Onset Of Guillain-Barré Syndrome Research Articles

Health‐related quality of life in Guillain‐Barré syndrome patients: a systematic review

Guillain-Barré syndrome (GBS) encompasses a broad spectrum of health-related quality of life (HRQL) determinants, including mobility, fatigue, pain, and depression. We systematically reviewed the literature on functional outcome domains in which GBS patients experience limitations in the short and long terms and evaluated determinants of HRQL in GBS patients. MEDLINE and EMBASE were systematically searched by two independent reviewers for articles covering HRQL data of GBS patients. Of 730 abstracts screened, 17 articles covering data of 14 studies matched the selection criteria. The included articles showed that many GBS patients experienced physical limitations, even years after the acute phase of the disease, while results were inconsistent for perceived levels of pain, fatigue, and general mental well-being. Only three papers covered HRQL assessments at more than one time point, generally showing large improvements in HRQL in the first year after GBS onset, but not thereafter. We appraised the methodological quality of included studies using a 13-item checklist; none of the articles fulfilled all items and only seven articles presented data on correlations between HRQL and determinants. In conclusion, the majority of studies on HRQL in GBS patients are cross-sectional and of low methodological quality. This paper provides guidance for much needed high-quality studies on patterns of patient-perceived recovery after GBS onset.

Pandemic A/H1N1 2009 influenza vaccination, preceding infections and clinical findings in UK children with Guillain–Barré syndrome

ObjectiveTo record clinical findings in all new cases of Guillain–Barré syndrome (GBS) or Fisher syndrome (FS) in UK children in the 2 years following September 2009 and determine the proportion...

Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS) is the most common cause of acute neuromuscular paralysis in the Western world. We describe the only known case presentation of pharyngeal-cervical-brachial variant following a subacute myocardial infarction and Vibrio cholerae vaccination. A 55-year-old Filipino man presented to our emergency department with a one-day history of progressive oropharyngeal and cervicobrachial weakness and areflexia in the upper limbs. His review of systems was unremarkable except for receiving “Dukoral” traveller’s diarrhea vaccine 3 weeks prior. His physical exam was compatible with GBS. EMG and nerve conduction studies showed low motor amplitudes, prolonged distal latency and absent F-waves in the arms. Lumbar puncture showed a protein level of 579 mg/L. Nuclear perfusion scan was consistent with a subacute myocardial infarction. He received a 2-day course of intravenous immunoglobulin. He showed significant improvement in his weakness over 3 days. Recent vaccination and myocardial infarction may be important triggers for GBS onset. J Neurol Res. 2014;4(2-3):88-90 doi: http://dx.doi.org/10.14740/jnr270w

