID: PMC8850251 DOI: 10.3389/fimmu.2022.782198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/14/2022] [Indexed: 01/22/2023] Open
Abstract
Misunderstanding temporal coincidence of adverse events during mass vaccination and invalid assessment of possible safety concerns have negative effects on immunization programs, leading to low immunization coverage. We conducted this systematic review and meta-analysis to identify the incidence rates of GBS that are temporally associated with viral vaccine administration but might not be attributable to the vaccines. By literature search in Embase and PubMed, we included 48 publications and 2,110,441,600 participants. The pooled incidence rate of GBS was 3.09 per million persons (95% confidence interval [CI]: 2.67 to 3.51) within six weeks of vaccination, equally 2.47 per 100,000 person-year (95%CI: 2.14 to 2.81). Subgroup analyses illustrated that the pooled rates were 2.77 per million persons (95%CI: 2.47 to 3.07) for individuals who received the influenza vaccine and 2.44 per million persons (95%CI: 0.97 to 3.91) for human papillomavirus (HPV) vaccines, respectively. Our findings evidence the GBS-associated safety of virus vaccines. We present a reference for the evaluation of post-vaccination GBS rates in mass immunization campaigns, including the SARS-CoV-2 vaccine.
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Affiliation(s)
- Fengge Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Donglan Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yingjie Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Cancan Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yulu Zheng
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Zheng Guo
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Pengcheng Liu
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yichun Zhang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Wei Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China.,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Haifeng Hou
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China.,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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7
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Salmon DA, Dudley MZ, Carleton BC. Guillain-Barré Syndrome Following Influenza Vaccines Affords Opportunity to Improve Vaccine Confidence. J Infect Dis 2021; 223:355-358. [PMID: 33137189 PMCID: PMC8502426 DOI: 10.1093/infdis/jiaa544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 08/25/2023] Open
Affiliation(s)
- Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
- Pharmaceutical Outcomes Program, British Columbia Children’s Hospital, Vancouver, Canada
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8
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Principi N, Esposito S. Do Vaccines Have a Role as a Cause of Autoimmune Neurological Syndromes? Front Public Health 2020; 8:361. [PMID: 32850592 PMCID: PMC7399175 DOI: 10.3389/fpubh.2020.00361] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/24/2020] [Indexed: 01/05/2023] Open
Abstract
Vaccines are the most important preventive measure against infectious diseases presently available. Although they have led to the eradication or the elimination of some infectious diseases, concerns about safety are among the main reasons for vaccine hesitancy. In some cases, the biological plausibility of a given damage in association with the temporal association between vaccine administration and disease development makes it difficult to define causality and can justify hesitancy. Only well-conducted epidemiological studies with adequate evaluation of results can clarify whether a true association between vaccines and adverse event development truly exists. Autoimmune neurological syndromes that follow vaccine use are among these. In this narrative review, the potential association between vaccines and the development of these syndromes are discussed. Literature analysis showed that most of the associations between vaccines and nervous system autoimmune syndromes that have been reported as severe adverse events following immunization are no longer evidenced when well-conducted epidemiological studies are carried out. Although the rarity of autoimmune diseases makes it difficult to strictly exclude that, albeit exceptionally, some vaccines may induce an autoimmune neurological disease, no definitive demonstration of a potential role of vaccines in causing autoimmune neurological syndromes is presently available. Consequently, the fear of neurological autoimmune disease cannot limit the use of the most important preventive measure presently available against infectious diseases.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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9
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Lee H, Kim HJ, Choe YJ, Shin JY. Signals and trends of Guillain-Barré syndrome after the introduction of live-attenuated vaccines for influenza in the US and South Korean adverse event reporting systems. Vaccine 2020; 38:5464-5473. [PMID: 32600907 DOI: 10.1016/j.vaccine.2020.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/23/2020] [Accepted: 06/14/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND With the advent of live-attenuated, quadrivalent, and cell-cultured vaccines for influenza, there have been discussions on the safety of these vaccines compared to conventional vaccines (such as inactivated, trivalent, and egg-cultured vaccines) because of the development of neurological adverse events (AEs). This study aimed to compare the trends and safety signals in the AE reporting systems of the US and South Korea and, more particularly, to evaluate the association between influenza vaccination and Guillain-Barré syndrome (GBS). METHODS In total, 400,535 AE reports from the US Vaccine Adverse Event Reporting System (VAERS) and 28,766 AE reports from the Korea Adverse Event Reporting System (KAERS) between 2005 and 2017 were assessed. Disproportionality analysis was performed to detect the safety signals and examine the potential risk of GBS with influenza vaccination using the case/non-case approach. RESULTS In both databases, GBS was the most frequently reported AE following influenza immunization. Using the case/non-case approach, the adjusted reporting odds ratio (ROR) of GBS was 3.57 (95% confidence interval [CI], 3.16-4.03) and 3.09 (95% CI, 0.83-11.45) in the VAERS and KAERS data, respectively. People vaccinated with live-attenuated vaccines reported 2.30 times (95% CI, 1.74-3.05) more cases of GBS than those vaccinated with other types of vaccines. CONCLUSIONS Our analysis of the VAERS and KAERS reports for AEs following immunization (AEFI) for influenza shows the need for cautious monitoring regarding the development of GBS after influenza vaccination, particularly, after live-attenuated vaccination. However, owing to potential reporting bias caused by limited AEFI reports after the introduction of new types of influenza vaccines, further prospective safety studies are needed.
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Affiliation(s)
- Hankil Lee
- CONNECT-AI Research Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Hyun Jeong Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-to, Jangan-gu, Suwon, Gyeong gi-do, South Korea.
| | - Young June Choe
- Department of Social and Preventive Medicine, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do 24252, South Korea.
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-to, Jangan-gu, Suwon, Gyeong gi-do, South Korea.
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10
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Petráš M, Králová Lesná I, Dáňová J, Čelko AM. Is an Increased Risk of Developing Guillain-Barré Syndrome Associated with Seasonal Influenza Vaccination? A Systematic Review and Meta-Analysis. Vaccines (Basel) 2020; 8:vaccines8020150. [PMID: 32230964 PMCID: PMC7349742 DOI: 10.3390/vaccines8020150] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 01/04/2023] Open
Abstract
While the weight of epidemiological evidence does not support a causal link with influenza vaccination evaluated over the last 30 years, Guillain–Barré syndrome (GBS) has been considered a vaccine-associated adverse event of interest since 1976. To investigate the existence of GBS risk after vaccination against seasonal influenza, a systematic review and meta-analysis have been conducted based on 22 eligible epidemiological studies from 1981 to 2019 reporting 26 effect sizes (ESs) in different influenza seasons. The primary result of our meta-analysis pointed to no risk of vaccine-associated GBS, as documented by a pooled ES of 1.15 (95% CI: 0.97–1.35). Conversely, an obvious high risk of GBS was observed in patients with previous influenza-like illness (ILI), as demonstrated by a pooled ES of 9.6 (95% CI: 4.0–23.0) resulting from a supplementary analysis. While the meta-analysis did not confirm the putative risk of vaccine-associated GBS suggested by many epidemiological studies, vaccination against seasonal influenza reduced the risk of developing ILI-associated GBS by about 88%. However, to obtain strong evidence, more epidemiological studies are warranted to establish a possible coincidence between vaccination and ILI prior to GBS onset.
