FA16 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

  • Katherine Zitello
  • Marissa Davis
  • Daniel Reine