Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elizabeth Edwards
Matthew LawFA16 Immunization Module’s Updates
Adverse reactions to vaccines
Guillain-Barre Syndrome (GBS) is a rare, but fairly severe adverse reaction to vaccines. Although most cases of GBS arise after a minor antecedent infection, several studies have shown approximately 1 to 2 excess cases of GBS per million people vaccinated against influenza.
GBS is thought to result from an immune response cross-reacting with peripheral nerve components, resulting in macrophage, complement, and immunoglobulin mediated demyelination or axonal damage. Patients typically present with numbness and tingling in their hands and feet that progressively worsens and is associated w/ decreased deep tendon reflexes. GBS typically worsens over 2 weeks, often involving respiration and the autonomic nervous system. The disease then typically plateaus and improves, with 60% of patients recovering full motor strength within 1 year. The recommended treatment for GBS is supportive care and intravenous immune globulin, although the mechanism by which IVIG leads to improvement of GBS is unknown.
Vaccination in patients with a history of GBS is evaluated on a case by case basis, even if the antecedent event was illness. Vaccination is not recommended for the first year after the onset of GBS, but there is no need to withhold any vaccines after 1 year. If, however, the GBS began up to 6 weeks after an immunization, that immunization should be avoided in the future.
It’s also important to note that the risk of influenza infection far outpaces the risk of GBS provoked by the influenza vaccine. This is true even if the patient has a history of GBS (assuming the influenza vaccine was not the instigating factor). In fact, one of the complications of influenza is an increased risk of GBS that is several times greater than the increased risk from the vaccine.
https://www-uptodate-com.proxy.cc.uic.edu/contents/treatment-and-prognosis-of-guillain-barre-syndrome-in-adults?source=search_result&search=guillain%20barre%20prognosis&selectedTitle=1~150#H23
https://www-uptodate-com.proxy.cc.uic.edu/contents/pathogenesis-of-guillain-barre-syndrome?source=search_result&search=guillain%20barre%20vaccines&selectedTitle=1~150#H9
I agree with the previous commenters in that if I had a history of GBS I would be extremely hesitant to undergo subsequent vaccinations. There was a woman in one of my undergrad classes who had had GBS in high school and gave a presentation about the syndrome. Within a few weeks of getting a flu shot, she was unable to walk for over six months. She had been active in sports, and was looking forward to playing on her varsity team for senior year, and found herself unable to do so, which was incredibly saddening to her. I cannot imagine having gone through that and ever agreeing to get a flu shot again, which is why it surprised my that GBS is not a true contraindication against being vaccinated.
@ZoeScharf My grandfather developed GBS after receiving a flu shot and ultimately died from it. I have to admit, this has made me extremely hesitant to get the flu shot and only got it today because it was a requirement. Like @DanielReine I strongly question if I would have obtained the vaccine if we weren't required to do so. At the same time I do realize that flu infection increases the risk for GBS onset. For me personally, this may be one of those situations where fear outweighs education and rationale.
Call it coincidental, but I actually just had complications with this earlier today. I have a history of GBS, which I contracted at 8 y/o with full recovery after a year of rehab. However, I did not receive a flu vaccine within the 6 months prior, so there was no obvious correlation. Yet, I never obtained a subsequent flu vaccine at the behest of my mother and for self-concern until today as a requirement for Castle Branch. Unfortunately I was unable to get the vaccine in the MSB due to my history; I was directed to McKinley Health Center instead where a physician had to be present for supervision. Despite the fact that I still worry about the risk of GBS provocation by the influenza vaccine, I also know that it is a small risk, especially compared to the fact that contraction of actual influenza virus is far more dangerous. On the other hand, I have to admit that if the vaccine wasn't a requirement for clinical involvement, I question whether I would have gotten it otherwise . . .