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Affiliation(s)
- Marek Petráš
- Department of Epidemiology and Biostatistics, Charles University in Prague-Third Faculty of Medicine, 100 00 Prague, Czech Republic; (J.D.); (A.M.Č.)
- Correspondence: ; Tel.:+00420-774-738-727
| | - Ivana Králová Lesná
- Laboratory for Atherosclerosis Research, Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic;
| | - Jana Dáňová
- Department of Epidemiology and Biostatistics, Charles University in Prague-Third Faculty of Medicine, 100 00 Prague, Czech Republic; (J.D.); (A.M.Č.)
| | - Alexander M. Čelko
- Department of Epidemiology and Biostatistics, Charles University in Prague-Third Faculty of Medicine, 100 00 Prague, Czech Republic; (J.D.); (A.M.Č.)
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11
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Grave C, Boucheron P, Rudant J, Mikaeloff Y, Tubert-Bitter P, Escolano S, Hocine MN, Coste J, Weill A. Seasonal influenza vaccine and Guillain-Barré syndrome: A self-controlled case series study. Neurology 2020; 94:e2168-e2179. [PMID: 32098853 DOI: 10.1212/wnl.0000000000009180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the risk of Guillain-Barré syndrome (GBS) following seasonal influenza vaccination based on French nationwide data. METHODS All cases of GBS occurring in metropolitan France between September 1 and March 31 from 2010 to 2014 were identified from the French national health data system. Data were analyzed according to the self-controlled case series method. The risk period started 1 day after the patient received vaccine (D1) until 42 days after vaccination (D42). The incidence of GBS during this risk period was compared to that of the control period (D43-March 31). The incidence rate ratio (IRR) was estimated after adjusting for seasonality and presence or not of acute infections. RESULTS Between September and March, of the 2010/2011 to 2013/2014 influenza vaccination seasons, 3,523 cases of GBS occurred in metropolitan France and were included in the study. Among them, 15% (527 patients) had received influenza vaccination. A total of 140 patients developed GBS during the 42 days following influenza vaccination. The crude risk of developing GBS was not significantly increased during the 42 days following influenza vaccination (IRR, 1.02; 95% confidence interval [CI], 0.83-1.25; p = 0.85). This result remained nonsignificant after adjustment for calendar months and the incidence of acute gastrointestinal and respiratory tract infections (IRR, 1.10; 95% CI, 0.89-1.37; p = 0.38). In contrast, the risk of GBS was fourfold higher after acute respiratory tract infection (IRR, 3.89; 95% CI, 3.52-4.30; p < 0.0001) or gastrointestinal infection (IRR, 3.64; 95% CI, 3.01-4.40; p < 0.0001). CONCLUSIONS No association between seasonal influenza vaccination and GBS was shown during the 42 days following vaccination.
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Affiliation(s)
- Clémence Grave
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France.
| | - Pauline Boucheron
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Jérémie Rudant
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Yann Mikaeloff
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Pascale Tubert-Bitter
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Sylvie Escolano
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Mounia N Hocine
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Joël Coste
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Alain Weill
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
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Comparison of alpha-spending plans for near real-time monitoring for Guillain-Barré Syndrome after influenza vaccination during the 2010/11 influenza season. Vaccine 2020; 38:2221-2228. [PMID: 31932134 DOI: 10.1016/j.vaccine.2019.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Near real-time surveillance of the influenza vaccine, which is administered to a large proportion of the US population every year, is essential to ensure safety of the vaccine. For efficient near real-time surveillance, it is key to select appropriate parameters such as monitoring start date, number of interim tests and a scheme for spending a pre-defined total alpha across the entire influenza season. Guillain-Barré Syndrome, shown to be associated with the 1976 influenza vaccine, is used to evaluate how choices of these parameters can affect whether or not a signal is detected and the time to signal. FDA has been monitoring for the risk of GBS after influenza vaccination for every influenza season since 2008. METHODS Using Medicare administrative data and the Updating Sequential Probability Ratio Test methodology to account for claims delay, we evaluated a number of different alpha-spending plans by varying several parameters. RESULTS For relative risks of 5 or greater, almost all alpha-spending plans have 100% power; however, for relative risks of 1.5 or lower, the constant and O'Brien-Fleming plans have increasingly more power. For RRs of 1.5 and greater, the Pocock plan signals earliest but would not signal at a RR of 1.25, as observed in prior influenza seasons. There were no remarkable differences across the different plans in regards to monitoring start dates defined by the number of vaccinations; reducing the number of interim tests improves performance only marginally. CONCLUSIONS A constant alpha-spending plan appears to be robust, in terms of power and time to detect a signal, across a range of these parameters, including alternate monitoring start dates based on either cumulative vaccinations or GBS claims observed, frequency of monitoring, hypothetical relative risks, and vaccine uptake patterns.
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Tadount F, Doyon-Plourde P, Rafferty E, MacDonald S, Sadarangani M, Quach C. Is there a difference in the immune response, efficacy, effectiveness and safety of seasonal influenza vaccine in males and females? - A systematic review. Vaccine 2019; 38:444-459. [PMID: 31711676 DOI: 10.1016/j.vaccine.2019.10.091] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Seasonal influenza is an important cause of morbidity and mortality, despite being vaccine-preventable. Sex factors (genes and hormones) seem to impact individuals' susceptibility to infectious diseases and their response to vaccination. However, most vaccine studies do not explicitly assess sex differences in vaccine response, but rather adjust for sex. METHODS We conducted a systematic review to analyze immunogenicity, efficacy, effectiveness and/or safety of seasonal influenza vaccine data stratified by sex. We searched PubMed, EMBASE, CINAHL, Web of Science and clinicaltrials.gov for observational studies and phase III/IV trials from January 1990 to June 2018, published in English or French. Two reviewers independently screened all references, then proceeded to data extraction and quality assessment using the Cochrane tools (RoB and ROBINS-I) on included studies. RESULTS Of the 5,745 citations retrieved, 46 studies were included in the SR. Overall, 18 studies assessed immunogenicity, 1 estimated efficacy, 6 measured effectiveness and 25 evaluated safety of seasonal influenza vaccine in females and males (four studies reported on two sex-stratified outcomes concomitantly). CONCLUSION No clear conclusion could be drawn regarding the effect of sex on the immunogenicity and effectiveness of seasonal influenza vaccine, but higher rates of adverse events following immunization (AEFIs) were reported in females. The heterogeneity of data and studies' low quality prevented us from conducting a meta-analysis. There is a need to emphasize on the appropriate use of the terms sex and gender in biomedical research. Evidence of higher quality is needed to better understand sex differences in response to influenza vaccine.