Lack of Association of Vaccinations With Guillain-Barré Syndrome

Source: Baxter R, Bakshi N, Fireman B, et al. Lack of association of Guillain-Barré syndrome with vaccinations. Clin Infect Dis. 2013; 57(2): 197– 204; doi: 10.1093/cid/cit222Investigators from the Kaiser Permanente Medical Group and Vaccine Study Center and the Centers for Disease Control and Prevention (CDC) retrospectively evaluated a cohort of individuals with documented Guillain-Barré syndrome (GBS) to see if there was an association with vaccination in the 6 or 10 weeks prior to onset. Cases were classified based on a review of medical records by a neurologist according to the Brighton Collaboration case definition criteria.1 The study population was comprised of the >3 million individuals in Northern California insured by Kaiser Permanente. Cases included all individuals hospitalized with first occurrence of verified GBS between 1995 and 2006. Only those who received any vaccine dose within a year of onset of GBS (9 months for influenza vaccine to avoid confounding from the previous year’s vaccine) were included. Odds ratios were calculated by comparing the observed odds that vaccination of cases occurred within the risk interval prior to GBS onset compared to the expected odds derived from the proportion of the vaccinated health plan population, matched for age and sex, who were vaccinated with that same vaccine within the same risk interval.Electronic medical record review revealed 415 confirmed cases of GBS during the study follow-up period of over 32 million person-years, yielding an incidence of 1.27 cases/100,000 person-years. Two thirds of cases had a documented respiratory or gastrointestinal illness in the 90 days preceding onset of GBS. Cases peaked in March and were more common in winter compared to nonwinter months (P = .003). Among the 415 cases, 25 (6%) had received any vaccine in the 6 weeks prior to onset. The odds ratio for receipt of influenza vaccine (TIV) within 6 weeks of onset of GBS compared to the prior 9 months was 1.1 (95% CI, 0.4–3.1). The odds ratios of receipt of tetanus-diphtheria-containing vaccine, 23-valent pneumococcal vaccine, or all vaccines combined in the 6 weeks prior to onset of GBS compared to the prior 12 months were 1.4 (95% CI, 0.3–4.5), 0.7 (95% CI, 0.1–2.9), and 1.3 (95% CI, 0.8–2.3), respectively. Using the 10-week risk interval, 37 (9%) of the individuals with GBS had been vaccinated. However, only injectable typhoid vaccine had an elevated odds ratio (10.75; 95% CI, 1.14–285.04) for GBS. For childhood vaccines, there were no cases of GBS during the risk intervals, despite administration of >8 million doses. Of the 18 persons with onset of GBS within 6 weeks of receipt of TIV, 13 (72%) had a documented antecedent respiratory or gastrointestinal infection.The authors conclude that there is no evidence for an association of GBS with antecedent vaccination, including influenza vaccination. They point out that a very small increased risk of GBS cannot be excluded, however, because of the rarity of the outcome (despite the large numbers included in the study).Dr Tolan has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The use of a case-centered approach and a large cohort of individuals renders this study a valuable addition to the evidence that vaccines are rarely, if at all, associated with GBS (since the 1976 A/ New Jersey swine influenza vaccine was removed from the market).2 As pointed out in the editorial commentary that accompanies this article,3 the power of the study was insufficient to completely exclude any association between vaccines and GBS. Further, the reviewing neurologist was not blind to the diagnosis and possible vaccine triggers documented in the charts, although the criteria used to assign a GBS diagnosis were strict. Most important, however, is the potential that vaccine uptake was underestimated by relying solely on the electronic medical record. In fact, this population was 1 of 4 cohorts analyzed to ascertain the sensitivity of the electronic medical record for TIV receipt.4 Although blinded to particular site, only 51% to 89% of TIV doses actually received were captured in the electronic record. Thus, an important number of TIV doses (11%–49%) were not identified in this study.This important study addresses both influenza and other vaccines, and provides reassurance that childhood vaccines are not associated with GBS. Even if there is a risk on the order of 1 or 2 cases of GBS per million doses of TIV, this risk pales in comparison to the lives saved by influenza vaccination.GBS, an acute inflammatory polyneuropathy, has been associated with one universally administered vaccine, the 1976 Swine influenza vaccine – and, despite continuing concerns as underscored by this report, none since. Pediatricians might well be reminded that the most frequent antecedents of GBS are infectious. Campylobacter jejuni, the most commonly associated agent, is a preventable food-borne and zoonotic pathogen.

Binational outbreak of Guillain–Barré syndrome associated withCampylobacter jejuniinfection, Mexico and USA, 2011

In June 2011, a cluster of suspected cases of Guillain-Barré syndrome (GBS), which can follow Campylobacter jejuni infection, was identified in San Luis Río Colorado (SLRC), Sonora, Mexico and Yuma County, Arizona, USA. An outbreak investigation identified 26 patients (18 from Sonora, eight from Arizona) with onset of GBS 4 May-21 July 2011, exceeding the expected number of cases (n = 1-2). Twenty-one (81%) patients reported antecedent diarrhoea, and 61% of 18 patients tested were seropositive for C. jejuni IgM antibodies. In a case-control study matched on age group, sex, ethnicity, and neighbourhood of residence, all Arizona GBS patients travelled to SLRC during the exposure period vs. 45% of matched controls (matched odds ratio 8·1, 95% confidence interval 1·5-∞). Exposure information and an environmental assessment suggested that GBS cases resulted from a large outbreak of C. jejuni infection from inadequately disinfected tap water in SLRC. Binational collaboration was essential in investigating this cross-border GBS outbreak, the first in mainland North America since 1976.

Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009-2011.

