329. Revaccination of persons with Guillain-Barré Syndrome
Session: Poster Abstract Session: Challenges in Vaccinology and Vaccine Exploration
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Baxter GBS recurrence IDSA poster 10-4-11.pdf (425.6 kB)
  • Background:   Guillain-Barré syndrome (GBS) is an acute polyradiculopathy, thought to be an autoimmune disorder.  GBS has been reported following vaccines.  The current CDC recommendation is to avoid vaccinating individuals who have had a history of GBS within six weeks of a prior influenza (TIV) vaccination if they are not at high risk of severe complications from influenza illness.

    Methods:   We identified GBS cases from the Kaiser Permanente Northern California  (KPNC) databases from 1995 into 2006, using  hospital discharge codes; each medical record was neurologist-reviewed and only confirmed GBS cases were included for follow up.  We followed confirmed cases through 2008 for vaccinations and  recurrent GBS. To distinguish recurrent GBS from Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), we defined recurrent GBS as ≥ one subsequent episode of acute monophasic neuropathy followed by near complete recovery between acute episodes. 

    Results:   We identified 550 neurologist-confirmed individual cases of GBS over 33 million person-years.  During the follow-up period, 989 vaccines were given to 279 of these individuals after the diagnosis of GBS.  405 TIV vaccines were administered to 107 individuals with a prior diagnosis of GBS.  18 of the 550 cases of GBS had onset within 6 weeks of TIV; of these, 2 were revaccinated with influenza vaccines and these 2 did not experience a recurrence of GBS.  Only 6 individuals had a second (recurrent) diagnosis of GBS.  Among these 6 individuals, only 1 had any vaccine exposure at all in the year prior to the 2nd onset of GBS.  This was a single dose of MMR 4 months prior to the onset of the 2nd episode of GBS.

    Conclusion:   In our population of over 3 million members, over an 11 year period, risk of GBS recurrence was low (6/550 = 1.1%).  There were no cases of recurrent GBS after influenza vaccination, and none within an accepted risk interval after any vaccine.  There were too few GBS cases following influenza vaccines to draw conclusions about revaccinating those whose GBS occurs within 6 weeks of TIV.

     


    Subject Category: I. Adult and Pediatric Vaccines

    Roger Baxter, MD1, Nandini Bakshi, MD2, Ned Lewis, MPH1, Claudia Vellozzi, MD3 and Nicola Klein, MD, PhD1, (1)Kaiser Permanente Vaccine Study Center, Oakland, CA, (2)The Permanente Medical Group, Walnut Creek, CA, (3)Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    R. Baxter, Sanofi Pasteur: Grant Investigator, Research grant
    Merck & Co.: Grant Investigator, Research grant
    GSK: Grant Investigator, Research grant
    MedImmune: Grant Investigator, Research grant
    Novartis: Grant Investigator, Research grant
    Pfizer: Grant Investigator, Research grant

    N. Bakshi, None

    N. Lewis, None

    C. Vellozzi, None

    N. Klein, GSK: Grant Investigator, Grant recipient
    Sanofi Pasteur: Grant Investigator, Grant recipient
    Merck: Grant Investigator, Grant recipient
    Pfizer: Grant Investigator, Grant recipient
    medImmune: Grant Investigator, Grant recipient
    Novartis: Grant Investigator, Grant recipient

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.