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Affiliation(s)
- Fazia Tadount
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal (QC) Canada; Research Institute - CHU Sainte Justine, Montreal (QC) Canada
| | - Pamela Doyon-Plourde
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal (QC) Canada; Research Institute - CHU Sainte Justine, Montreal (QC) Canada
| | - Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton (AB) Canada
| | | | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver (BC) Canada; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver (BC) Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal (QC) Canada; Research Institute - CHU Sainte Justine, Montreal (QC) Canada; Department of Pediatric Laboratory Medicine, CHU Sainte-Justine, Montreal (QC) Canada; Infection Prevention & Control, CHU Sainte-Justine, Montreal (QC) Canada.
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14
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Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, van Doorn PA, Dourado ME, Hughes RAC, Islam B, Kusunoki S, Pardo CA, Reisin R, Sejvar JJ, Shahrizaila N, Soares C, Umapathi T, Wang Y, Yiu EM, Willison HJ, Jacobs BC. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15:671-683. [PMID: 31541214 PMCID: PMC6821638 DOI: 10.1038/s41582-019-0250-9] [Citation(s) in RCA: 401] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
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Affiliation(s)
- Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Melissa R Mandarakas
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francisco A A Gondim
- Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Kathleen Bateman
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maria L B Ferreira
- Department of Neurology, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mario E Dourado
- Department of Integrative Medicine, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Richard A C Hughes
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Badrul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Cristiane Soares
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Eppie M Yiu
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J Willison
- College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
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15
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Arya DP, Said MA, Izurieta HS, Perez-Vilar S, Zinderman C, Wernecke M, Alexander M, White T, Su IH, Lufkin B, MaCurdy T, Kelman J, Forshee R. Surveillance for Guillain-Barré syndrome after 2015-2016 and 2016-2017 influenza vaccination of Medicare beneficiaries. Vaccine 2019; 37:6543-6549. [PMID: 31515146 DOI: 10.1016/j.vaccine.2019.08.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a serious acute demyelinating disease, an increased risk of which was found after the 1976 swine flu vaccinations. The U.S. Food and Drug Administration, in collaboration with the Centers for Medicare & Medicaid Services, has been conducting active surveillance for GBS after influenza vaccinations of Medicare Fee-For-Service beneficiaries since 2009. METHODS We conducted active surveillance for GBS claims in the 2015-2016 and 2016-2017 influenza seasons using the Updating Sequential Probability Ratio Test (USPRT) to monitor for signals of GBS risk. We performed self-controlled risk interval (SCRI) analyses at the end of both seasons, including chart confirmation in the 2015-2016 season, to estimate the odds ratio of GBS risk. We used 1-42 and 8-21 days post-vaccination as primary and secondary risk windows, respectively, and 43-84 days post-vaccination as the control window. RESULTS Over 13 million beneficiaries were vaccinated in each season. USPRT found a low magnitude signal for GBS in both seasons. SCRI analyses did not find excess GBS risk following any influenza vaccine for days 1-42 post-vaccination in either season. In the 2015-2016 season, for the 8-21 day window, our chart-confirmation showed an attributable GBS risk of 0.87 (95% CI: 0.16, 1.49) and 1.68 (95% CI: 0.69, 2.41) cases per million vaccinees after all seasonal and high dose (HD) vaccines, respectively, an elevated GBS risk for beneficiaries aged ≥75 years following all seasonal vaccines (OR: 2.25; 95% CI: 1.15, 4.39) and HD vaccine (OR: 3.67, 95% CI: 1.52, 8.85), and an elevated GBS risk for males who received seasonal vaccines (OR: 2.18; 95% CI: 1.15, 4.15) and HD vaccine (OR: 3.33; 95% CI: 1.35, 8.20). The finding of elevated GBS risk with advancing age and in males is consistent with literature; however, a distinction between HD and SD was a new finding. In the 2016-17 season, for the 8-21 day window, attributed cases showed an attributable GBS risk of 0.87 (95% CI: 0.03, 1.61) and 1.11 (95% CI: 0.00, 2.01) cases per million vaccinees after all seasonal and HD vaccines, respectively. We found no excess GBS risk for standard dose vaccines in the 8-21 day window in either season. CONCLUSIONS Our primary analysis finding of no excess GBS risk during both seasons was reassuring. The slightly elevated GBS risk, although in the expected range, in the 8-21 day window after all seasonal and high dose vaccines, but not after standard dose vaccines is hypothesis-generating because the difference may be due to vaccine factors such as antigen amount or strains in various seasons or due to host factors.
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Affiliation(s)
- Deepa P Arya
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | - Maria A Said
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Silvia Perez-Vilar
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Craig Zinderman
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | - Thomas MaCurdy
- Acumen, LLC, Burlingame, CA, USA; Stanford University, Stanford, CA, USA
| | - Jeffrey Kelman
- Centers for Medicare & Medicaid Services, Washington, DC, USA
| | - Richard Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
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Forshee RA, Hu M, Arya D, Perez-Vilar S, Anderson SA, Lo AC, Swarr M, Wernecke M, MaCurdy T, Chu S, Kelman J. A simulation study of the statistical power and signaling characteristics of an early season sequential test for influenza vaccine safety. Pharmacoepidemiol Drug Saf 2019; 28:1077-1085. [PMID: 31222967 DOI: 10.1002/pds.4807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE The US Food and Drug Administration monitors the risk of Guillain-Barré syndrome (GBS) following influenza vaccination using several data sources including Medicare. In the 2017 to 2018 season, we transitioned our near real-time surveillance in Medicare to more effectively detect large GBS risk increases early in the season while avoiding false positives. METHODS We conducted a simulation study examining the ability of the updating sequential probability ratio test (USPRT) to detect substantially elevated GBS risk in the 8- to 21-day postvaccination versus 5× to 30× the historical rate. We varied the first testing week (weeks 5-8) and the null rate (1×-3×) and evaluated power. We estimated signal probability and the risk ratio (RR) after signaling when high-risk seasons were rare. RESULTS Applying fixed alternatives, we found >80% power to detect a risk 30× the historical rate in week 5 for the 1× null and in week 6 for the 1.5× to 3× nulls. Nearly all testing schedules had >80% power for a 5× risk by week 11. To test the robustness of USPRT, we further simulated seasons where 1% were true high-risk seasons. Using a 1× null led to 10% of seasons signaling by week 11 (median RR approximately 1.4), which decreased to approximately 1% with the ≥2.5× null (median RR approximately 16.0). CONCLUSIONS On the basis of the results from this simulation and subsequent consultations with experts and stakeholders, we specified USPRT to test continuously from weeks 7 to 11 using the null hypothesis that the observed GBS rate was 2.5× the historical rate. This helped improve the ability of USPRT to provide early detection of GBS risk following influenza vaccination as part of a multilayered system of surveillance.