BackgroundGuillain-Barré Syndrome (GBS) can be triggered by gastrointestinal or respiratory infections, including influenza. During the 2009 influenza A (H1N1) pandemic in the United States, monovalent inactivated influenza vaccine (MIV) availability coincided with high rates of wildtype influenza infections. Several prior studies suggested an elevated GBS risk following MIV, but adjustment for antecedent infection was limited.MethodsWe identified patients enrolled in health plans participating in the Vaccine Safety Datalink and diagnosed with GBS from July 2009 through June 2011. Medical records of GBS cases with 2009–10 MIV, 2010–11 trivalent inactivated influenza vaccine (TIV), and/or a medically-attended respiratory or gastrointestinal infection in the 1 through 141 days prior to GBS diagnosis were reviewed and classified according to Brighton Collaboration criteria for diagnostic certainty. Using a case-centered design, logistic regression models adjusted for patient-level time-varying sources of confounding, including seasonal vaccinations and infections in GBS cases and population-level controls.ResultsEighteen confirmed GBS cases received vaccination in the 6 weeks preceding onset, among 1.27 million 2009–10 MIV recipients and 2.80 million 2010–11 TIV recipients. Forty-four confirmed GBS cases had infection in the 6 weeks preceding onset, among 3.77 million patients diagnosed with medically-attended infection. The observed-versus-expected odds that 2009–10 MIV/2010–11 TIV was received in the 6 weeks preceding GBS onset was odds ratio = 1.54, 95% confidence interval (CI), 0.59–3.99; risk difference = 0.93 per million doses, 95% CI, −0.71–5.16. The association between GBS and medically-attended infection was: odds ratio = 7.73, 95% CI, 3.60–16.61; risk difference = 11.62 per million infected patients, 95% CI, 4.49–26.94. These findings were consistent in sensitivity analyses using alternative infection definitions and risk intervals for prior vaccination shorter than 6 weeks.ConclusionsAfter adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009–10 MIV/2010–11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated.

Serial cerebrospinal fluid neurofilament heavy chain levels in severe Guillain‐Barré syndrome

Proximal axonotmesis results in the release of neurofilament (Nf) proteins into the cerebrospinal fluid (CSF) in patients with Guillain-Barré syndrome (GBS). High CSF levels of the phosphorylated form of Nf-heavy chain (NfH(SMI35) ) at GBS onset have been reported to be a poor prognostic marker, but routine measurement of CSF NfH(SMI35) levels has not been done and the longitudinal profile of CSF NfH(SMI35) levels in GBS is not known. This prospective case series describes the clinical, neurophysiological, and biomarker characteristics of 3 patients with severe GBS. High and increasing levels of CSF NfH(SMI35) in serial CSF samples were associated with poor clinical and electrophysiological outcome. These data further suggest that CSF NfH(SMI35) could be a prognostic biomarker which might indicate the development of retrograde axonal degeneration or additional proximal axonal damage during the course of GBS.

Lack of Association of Guillain-Barre Syndrome With Vaccinations

Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy, thought to be an autoimmune process. Although cases of GBS have been reported following a wide range of vaccines, a clear association has only been established with the 1976 H1N1 inactivated influenza vaccine. We identified hospitalized GBS cases from Kaiser Permanente Northern California (KPNC) from 1995 through 2006. The medical record of each suspected case was neurologist-reviewed according to the Brighton Collaboration GBS case definition; only confirmed cases were included in the analyses, and cases of Miller Fisher syndrome were excluded. Using a case-centered design, we compared the odds of vaccination in the 6 and 10 weeks prior to onset of GBS to the odds of vaccination during the same time intervals in all vaccinated individuals in the entire KPNC population. We confirmed 415 incident cases of GBS (including Brighton levels 1, 2, and 3) during the study period (>30 million person-years). Incidence peaked during the winter months. The odds ratio of influenza vaccination within a 6-week interval prior to GBS, compared with the prior 9 months, was 1.1 (95% confidence interval [CI], .4-3.1). The risk in the 6-week interval compared to the prior 12 months for tetanus diphtheria combination, 23-valent pneumococcal polysaccharide, and for all vaccines combined was 1.4 (95% CI, .3-4.5), 0.7 (95% CI, .1-2.9), and 1.3 (95% CI, .8-2.3), respectively. In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.

