5 Qs on Vaccines and Guillain-Barre Syndrome

Question 1. Which of the following vaccines have been found to have a causal association with GBS?

A. Measles/mumps/rubella
B. Human papilloma virus (HPV)
C. Influenza
D. B and C

The only vaccine for which a causal association has been found for GBS is the influenza vaccine. In 1976, GBS was linked to vaccination for swine flu, with about 1 additional GBS for every 100 000 doses of swine flu administered. The risk of GBS with current flu vaccines is much lower, about 1-2 additional GBS cases for every 1 million flu doses administered, and is monitored yearly by the CDC.

Source: Center for Disease Control. Guillain-Barré Syndrome. https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html. Accessed September 18, 2018.

Question 2. GBS has developed after infection with which of the following?

A. Campylobacter
B. Cytomegalovirus
C. Epstein Barr Virus
D. All of the above

GBS is a rare condition affecting an estimated 3000 to 6000 people in the US each year. GBS results from an autoimmune reaction directed toward nerve cells, causing muscle weakness and sometimes paralysis. While the etiology of GBS remains unknown, about two-thirds of people develop it after a diarrheal or respiratory illness. Infection with campylobacter jejuni, cytomegalovirus, and the Epstein Barr virus have been associated with GBS.

Source: Center for Disease Control. Guillain-Barré Syndrome. https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html. Accessed September 18, 2018.

Question 3. The most common risk factor for GBS is:

A. Young age
B. Campylobacter jejuni infection
C. Influenza vaccination
D. Cytomegalovirus infection

While GBS is more common among people aged ≥50 years (with the lowest incidence in children), the primary risk factor for GBS is infection with campylobacter jejuni, a common cause of food poisoning.¹ Research suggests that about 30% of cases may be linked to campylobacter jejuni infection, while 10% may be linked to cytomegalovirus infection.²

Sources:

1. Center for Disease Control. Guillain-Barré Syndrome. https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html. Accessed September 18, 2018.
2. Vellozzi C, Iqbal S, Stewart B, Tokars J, DeStefano F. Cumulative risk of Guillain-Barré syndrome among vaccinated and unvaccinated populations during the 2009 H1N1 influenza pandemic. Am J Public Health. 2014;104:696-701.

Question 4. Which of the following may be protective against GBS?

A. HPV vaccine
B. Meningococcal vaccine
C. Influenza virus vaccine
D. A and C

Research suggests that the HPV vaccine and the influenza vaccine may be protective effect against GBS. A recent prospective study of females aged 11-25 years old in France found that cases of autoimmune disease like GBS were negatively linked to vaccination for HPV.¹ Another study found that influenza vaccination was linked to lower risk of GBS compared to not being vaccinated during the 2009 H1N1 pandemic.² Despite fears about vaccination, risk for GBS due to infection is much greater than possible risk related to vaccination.

Sources:

1. Grimaldi-Bensouda L, Rossignol M, Koné-Paut I, et al. Risk of autoimmune diseases and human papilloma virus (HPV) vaccines: Six years of case-referent surveillance. J Autoimmun. 2017;79:84-90.
2. Vellozzi C, Iqbal S, Stewart B, Tokars J, DeStefano F. Cumulative risk of Guillain-Barré syndrome among vaccinated and unvaccinated populations during the 2009 H1N1 influenza pandemic. Am J Public Health. 2014;104:696-701.

Question 5. Classic GBS is characterized by all of the following except:

A. Spastic paralysis
B. Symmetrical limb weakness
C. Hyporeflexia
D. Progressive onset

Classic GBS is characterized by bilateral, symmetric weakness of the limbs, as well as hyporeflexia or areflexia. Symptoms usually occur over 12 hours to 28 days, may progress to flaccid paralysis, and usually reach a plateau. Most individuals achieve full recovery within a few weeks, though some may continue to progress. In rare cases, death may ensue due to respiratory muscle paralysis or opportunistic infections.

Source: Vellozzi C, Iqbal S, Stewart B, Tokars J, DeStefano F. Cumulative risk of Guillain-Barré syndrome among vaccinated and unvaccinated populations during the 2009 H1N1 influenza pandemic. Am J Public Health. 2014;104:696-701.