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Affiliation(s)
- Richard A Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mao Hu
- Acumen LLC, Burlingame, California, USA
| | - Deepa Arya
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Silvia Perez-Vilar
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Steven A Anderson
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - An-Chi Lo
- Acumen LLC, Burlingame, California, USA
| | | | | | - Tom MaCurdy
- Acumen LLC, Burlingame, California, USA.,Department of Economics, Stanford University, Stanford, California, USA
| | - Steve Chu
- Center for Medicare, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | - Jeffrey Kelman
- Center for Medicare, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
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Perez-Vilar S, Wernecke M, Arya D, Lo AC, Lufkin B, Hu M, Chu S, MaCurdy TE, Kelman J, Forshee RA. Surveillance for Guillain-Barré syndrome after influenza vaccination among U.S. Medicare beneficiaries during the 2017-2018 season. Vaccine 2019; 37:3856-3865. [PMID: 31122853 DOI: 10.1016/j.vaccine.2019.05.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration and the Centers for Medicare & Medicaid Services have been actively monitoring the risk of Guillain-Barré syndrome (GBS) following influenza vaccination among Fee-for-Service (FFS) Medicare beneficiaries every season since 2008. We present our evaluation of the GBS risk following influenza vaccinations during the 2017-2018 season. METHODS We implemented a multilayered approach to active safety surveillance that included near real-time surveillance early in the season, comparing GBS rates post-vaccination during the 2017-2018 season with rates from five prior seasons using the Updating Sequential Probability Ratio Test (USPRT), and end-of-season self-controlled risk interval (SCRI) analyses. RESULTS We identified approximately 16 million influenza vaccinations. The near real-time surveillance did not signal for a potential 2.5-fold increased GBS risk either in days 8-21 or 1-42 post-influenza vaccination. In the SCRI analyses, we did not detect statistically significant increased GBS risks among influenza-vaccinated Medicare beneficiaries ≥65 years for either the 8-21 or 1-42-day risk windows for all seasonal vaccines combined, high-dose vaccine, or standard-dose vaccines; we did detect an increased GBS risk in days 8-21 post-vaccination for individuals vaccinated with the adjuvanted vaccine (OR: 3.75; 95% CI: 1.01, 13.96), although this finding was not statistically significant after multiplicity adjustment (p = 0.146). CONCLUSIONS Our multilayered surveillance approach-which allows for early detection of elevated GBS risk and provides reliable end-of-season SCRI estimates of effect size-did not identify an increased GBS risk following 2017-2018 influenza vaccinations. The slightly increased GBS risk with the adjuvanted vaccine, which was not statistically significant following multiplicity adjustment, is consistent with the package inserts of all U.S.-licensed influenza vaccines, which warn of a potential low increased GBS risk. The benefits of influenza vaccines in preventing morbidity and mortality heavily outweigh this potential risk.
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Affiliation(s)
- Silvia Perez-Vilar
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, United States.
| | | | - Deepa Arya
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, United States.
| | | | | | - Mao Hu
- Acumen LLC, United States.
| | - Steve Chu
- Centers for Medicare and Medicaid Services, United States.
| | - Thomas E MaCurdy
- Stanford University, Department of Economics and Hoover Institution, United States; Acumen LLC, United States.
| | - Jeffrey Kelman
- Centers for Medicare and Medicaid Services, United States.
| | - Richard A Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, United States.
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Yonekura S, Anno T, Kobayashi N. Posterior Reversible Encephalopathy Syndrome and Guillain-Barré Syndrome after Head Injury: Case Report. Neurol Med Chir (Tokyo) 2018; 58:453-458. [PMID: 30078819 PMCID: PMC6186763 DOI: 10.2176/nmc.cr.2018-0049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a case of head injury with posterior reversible encephalopathy syndrome (PRES), followed by Guillain-Barré syndrome (GBS). A 74-year-old man was brought to our hospital after a fall. Computed tomography revealed intracranial hemorrhage. Magnetic resonance imaging showed bilateral reversible intensities with features of vasogenic edema in parietooccipital areas, suggesting PRES. After admission, weakness and areflexia of extremities and respiratory muscles developed gradually, which favored a diagnosis of GBS. Common etiologies of PRES were absent. Concurrent occurrence of PRES and GBS is rare. Given that PRES can be an initial manifestation of GBS, GBS must be considered in head trauma patients with PRES.
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Affiliation(s)
- Satoru Yonekura
- Department of Neurosurgery, Tochigi Medical Center Shimotsuga
| | - Takayuki Anno
- Department of Neurosurgery, Tochigi Medical Center Shimotsuga
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Principi N, Esposito S. Vaccine-preventable diseases, vaccines and Guillain-Barre' syndrome. Vaccine 2018; 37:5544-5550. [PMID: 29880241 DOI: 10.1016/j.vaccine.2018.05.119] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/27/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
Abstract
Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy. Infections and vaccines have been hypothesized to play a role in triggering GBS development. These beliefs can play a role in reducing vaccination coverage. In this report, data concerning this hypothesis are discussed. It is shown that an association between vaccine administration and GBS has never been proven for most of debated vaccines, although it cannot be definitively excluded. The only exception is the influenza vaccine, at least for the preparation used in 1976. For some vaccines, such as measles/mumps/rubella, human papillomavirus, tetravalent conjugated meningococcal vaccine, and influenza, the debate between supporters and opponents of vaccination remains robust and perception of vaccines' low safety remains a barrier to achieving adequate vaccination coverage. Less than 1 case of GBS per million immunized persons might occur for these vaccines. However, in some casesimmunization actually reduces the risk of GBS development. In addition, the benefits of vaccination are clearly demonstrated by the eradication or enormous decline in the incidence of many vaccine-preventable diseases. These data highlight that the hypothesized risks of adverse events, such as GBS, cannot be considered a valid reason to avoid the administration of currently recommended vaccines.
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Affiliation(s)
- Nicola Principi
- Professor Emeritus of Pediatrics, Università degli Studi di Milano, Milano, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy.