Seasonal, Age & Gender Variation of Guillain Barre Syndrome in a Tertiary Referral Center in India

Background: Seasonal variation & gender preponderance have not been adequately studied in Guillain Barre Syndrome (GBS). University of Health Sciences, Rohtak is the tertiary referral facility for a large part of North West India. We conducted a prospective study to investigate differences in GBS incidence between males and females & across different seasons of the year. Methods:65 clinically diagnosed GBS patients, aged 5 - 70 years, referred for nerve conduction, Fwave & EMG studies for 3 years. Results: 64.61% were males while 35.38% were females. Maximum patients were in the age group 5 - 20 years (46.15%). The highest incidence of GBS (41.53%) were seen in the summer months; 19 (29.23%) in the spring season, 11 (16.92%) in winter season and 8 (12.30%) in rainy season. 5 patients had diarrhoea while 12 patients had flu like syndrome 1 - 2 weeks before the onset of GBS. Conclusion: The peak seasonal clustering noted by us in the summer months was consistent significantly with other Asian studies. The age and sex distribution of GBS in our series, which showed children & minor preponderance with peak incidence in 5 - 20 years age followed by another in the age group 21 - 40 years, is different from most studies which report a second peak after 50 years of age.

Electrophysiological subtypes and prognosis of Guillain–Barré syndrome in Northeastern China

The purpose of this study was to assess the electrophysiological subtypes and prognosis of Guillain-Barré syndrome (GBS) in northeastern China. Ninety-nine patients with GBS were recruited between 2006 and 2010 and retrospectively reviewed. Sixty-seven percent of patients had acute inflammatory demyelinating polyneuropathy (AIDP). Patients with acute motor axonal neuropathy (AMAN) had more severe symptoms at onset of GBS, and intravenous immunoglobulin (IVIg) was less effective in these patients. The prognosis may have been associated with the severity of the illness and did not differ between AMAN and AIDP patients. Abnormal motor nerve conduction studies (NCS) of the lower limbs and sensory NCS of the upper limbs with normal sural sensory nerve studies were the main electrophysiological features of AIDP. AIDP is the main subtype of GBS, and it has specific electrophysiological characteristics in northeastern China. The prognosis of patients with AMAN was similar to that of patients with AIDP. Moreover, IVIg was more effective in patients with AIDP.

Clinical and electrophysiologic features of childhood Guillain-Barré syndrome in Northeast China.

Since little has been reported in previous studies, we aimed to find the clinical and electrophysiologic characteristics associated with childhood Guillain-Barré Syndrome (GBS) in Northeast China. The clinical and electrophysiologic data were collected and reviewed retrospectively in 33 children and 105 adults with GBS during the period between 2006 and 2010 from the First Hospital of Jilin University. Most of the children with GBS were older than 8 years of age and symptoms were severe at GBS onset. Simultaneous involvement of four limbs was the most common clinical feature, and cranial nerve involvement was common; however, previous infection, sensory nerve involvement and elevated proteins in cerebrospinal fluid occurred much less in the children with GBS than those in adult patients. Recruited children were classified as having acute inflammatory demyelinating polyneuropathy (AIDP; 41%), acute motor axonal neuropathy (AMAN; 38%), and were unclassified (21%). Electrophysiologic features and prognosis in these children were not different from those in adults. For children with AMAN, the efficacy of intravenous immunoglobulin (IVIg) was not different from that in adults; however, IVIg was not significantly effective for AIDP in these children. Childhood GBS in Northeast China exhibits characteristics of clinical and electrophysiologic alternations; early diagnosis and appropriate treatments should be provided accordingly.

Risk of Confirmed Guillain-Barre Syndrome Following Receipt of Monovalent Inactivated Influenza A (H1N1) and Seasonal Influenza Vaccines in the Vaccine Safety Datalink Project, 2009-2010

