Risk of Guillain-Barré syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study
| Autor: | Steven Hawken, Kumanan Wilson, Priya Vasa, Natasha S. Crowcroft, Shelley L. Deeks, Jeffrey C. Kwong, Laura C. Rosella, Therese A. Stukel, Michael A. Campitelli, Lorne Zinman, Allison McGeer |
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| Rok vydání: | 2013 |
| Předmět: |
Pediatrics
medicine.medical_specialty Guillain-Barre syndrome business.industry Influenza vaccine Incidence (epidemiology) medicine.disease nervous system diseases Vaccination Seasonal influenza symbols.namesake Infectious Diseases immune system diseases Health care medicine symbols Medical emergency Poisson regression Young adult business |
| Zdroj: | The Lancet Infectious Diseases. 13:769-776 |
| ISSN: | 1473-3099 |
| DOI: | 10.1016/s1473-3099(13)70104-x |
| Popis: | Summary Background The possible risk of Guillain-Barre syndrome from influenza vaccines remains a potential obstacle to achieving high vaccination coverage. However, influenza infection might also be associated with Guillain-Barre syndrome. We aimed to assess the risk of Guillain-Barre syndrome after seasonal influenza vaccination and after influenza-coded health-care encounters. Methods We used the self-controlled risk interval design and linked universal health-care system databases from Ontario, Canada, with data obtained between 1993 and 2011. We used physician billing claims for influenza vaccination and influenza-coded health-care encounters to ascertain exposures. Using fixed-effects conditional Poisson regression, we estimated the relative incidence of hospitalisation for primary-coded Guillain-Barre syndrome during the risk interval compared with the control interval. Findings We identified 2831 incident admissions for Guillain-Barre syndrome; 330 received an influenza vaccine and 109 had an influenza-coded health-care encounter within 42 weeks before hospitalisation. The risk of Guillain-Barre syndrome within 6 weeks of vaccination was 52% higher than in the control interval of 9–42 weeks (relative incidence 1·52; 95% CI 1·17–1·99), with the greatest risk during weeks 2–4 after vaccination. The risk of Guillain-Barre syndrome within 6 weeks of an influenza-coded health-care encounter was greater than for vaccination (15·81; 10·28–24·32). The attributable risks were 1·03 Guillain-Barre syndrome admissions per million vaccinations, compared with 17·2 Guillain-Barre syndrome admissions per million influenza-coded health-care encounters. Interpretation The relative and attributable risks of Guillain-Barre syndrome after seasonal influenza vaccination are lower than those after influenza illness. Patients considering immunisation should be fully informed of the risks of Guillain-Barre syndrome from both influenza vaccines and influenza illness. Funding Canadian Institutes of Health Research. |
| Databáze: | OpenAIRE |
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