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Near real-time surveillance for Guillain-Barré syndrome after influenza vaccination among the Medicare population, 2010/11 to 2013/14. Vaccine 2017; 35:2986-2992. [DOI: 10.1016/j.vaccine.2017.03.087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 11/21/2022]
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Jara LJ, Izquierdo E, Medina G. Is the immune neuroendocrine system the connection between epipharyngitis and chronic fatigue syndrome induced by HPV vaccine? : Editorial. Immunol Res 2016; 65:5-7. [PMID: 27605126 DOI: 10.1007/s12026-016-8854-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Luis J Jara
- Direction of Education and Research, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico. .,Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Elva Izquierdo
- Rheumatology Department, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gabriela Medina
- Universidad Nacional Autónoma de México, Mexico City, Mexico.,Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Martín Arias L, Sanz R, Sáinz M, Treceño C, Carvajal A. Guillain-Barré syndrome and influenza vaccines: A meta-analysis. Vaccine 2015; 33:3773-8. [DOI: 10.1016/j.vaccine.2015.05.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/20/2015] [Accepted: 05/07/2015] [Indexed: 11/25/2022]
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Lochner KA, Wynne MA, Wheatcroft GH, Worrall CM, Kelman JA. Medicare claims versus beneficiary self-report for influenza vaccination surveillance. Am J Prev Med 2015; 48:384-91. [PMID: 25700653 DOI: 10.1016/j.amepre.2014.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although self-reported influenza vaccination status is routinely used in surveillance to estimate influenza vaccine coverage, Medicare data are becoming a promising resource for influenza surveillance to inform vaccination program management and planning. PURPOSE To evaluate the concordance between self-reported influenza vaccination and influenza vaccination claims among Medicare beneficiaries. METHODS This study compared influenza vaccination based upon Medicare claims and self-report among a sample of Medicare beneficiaries (N=9,378) from the 2011 Medicare Current Beneficiary Survey, which was the most recent year of data at the time of analysis (summer 2013). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using self-reported data as the referent standard. Logistic regression was used to compute the marginal mean proportions for whether a Medicare influenza vaccination claim was present among beneficiaries who reported receiving the vaccination. RESULTS Influenza vaccination was higher for self-report (69.4%) than Medicare claims (48.3%). For Medicare claims, sensitivity=67.5%, specificity=96.3%, positive predictive value=97.6%, and negative predictive value=56.7%. Among beneficiaries reporting receiving an influenza vaccination, the percentage of beneficiaries with a vaccination claim was lower for beneficiaries who were aged <65 years, male, non-Hispanic black or Hispanic, and had less than a college education. CONCLUSIONS The classification of influenza vaccination status for Medicare beneficiaries can differ based upon survey and claims. To improve Medicare claims-based surveillance studies, further research is needed to determine the sources of discordance in self-reported and Medicare claims data, specifically for sensitivity and negative predictive value.
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Affiliation(s)
- Kimberly A Lochner
- Centers for Medicare & Medicaid Services, Sam Nunn Atlanta Federal Center, Atlanta, Georgia; Office of Information Products and Data Analytics, Baltimore, Maryland.
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Iqbal S, Li R, Gargiullo P, Vellozzi C. Relationship between Guillain-Barré syndrome, influenza-related hospitalizations, and influenza vaccine coverage. Vaccine 2015; 33:2045-9. [PMID: 25749247 DOI: 10.1016/j.vaccine.2015.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 11/27/2022]
Abstract
Some studies reported an increased risk of Guillain-Barré syndrome (GBS) within six weeks of influenza vaccination. It has also been suggested that this finding could have been confounded by influenza illnesses. We explored the complex relationship between influenza illness, influenza vaccination, and GBS, from an ecologic perspective using nationally representative data. We also studied seasonal patterns for GBS hospitalizations. Monthly hospitalization data (2000-2009) for GBS, and pneumonia and influenza (P&I) in the Nationwide Inpatient Sample were included. Seasonal influenza vaccination coverage for 2004-2005 through the 2008-2009 influenza seasons (August-May) was estimated from the National Health Interview Survey data. GBS seasonality was determined using Poisson regression. GBS and P&I temporal clusters were identified using scan statistics. The association between P&I and GBS hospitalizations in the same month (concurrent) or in the following month (lagged) were determined using negative binomial regression. Vaccine coverage increased over the years (from 19.7% during 2004-2005 to 35.5% during 2008-2009 season) but GBS hospitalization did not follow a similar pattern. Overall, a significant correlation between monthly P&I and GBS hospitalizations was observed (Spearman's correlation coefficient=0.7016, p<0.0001). A significant (p=0.001) cluster of P&I hospitalizations during December 2004-March 2005 overlapped a significant (p=0.001) cluster of GBS hospitalizations during January 2005-February 2005. After accounting for effects of monthly vaccine coverage and age, P&I hospitalization was significantly associated (p<0.0001) with GBS hospitalization in the concurrent month but not with GBS hospitalization in the following month. Monthly vaccine coverage was not associated with GBS hospitalization in adjusted models (both concurrent and lagged). GBS hospitalizations demonstrated a seasonal pattern with winter months having higher rates compared to the month of June. P&I hospitalization rates were significantly correlated with hospitalization rates for GBS. Vaccine coverage did not significantly affect the rates of GBS hospitalization at the population level.
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Affiliation(s)
- Shahed Iqbal
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Rongxia Li
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul Gargiullo
- Epidemiology and Prevention Branch, Influenza Division, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Claudia Vellozzi
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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25
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Ball R. Perspectives on the future of postmarket vaccine safety surveillance and evaluation. Expert Rev Vaccines 2014; 13:455-62. [DOI: 10.1586/14760584.2014.891941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Finch NA, Guarascio AJ, Suda KJ. Guillain-Barré syndrome in an older man following influenza vaccination. J Am Pharm Assoc (2003) 2014; 54:188-92. [PMID: 24531983 DOI: 10.1331/japha.2014.13152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report an atypical case of Guillain-Barré syndrome (GBS) after administration of the 2012-13 influenza vaccine. SETTING Urban tertiary hospital. PATIENT DESCRIPTION An 81-year-old man was admitted to the hospital after he began experiencing numbness and tingling in both feet that began ascending toward the waistline. The patient complained of intense neuropathic pain in his lower extremities and eventually lost the deep tendon reflexes in his ankles. CASE SUMMARY In addition to clinical manifestations of GBS, electromyography revealed a sensorimotor, polyneuropathy, predominantly axonal, with prolonged F-waves in all nerves tested. A lumbar puncture revealed clear and colorless cerebrospinal fluid with an elevated protein level of 66 mg/dL (reference, 15-60 mg/dL) despite the lack of a normal cell count, which indicates albuminocytologic dissociation. Based on these findings, the patient met Brighton level 3 diagnostic certainty and was diagnosed with GBS. MAIN OUTCOMES MEASURE Signs and symptoms of GBS. RESULTS On day 5 of hospitalization, intravenous immunoglobulin 0.4 mg/kg/d was initiated for 5 days in combination with gabapentin 100 mg at bedtime for neuropathic pain. After completing treatment, the patient experienced progressively improved sensation in his extremities and was discharged. CONCLUSION This is a rare report of GBS lacking albuminocytologic dissociation after an older patient received the 2012-13 influenza vaccine.