An increased risk of Guillain-Barré syndrome (GBS) following administration of the 1976 swine influenza vaccine led to a heightened focus on GBS when monovalent vaccines against a novel influenza A (H1N1) virus of swine origin were introduced in 2009. GBS cases following receipt of monovalent inactivated (MIV) and seasonal trivalent inactivated (TIV) influenza vaccines in the Vaccine Safety Datalink Project in 2009-2010 were identified in electronic data and confirmed by medical record review. Within 1-42 days following vaccination, 9 cases were confirmed in MIV recipients (1.48 million doses), and 8 cases were confirmed in TIV-only recipients who did not also receive MIV during 2009-2010 (1.72 million doses). Five cases following MIV and 1 case following TIV-only had an antecedent respiratory infection, a known GBS risk factor; furthermore, unlike TIV, MIV administration was concurrent with heightened influenza activity. In a self-controlled risk interval analysis comparing GBS onset within 1-42 days following MIV with GBS onset 43-127 days following MIV, the risk difference was 5.0 cases per million doses (95% confidence interval: 0.5, 9.5). No statistically significant increased GBS risk was found within 1-42 days following TIV-only vaccination versus 43-84 days following vaccination (risk difference = 1.1 cases per million doses, 95% confidence interval: -3.1, 5.4). Further evaluation to assess GBS risk following both vaccination and respiratory infection is warranted.

Residual disability 10 years after falling ill in Guillain–Barré syndrome: A prospective follow-up study

ObjectiveTo describe residual disability 10years after onset of Guillain–Barré syndrome (GBS) and longitudinal changes from 2weeks after onset until 10years afterwards. The Erasmus GBS Outcome score (EGOS) was applied for predicting prognosis at 2 and 10years. MethodsTwenty-nine patients, mean age at onset 49years, were followed prospectively from 2weeks to 10years after GBS onset. Measures included; GBS disability score, EGOS, Barthel Index, Frenchay Activity Index, Sickness Impact Profile (SIP), Overall Neuropathy Limitations Scale (ONLS), Walk-12, and Fatigue Severity Scale. ResultsAt 10years, the facial paralysis found in 5 participants at 2years was still present, 11 participants (38%) experienced paresthesia, 6 (21%) had limitations in their arms, and 15 (52%) had limitations in walking. Decreased health-related quality of life on comparison to the general population was seen in the physical dimension of SIP at 10years. The median EGOS at 2weeks was 4.5, which correlated highly only with the Barthel Index at 2years and the ONLS arm scale at 10years. ConclusionThe residual disabilities at 1–2years comprised mainly of reduced walking ability, and are still persistent 10years after GBS onset. For some individuals, facial paralysis caused major disability. The EGOS only partly predicted residual disability at 2 and 10years after onset.

Analysis ofCampylobacter jejuniisolates of various sources for loci associated with Guillain-Barré syndrome

Campylobacter jejuni is a major cause of the Guillain-Barré syndrome (GBS) and related diseases. These autoimmune diseases are caused by antibodies cross-reacting with the peripheral (GBS) and central neural tissue (Miller Fisher syndrome - MFS, Bicker-staff's brainstem encephalitis - BBE), leading to acute polyneuropathy. Recently, specific gene loci in C. jejuni have been distinguished which are associated with the onset of GBS, despite a molecular or phenotypic clustering. In this study, we used PCR to analyse C. jejuni isolates of different origin (i.e. bovine, poultry, human) for these genes. A total of 196 isolates were tested for cst-II and neuA. Of these, 101 isolates harboured the cst-II locus and 102 the neuA locus. Eighty-six isolates (44%) hold both genes. The frequency of cst-II in different sources of isolates of bovine, poultry and human isolates did not vary significantly (52, 50 and 52%, respectively). In contrast, the neuA locus was less often found in poultry isolates. Two human strains - from a family outbreak of campylobacteriosis (in 1989 in Austria) in which one person developed MFS - harboured both genes. Thus, although only one in more than 3000 patients with Campylobacter-associated enteritis develop GBS, about half of Campylobacter jejuni strains found in different environments are possibly able to cause GBS. These strains almost equally distributed in bovine, poultry and human isolates. Our results suggest that isolates associated with GBS are not selected by environmental or host-specific factors. Accordingly, this study indicates that host factors such as humoral and cellular immunity are possibly responsible for the development of these autoimmune diseases.

Relevance of anxiety in clinical practice of Guillain-Barré syndrome: a cohort study

ObjectivesIllness is often associated with anxiety, but few data exist about the prognostic significance of this phenomenon. To address this issue, we assessed whether patient anxiety is associated with subsequent...

