Guillain-Barré Syndrome and the 1978–1979 Influenza Vaccine

• Published in: The New England journal of medicine Vol. 304; no. 26; pp. 1557 - 1561
• Main Authors: Hurwitz, Eugene S, Schonberger, Lawrence B, Nelson, David B, Holman, Robert C
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 25.06.1981
• Subjects: Adolescent; Adult; Adults; Aged; Child; Child, Preschool; Disease control; Epidemiologic Methods; Female; Guillain-Barre syndrome; Health surveillance; Humans; Immunization; Infant; Influenza; influenza A virus; Influenza A virus - immunology; Influenza Vaccines - adverse effects; Male; Middle Aged; Patients; Polyradiculoneuropathy - epidemiology; Polyradiculoneuropathy - etiology; Risk; Statistical analysis; United States; Vaccination; Vaccines; United States
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198106253042601

An ongoing surveillance program was intensified to determine whether an increased risk of acquiring vaccine-related Guillain-Barré syndrome (GBS) (similar to that observed after vaccination with the A/New Jersey swine-influenza vaccine in 1976) existed for the approximately 12.5 million adults (≥18 years old) vaccinated in the 1978–1979 influenza campaign. In the contiguous United States (excluding Maryland) 544 cases of GBS with onset between September 1, 1978, and March 31, 1979, were reported, including 12 adults who had been vaccinated within eight weeks before the onset of GBS and 393 who had not. The relative risk of vaccine-associated GBS for adults reported in this surveillance was 1.4 (95 per cent confidence limits, 0.7 to 2.7) — significantly below the risk (6.2) associated with A/New Jersey vaccine for the equivalent eight-week period. In contrast to the A/New Jersey vaccine, the 1978–1979 influenza vaccine was not associated with a statistically significant excess risk of GBS. (N Engl J Med. 1981; 304:1557–61.) BEFORE 1976, no causal relation between Guillain-Barré syndrome (GBS) and influenza vaccination had been epidemiologically documented, and few cases after vaccination had been reported. 1 , 2 In 1976, however, after the largest influenza vaccination program ever initiated in the United States, an increase in the number of reports of GBS associated with A/New Jersey (swine) influenza vaccination led to intensive, nationwide GBS surveillance. This surveillance program, conducted between October 1, 1976, and March 1977, provided strong epidemiologic evidence that there was an excess risk of vaccine-related GBS for persons 18 years of age or older. For the 10 weeks after vaccination, this . . .