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Vellozzi C, Iqbal S, Broder K. Guillain-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence. Clin Infect Dis 2014; 58:1149-55. [PMID: 24415636 DOI: 10.1093/cid/ciu005] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide, and is thought to be immune-mediated. It is preceded by upper respiratory or gastrointestinal infection in about two-thirds of cases and is associated with some viral infections, including influenza. GBS has also been associated with the 1976 swine-influenza vaccine. Thereafter, some studies have shown a small increased risk of GBS following receipt of seasonal and 2009 H1N1 monovalent influenza vaccines. Studies over the years have also shown an increased risk of GBS following influenza infection, and the magnitude of risk is several times greater than that following influenza vaccination. Because GBS is rare, and even rarer following vaccination, it is difficult to estimate precise risk. We try to shed light on the complex relationship of GBS and its association with influenza and influenza vaccines over the past 35 years.
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Affiliation(s)
- Claudia Vellozzi
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Polakowski LL, Sandhu SK, Martin DB, Ball R, Macurdy TE, Franks RL, Gibbs JM, Kropp GF, Avagyan A, Kelman JA, Worrall CM, Sun G, Kliman RE, Burwen DR. Chart-confirmed guillain-barre syndrome after 2009 H1N1 influenza vaccination among the Medicare population, 2009-2010. Am J Epidemiol 2013; 178:962-73. [PMID: 23652165 DOI: 10.1093/aje/kwt051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Given the increased risk of Guillain-Barré Syndrome (GBS) found with the 1976 swine influenza vaccine, both active surveillance and end-of-season analyses on chart-confirmed cases were performed across multiple US vaccine safety monitoring systems, including the Medicare system, to evaluate the association of GBS after 2009 monovalent H1N1 influenza vaccination. Medically reviewed cases consisted of H1N1-vaccinated Medicare beneficiaries who were hospitalized for GBS. These cases were then classified by using Brighton Collaboration diagnostic criteria. Thirty-one persons had Brighton level 1, 2, or 3 GBS or Fisher Syndrome, with symptom onset 1-119 days after vaccination. Self-controlled risk interval analyses estimated GBS risk within the 6-week period immediately following H1N1 vaccination compared with a later control period, with additional adjustment for seasonality. Our results showed an elevated risk of GBS with 2009 monovalent H1N1 vaccination (incidence rate ratio = 2.41, 95% confidence interval: 1.14, 5.11; attributable risk = 2.84 per million doses administered, 95% confidence interval: 0.21, 5.48). This observed risk was slightly higher than that seen with previous seasonal influenza vaccines; however, additional results that used a stricter case definition (Brighton level 1 or 2) were not statistically significant, and our ability to account for preceding respiratory/gastrointestinal illness was limited. Furthermore, the observed risk was substantially lower than that seen with the 1976 swine influenza vaccine.
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Association between vaccination and Guillain-Barré syndrome. THE LANCET. INFECTIOUS DISEASES 2013; 13:730-1. [DOI: 10.1016/s1473-3099(13)70142-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hua W, Sun G, Dodd CN, Romio SA, Whitaker HJ, Izurieta HS, Black S, Sturkenboom MCJM, Davis RL, Deceuninck G, Andrews NJ. A simulation study to compare three self-controlled case series approaches: correction for violation of assumption and evaluation of bias. Pharmacoepidemiol Drug Saf 2013; 22:819-25. [DOI: 10.1002/pds.3451] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 03/14/2013] [Accepted: 03/18/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Wei Hua
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research; Food and Drug Administration; Rockville Maryland USA
| | - Guoying Sun
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research; Food and Drug Administration; Rockville Maryland USA
| | - Caitlin N. Dodd
- Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
| | | | - Heather J. Whitaker
- Department of Mathematics and Statistics; The Open University; Milton Keynes United Kingdom
| | - Hector S. Izurieta
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research; Food and Drug Administration; Rockville Maryland USA
| | - Steven Black
- Center for Global Child Health; Cincinnati Children's Hospital; Cincinnati Ohio USA
| | | | - Robert L. Davis
- Center for Health Research Southeast; Kaiser Permanente Georgia; Atlanta Georgia USA
| | - Genevieve Deceuninck
- Public Health Research Unit; Quebec University Hospital Research Center; Quebec City Canada
| | - N. J. Andrews
- Statistics Unit, Health Protection Services; Health Protection Agency; London United Kingdom
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Salmon DA, Proschan M, Forshee R, Gargiullo P, Bleser W, Burwen DR, Cunningham F, Garman P, Greene SK, Lee GM, Vellozzi C, Yih WK, Gellin B, Lurie N. Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis. Lancet 2013; 381:1461-8. [PMID: 23498095 DOI: 10.1016/s0140-6736(12)62189-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The influenza A (H1N1) 2009 monovalent vaccination programme was the largest mass vaccination initiative in recent US history. Commensurate with the size and scope of the vaccination programme, a project to monitor vaccine adverse events was undertaken, the most comprehensive safety surveillance agenda in the USA to date. The adverse event monitoring project identified an increased risk of Guillain-Barré syndrome after vaccination; however, some individual variability in results was noted. Guillain-Barré syndrome is a rare but serious health disorder in which a person's own immune system damages their nerve cells, causing muscle weakness, sometimes paralysis, and infrequently death. We did a meta-analysis of data from the adverse event monitoring project to ascertain whether influenza A (H1N1) 2009 monovalent inactivated vaccines used in the USA increased the risk of Guillain-Barré syndrome. METHODS Data were obtained from six adverse event monitoring systems. About 23 million vaccinated people were included in the analysis. The primary analysis entailed calculation of incidence rate ratios and attributable risks of excess cases of Guillain-Barré syndrome per million vaccinations. We used a self-controlled risk-interval design. FINDINGS Influenza A (H1N1) 2009 monovalent inactivated vaccines were associated with a small increased risk of Guillain-Barré syndrome (incidence rate ratio 2·35, 95% CI 1·42-4·01, p=0·0003). This finding translated to about 1·6 excess cases of Guillain-Barré syndrome per million people vaccinated. INTERPRETATION The modest risk of Guillain-Barré syndrome attributed to vaccination is consistent with previous estimates of the disorder after seasonal influenza vaccination. A risk of this small magnitude would be difficult to capture during routine seasonal influenza vaccine programmes, which have extensive, but comparatively less, safety monitoring. In view of the morbidity and mortality caused by 2009 H1N1 influenza and the effectiveness of the vaccine, clinicians, policy makers, and those eligible for vaccination should be assured that the benefits of inactivated pandemic vaccines greatly outweigh the risks. FUNDING US Federal Government.
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Affiliation(s)
- Daniel A Salmon
- National Vaccine Program Office, Office of the Assistant Secretary for Health, Department of Health and Human Services, Washington, DC, USA.