Guillain-Barré syndrome and SIADH

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in Guillain-Barré syndrome (GBS) is a very often overlooked entity even though it is well-described. However, most of the previous observations are case reports. There are no systematic studies of SIADH in GBS. To assess the incidence and characteristics of SIADH in patients with GBS and to assess whether it is a predictor of poor outcome. We prospectively studied 50 patients with GBS admitted to the Department of Neurology in a tertiary care hospital in South India from January 2009 to April 2010. After obtaining clinical history, electrophysiologic studies were performed to determine the GBS subtype. SIADH was diagnosed based on modified Bartter and Schwartz criteria. SIADH was detected in 24 of the 50 patients (48%) at some stage of the illness (median 8.8 days after GBS onset). Six of them had mild SIADH, 12 patients had moderate SIADH, and 6 patients had severe SIADH. MRC sumscore at the time of admission and discharge was higher in patients with SIADH (p < 0.001) when compared to the normal group. Bulbar weakness and need for ventilatory support were higher in GBS with SIADH (13 vs 1, p < 0.001). Mean duration of hospitalization was longer in SIADH (29.15 vs 10.57, p < 0.001). Most of the patients with GBS with SIADH required plasmapheresis (23 vs 8, p < 0.001). There are 4 variables significantly associated with mortality, which include age >50, ventilatory support, hyponatremia, and bulbar weakness. SIADH is a common and important electrolyte disorder encountered in GBS. It has significant association with severity of GBS and is an indicator of poor prognosis. It can be symptomatic even though the majority of patients are asymptomatic.

Treatment guidelines for Guillain-Barré Syndrome

Guillain–Barre syndrome (GBS) is an acute onset, usually monophasic immune-mediated disorder of the peripheral nervous system. The term GBS is often considered to be synonymous with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), but with the increasing recognition of variants over the past few decades, the number of diseases that fall under the rubric GBS have grown to include axonal variants and more restricted variants, such as Miller Fisher syndrome (MFS) [Table 1].[1] Table 1 Guillain–Barre syndrome—clinical variants Epidemiology The reported incidence rates for GBS are 1–2 per 100,000 population.[2–4] The lifetime likelihood of any individual acquiring GBS is 1:1000.[5] The subtypes of GBS have different incidence rates in different parts of the world. In Europe and North America AIDP is dominant contributing to 90% of the cases. In contrast in China and Japan AMAN being the most common subtype.[6,7] The picture is intermediate when we look at other population. In Indian series the incidence of AIDP and AMAN are virtually equal although AMAN is more common in younger patients.[8] There seems to be a slight preponderance of AIDP in studies by Gupta et al[9] and by Meena et al (unpublished data from NIMS, Hyderabad). Available Indian literature indicates a peak incidence between June–July and Sept–October.[10] In western countries, GBS is common in the 5th decade,[11] but in India it occurs more commonly at a younger age.[10,12] GBS is equally common in men and women and can occur at any age. There is a male preponderance among the hospitalized population.[10,12]

Campylobacter jejuni infection in Guillain-Barré syndrome: A prospective case control study in a tertiary care hospital

Guillain-Barré syndrome (GBS), is a common post-infectious polyradiculoneuropathy worldwide. The commonest implicated causative organism the world over is Campylobacter jejuni (C. jejuni). This study was carried out to determine the relationship between C. jejuni infection and GBS in an Indian setting. This prospective study was carried out on a cohort of 50 patients with GBS who were treated in a tertiary care hospital in India. Based on electrophysiological findings the patients were divided into various subtypes. Serology for C. jejuni (Immunoglogulin G, IgG and Immunoglogulin, IgM) using an enzyme-linked immunosorbent assay method (ELISA) was done both in patients and 40 age, sex and geographically matched controls. Evidence of recent C. jejuni infection was present in 30% of GBS patients compared to 8% of controls (15/50 vs. 3/40 P<0.005). Eight (47%) C. jejuni-positive patients reported symptoms of gastroenteritis 4-30 days (mean 13 days) prior to onset of GBS. Of the 15 patients with evidence of C. jejuni infection, 10 (67%) patients had axonal type of GBS. Axonal variety of GBS presented in a younger age group compared to acute inflammatory demyelinating polyradiculoneuropathy (AIDP) patients (mean age: axonal vs. AIDP: 30.11 + 13.73 vs. 40.2 + 18.77). C. jejuni-positive patients presented mainly in spring and winter and had a similar age and sex incidence as compared to the rest of the GBS patients. Preceding C. jejuni infection is common among GBS patients and is often associated with the axonal variety of GBS. Axonal variety of GBS generally presents in a younger age group as compared to AIDP.