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Galeotti F, Massari M, D'Alessandro R, Beghi E, Chiò A, Logroscino G, Filippini G, Benedetti MD, Pugliatti M, Santuccio C, Raschetti R. Risk of Guillain-Barré syndrome after 2010-2011 influenza vaccination. Eur J Epidemiol 2013; 28:433-44. [PMID: 23543123 PMCID: PMC3672511 DOI: 10.1007/s10654-013-9797-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 03/15/2013] [Indexed: 11/29/2022]
Abstract
Influenza vaccination has been implicated in Guillain Barré Syndrome (GBS) although the evidence for this link is controversial. A case–control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case–control analysis and a self-controlled case series analysis (SCCS). Case–control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.
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Affiliation(s)
- Francesca Galeotti
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
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Rowhani-Rahbar A, Klein NP, Baxter R. Assessing the safety of influenza vaccination in specific populations: children and the elderly. Expert Rev Vaccines 2013; 11:973-84. [PMID: 23002978 DOI: 10.1586/erv.12.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Comprehensive monitoring of the safety of influenza vaccines remains a public health priority, particularly as immunization coverage increases across different age groups at the global level. In this review, the authors provide state-of-the-art knowledge on the safety of influenza immunization among children and the elderly. The authors review the safety information in each group separately for inactivated and live attenuated influenza vaccines. Adverse events of special concern including febrile seizure, narcolepsy, asthma and Guillain-Barré syndrome are covered under specific considerations. The authors discuss the current status of the field, particularly the use of new technologies for influenza vaccines and their potential safety profile.
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Affiliation(s)
- Ali Rowhani-Rahbar
- Kaiser Permanente Vaccine Study Center, One Kaiser Plaza, Floor 16, Oakland, CA 94612, USA.
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Poland GA, Jacobsen SJ. Influenza vaccine, Guillain-Barré syndrome, and chasing zero. Vaccine 2012; 30:5801-3. [PMID: 22883638 DOI: 10.1016/j.vaccine.2012.06.093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
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Sarntivijai S, Xiang Z, Shedden KA, Markel H, Omenn GS, Athey BD, He Y. Ontology-based combinatorial comparative analysis of adverse events associated with killed and live influenza vaccines. PLoS One 2012; 7:e49941. [PMID: 23209624 PMCID: PMC3509157 DOI: 10.1371/journal.pone.0049941] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/17/2012] [Indexed: 11/26/2022] Open
Abstract
Vaccine adverse events (VAEs) are adverse bodily changes occurring after vaccination. Understanding the adverse event (AE) profiles is a crucial step to identify serious AEs. Two different types of seasonal influenza vaccines have been used on the market: trivalent (killed) inactivated influenza vaccine (TIV) and trivalent live attenuated influenza vaccine (LAIV). Different adverse event profiles induced by these two groups of seasonal influenza vaccines were studied based on the data drawn from the CDC Vaccine Adverse Event Report System (VAERS). Extracted from VAERS were 37,621 AE reports for four TIVs (Afluria, Fluarix, Fluvirin, and Fluzone) and 3,707 AE reports for the only LAIV (FluMist). The AE report data were analyzed by a novel combinatorial, ontology-based detection of AE method (CODAE). CODAE detects AEs using Proportional Reporting Ratio (PRR), Chi-square significance test, and base level filtration, and groups identified AEs by ontology-based hierarchical classification. In total, 48 TIV-enriched and 68 LAIV-enriched AEs were identified (PRR>2, Chi-square score >4, and the number of cases >0.2% of total reports). These AE terms were classified using the Ontology of Adverse Events (OAE), MedDRA, and SNOMED-CT. The OAE method provided better classification results than the two other methods. Thirteen out of 48 TIV-enriched AEs were related to neurological and muscular processing such as paralysis, movement disorders, and muscular weakness. In contrast, 15 out of 68 LAIV-enriched AEs were associated with inflammatory response and respiratory system disorders. There were evidences of two severe adverse events (Guillain-Barre Syndrome and paralysis) present in TIV. Although these severe adverse events were at low incidence rate, they were found to be more significantly enriched in TIV-vaccinated patients than LAIV-vaccinated patients. Therefore, our novel combinatorial bioinformatics analysis discovered that LAIV had lower chance of inducing these two severe adverse events than TIV. In addition, our meta-analysis found that all previously reported positive correlation between GBS and influenza vaccine immunization were based on trivalent influenza vaccines instead of monovalent influenza vaccines.
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Affiliation(s)
- Sirarat Sarntivijai
- National Center for Integrative Biomedical Informatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Zuoshuang Xiang
- Unit of Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Kerby A. Shedden
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Howard Markel
- Center for the History of Medicine and Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gilbert S. Omenn
- National Center for Integrative Biomedical Informatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Departments of Internal Medicine and Human Genetics, and School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Brian D. Athey
- National Center for Integrative Biomedical Informatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: (YH); (BDA)
| | - Yongqun He
- National Center for Integrative Biomedical Informatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Unit of Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- * E-mail: (YH); (BDA)
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Burwen DR, Sandhu SK, MaCurdy TE, Kelman JA, Gibbs JM, Garcia B, Markatou M, Forshee RA, Izurieta HS, Ball R. Surveillance for Guillain-Barré syndrome after influenza vaccination among the Medicare population, 2009-2010. Am J Public Health 2012; 102:1921-7. [PMID: 22970693 PMCID: PMC3490645 DOI: 10.2105/ajph.2011.300510] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We implemented active surveillance for Guillain-Barré syndrome (GBS) following seasonal or H1N1 influenza vaccination among the Medicare population during the 2009-2010 influenza season. METHODS We used weekly Medicare claims data to monitor vaccinations and subsequent hospitalizations with principal diagnosis code for GBS within 42 days. Group sequential testing assessed whether the observed GBS rate exceeded a critical limit based on the expected rate from 5 previous years adjusted for claims delay. We evaluated the lag between date of service and date of claims availability and used it for adjustment. RESULTS By July 30, 2010 (after 26 interim surveillance tests), 14.0 million seasonal and 3.3 million H1N1 vaccinations had accrued. Taking into account claims delay appropriately lowered the critical limit during early monitoring. The observed GBS rate was below the critical limit throughout the surveillance. CONCLUSIONS Medicare data contributed rapid safety monitoring among millions of 2009-2010 influenza vaccine recipients. Adjustment for claims delay facilitates early detection of potential safety issues. Although limited by lack of medical record review to confirm cases, this claims-based surveillance did not indicate a statistically significant elevated GBS rate following seasonal or H1N1 influenza vaccination.
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Affiliation(s)
- Dale R Burwen
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, MD, USA.