Gardasil: A false sense of immunity?

e13023 Background: Gardasil, a quadrivalent vaccine for human papilloma virus (HPV), is recommended to women aged 9 to 26 to prevent cervical cancer. Over 26 million doses of Gardasil have been administered since its approval by the FDA in June 2006. The vaccine, which protects women from infection by four types of HPV, has been implicated in Guillain-Barre Syndrome (GBS), a rare paralytic disorder. Methods: We conducted a search of the Vaccine Adverse Event Reporting System (VAERS). Our analysis included reports from June 2006 and Aug 2009 of women ages 9 to 26 who had received Gardasil and no other vaccines (concurrent or recent) and presented with either confirmed or suspected GBS. Results: We found 42 incidences of Gardasil-related GBS (reported mainly by medical personnel), including pts receiving Gardasil alone (N=27; age 10-26 yrs; mean 16.67 for the 18 subjects for which age was reported). Of the 27 incidences, 33% were complete reports, with 10 reports after the first dose and 4 reports after the third dose. Initial symptoms averaged 30 days post-Gardasil injection for these 11 cases. GBS was confirmed as final diagnosis in 20 reports, and was highly suspected in 7 reports. Conclusions: A majority of the VAERS data was incomplete: missing pt age, Gardasil dose, or date of GBS onset. Serious adverse events such as GBS require improved efforts at obtaining complete information. Prospective studies are needed to evaluate the link between GBS and Gardasil. Date reported to VAERS (N=none) Age Gardasil dose Onset of symptoms (days) Confirmed diagnosis (Y=yes, S=suspected) 9/7/06 16 1 14 Y 9/14/06 15 1 50 Y 12/3/06 13 N/A 9 Y 4/6/07 N/A N/A N/A Y 5/3/07 18 1 1 Y 5/14/07 13 N/A N/A Y 8/2/07 N/A N/A N/A S 10/12/07 19 1 N/A Y 11/26/07 14 1 1 Y 10/15/07 N/A N/A N/A S 10/15/07 23 N/A N/A Y 1/16/08 18 N/A 15 Y 3/17/08 N/A 1 N/A Y 3/17/08 19 1 150 Y 5/19/08 14 N/A N/A Y 6/19/08 N/A 3 N/A S 6/19/08 N/A 3 N/A S 8/18/08 N/A N/A N/A S 9/17/08 11 N/A N/A S 9/17/08 15 1 75 Y 12/9/08 11 N/A N/A Y 12/22/08 24 3 1 Y 2/10/09 10 1 13 Y 2/18/09 26 1 1 Y 3/16/09 N/A N/A N/A S 4/8/09 N/A N/A N/A Y 4/17/09 21 3 N/A Y No significant financial relationships to disclose.

Guillain-Barré Syndrome after Vaccination in United States: Data From the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005)

There are isolated reports of Guillain-Barré syndrome (GBS) after receiving vaccination. To determine the rates and characteristics of GBS after administration of vaccination in United States We used data for 1990 to 2005 from the Vaccine Adverse Event Reporting System, which is a cooperative program of the Centers for Disease Control and Prevention and the US Food and Drug Administration. There were 1000 cases (mean age, 47 years) of GBS reported after vaccination in the United States between 1990 and 2005. The onset of GBS was within 6 weeks in 774 cases, >6 weeks in 101, and unknown in 125. Death and disability after the event occurred in 32 (3.2%) and 167 (16.7%) subjects, respectively. The highest number (n = 632) of GBS cases was observed in subjects receiving influenza vaccine followed by hepatitis B vaccine (n = 94). Other vaccines or combinations of vaccines were associated with 274 cases of GBS. The incidence of GBS after influenza vaccination was marginally higher in subjects <65 years compared with those >or=65 years (P = 0.09); for hepatitis vaccine, the incidence was significantly higher (P < 0.0001) in the <65 group. Death was more frequent in subjects >or=65 years compared with those <65 years (P < 0.0001). Our results suggest that vaccines other than influenza vaccine can be associated with GBS. Vaccination-related GBS results in death or disability in one fifth of affected individuals, which is comparable to the reported rates in the general GBS population.