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Lei T, Siu KL, Kok KH, Chan KH, Chan EYT, Hung IFN, To KKW, Li PCK, Zhou J, Zheng BJ, Yuen KY, Wang M, Jin DY. Anti-ganglioside antibodies were not detected in human subjects infected with or vaccinated against 2009 pandemic influenza A (H1N1) virus. Vaccine 2012; 30:2605-10. [PMID: 22342549 DOI: 10.1016/j.vaccine.2012.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/02/2012] [Accepted: 02/03/2012] [Indexed: 01/12/2023]
Abstract
Recipients of influenza A (H1N1) vaccine in 1976 had an increased risk for the neurologic disorder Guillain-Barré syndrome (GBS). Anti-ganglioside antibodies, which might be associated with the development of GBS, were previously reported to be induced in mice immunized with an H1N1 vaccine of 1976 or another influenza vaccine. In this study we analyzed anti-ganglioside antibodies in human subjects infected with or vaccinated against 2009 pandemic H1N1, including eight patients diagnosed to have post-vaccination GBS. Antibodies against GM1 or another ganglioside were not detected in any subject or in vaccinated mice. Our results did not support the induction of anti-ganglioside antibodies by influenza viruses or vaccines.
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Affiliation(s)
- Ting Lei
- Department of Pathology, School of Medicine, Xi'an Jiaotong University, Xi'an, China
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Nguyen M, Ball R, Midthun K, Lieu TA. The Food and Drug Administration's Post-Licensure Rapid Immunization Safety Monitoring program: strengthening the federal vaccine safety enterprise. Pharmacoepidemiol Drug Saf 2012; 21 Suppl 1:291-7. [DOI: 10.1002/pds.2323] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michael Nguyen
- Center for Biologics Evaluation and Research; Food and Drug Administration; Rockville MD 20852 USA
| | - Robert Ball
- Center for Biologics Evaluation and Research; Food and Drug Administration; Rockville MD 20852 USA
| | - Karen Midthun
- Center for Biologics Evaluation and Research; Food and Drug Administration; Rockville MD 20852 USA
| | - Tracy A. Lieu
- Department of Population Medicine; Harvard Pilgrim Health Care Institute and Harvard Medical School; Boston MA 02215 USA
- Division of General Pediatrics; Children's Hospital Boston; Boston MA 02115 USA
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Sejvar JJ, Pfeifer D, Schonberger LB. Guillain-barré syndrome following influenza vaccination: causal or coincidental? Curr Infect Dis Rep 2011; 13:387-98. [PMID: 21681501 DOI: 10.1007/s11908-011-0194-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 1976, the emergence of a new swine-origin influenza virus prompted concerns about an impending influenza pandemic. Although the outbreak never materialized, the epidemiological link between Guillain-Barre syndrome, a potentially severe peripheral nerve disorder, and the influenza vaccines developed against this virus caught public health officials, clinicians, and the public by surprise. Subsequently, a great deal of scrutiny has been placed on the possible risk of other formulations of influenza vaccine causing this adverse event. Several epidemiologic and biological assessments have been performed in subsequent years to assess this risk, yet considerable uncertainty remains among health care providers about the possible association. The development and rapid implementation of vaccines against the pandemic 2009 A(H1N1) influenza virus once again highlighted this issue. This article reviews the evidence for and against the association of the 1976 influenza vaccines and subsequent seasonal influenza vaccines with the development of Guillain-Barré syndrome.
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Affiliation(s)
- James J Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-39, Atlanta, GA, 30333, USA,
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Serious adverse events following receipt of trivalent inactivated influenza vaccine in Korea, 2003-2010. Vaccine 2011; 29:7727-32. [PMID: 21827815 DOI: 10.1016/j.vaccine.2011.07.129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vaccination is very important for the control and prevention of influenza, yet no vaccine is perfectly safe. Little is known, however, about influenza vaccination-associated serious adverse events following immunization (AEFI). This study aimed to identify background information on influenza vaccination-related serious AEFI in Korea. METHODS Retrospective review of data from Korea National Vaccine Injury Compensation Program from 2003 to 2010. RESULTS Distribution of approximately 75 million doses of influenza vaccine by end of 2010 gave rise to 42 potentially serious AEFI. In all, nine Guillain-Barré syndrome, eighteen other neurologic events, eight local events, and seven miscellaneous events were included. 62% of these events were identified to have unlike causal association with the vaccine. The reporting rate of serious AEFI ranged from 0.006 to 0.07 cases per 100,000 distributed doses of the vaccine. CONCLUSION GBS was the most common influenza vaccination-related serious AEFI. Enhancing post-vaccination GBS surveillance may increase public confidence in future routine and pandemic influenza vaccination.
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Choe YJ, Cho H, Bae GR, Lee JK. Guillain-Barré syndrome following receipt of influenza A (H1N1) 2009 monovalent vaccine in Korea with an emphasis on Brighton Collaboration case definition. Vaccine 2011; 29:2066-70. [PMID: 21255684 DOI: 10.1016/j.vaccine.2011.01.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/04/2011] [Accepted: 01/05/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2009-2010 season, with ongoing of influenza A (H1N1), employment of mass vaccination has generated concerns in issue of adverse events following immunization (AEFI). This study investigates the clinical and laboratory data of reported cases of Guillain-Barré syndrome (GBS) and Fisher syndrome (FS) following receipt of influenza A (H1N1) 2009 monovalent vaccine to the National Vaccine Injury Compensation Program (NVICP) in Korea, with all cases reviewed under case definition developed by Brighton Collaboration GBS Working Group. METHOD Retrospective review of medical records for all suspected cases of GBS ad FS following receipt of influenza A (H1N1) monovalent vaccine reported to NVICP from December 1, 2009, through April 28, 2010 was conducted. Additional analyses were performed for identification of levels of diagnostic certainty according to Brighton Collaboration case definition. RESULT Of 29 reported cases, 22 were confirmed to meet Brighton criteria level 1, 2, or 3 for GBS (21) or FS (1). Of those, 2 (9.1%) met level 1, 9 (40.9%) met level 2, and 11 (50.0%) met level 3. The male to female ratio was 2:0 in cases with level 1, 8:1 in cases with level 2, and 3:8 in cases with level 3. The mean age was older in cases with level 1 (54.0 ± 26.9) than that of cases with level 2 (25.6 ± 22.8), and level 3 (13.6 ± 2.4, P=0.005). The median onset interval was longer in cases with level 1 (16 days) than that of cases that met level 2 (12.44 days), and 3 (1.09 days, P=0.019). CONCLUSION The Brighton case definition was used to improve the quality of AEFI data in Korea, and was applicable in retrospective review of medical records in cases with GBS and FS after influenza A (H1N1) vaccination. These findings suggest that standardized case definition was feasible in clarifying the AEFI data, and to further increase the understanding of possible relationship of influenza vaccine and GBS.
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Affiliation(s)
- Young June Choe
- Division of Vaccine Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, Pepublic of Korea.
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