tetano
Editor, Senior Moderator
The Lancet, Volume 378, Issue 9802, Pages 1545 - 1546, 29 October 2011
doi:10.1016/S0140-6736(11)61665-6Cite or Link Using DOI
Guillain-Barr? syndrome and H1N1 influenza vaccine in UK children
Christopher Verity aEmail Address, Lesley Stellitano a, Anne Marie Winstone a, Nick Andrews b, Julia Stowe b, Elizabeth Miller b
In 1976, the US National Influenza Immunization Programme (against swine influenza) was discontinued because of an increased risk of Guillain-Barr? syndrome within 6 weeks of vaccination.1 Guillain-Barr? syndrome surveillance was therefore imperative for pandemic H1N1 (swine) influenza vaccines and was fast-tracked for UK children younger than 17 years by use of the British Paediatric Surveillance Unit (BPSU) system. Fisher's syndrome is related to Guillain-Barr? syndrome, so both disorders were included. Follow-up clinical questionnaires were sent to paediatricians who reported cases via the BPSU. Histories of H1N1 and seasonal influenza vaccination were obtained from general practitioners.
Between September, 2009, and August, 2010, 55 children developed symptoms of Guillain-Barr? syndrome and two of Fisher's syndrome. Of these, 49 had clinical or laboratory evidence (or both) of an infection in the 3 months before the neurological symptoms started?22 had respiratory infections, 13 gastroenteritis, seven H1N1 influenza (five laboratory-confirmed), two seasonal influenza (one laboratory confirmed), two Epstein-Barr virus, one chickenpox, and two had unexplained fevers. Three children with Guillain-Barr? syndrome had received H1N1 or seasonal influenza vaccines. One child had two H1N1 doses of a whole-virion unadjuvanted vaccine at 5 weeks and 10 days before onset?the only case with an interval potentially indicating a causal relation with Guillain-Barr? syndrome.1 Another had received one dose of H1N1 vaccine 6 months before and the third a seasonal influenza vaccine 4 months before onset.
Between October, 2009, and March 31, 2010, an estimated 855 378 children in England received H1N1 vaccine,2 most with an AS03B adjuvanted split-virion vaccine. Additional children were vaccinated elsewhere in the UK (which our study covers). A single case of Guillain-Barr? syndrome with onset within 6 weeks of H1N1 vaccination is what would be expected by chance in the vaccinated cohort given the background rate of Guillain-Barr? syndrome in this age group.3
Of the 57 cases of Guillain-Barr? syndrome or Fisher's syndrome, nine had influenza (six laboratory-confirmed). This finding is consistent with that of a recent study that found no association between Guillain-Barr? syndrome and seasonal influenza vaccination but a 16-fold increased risk within 1 month of an influenza-like illness.4 The peak in the number of children with Guillain-Barr? syndrome or Fisher's syndrome shortly after the peak of the second wave of H1N1 infection in November, 2009, might reflect this causal association (figure). Given the proven effectiveness of pandemic influenza vaccine used in UK children,5 the vaccination programme might have had an overall protective effect against Guillain-Barr? syndrome.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61665-6/fulltext?rss=yes
doi:10.1016/S0140-6736(11)61665-6Cite or Link Using DOI
Guillain-Barr? syndrome and H1N1 influenza vaccine in UK children
Christopher Verity aEmail Address, Lesley Stellitano a, Anne Marie Winstone a, Nick Andrews b, Julia Stowe b, Elizabeth Miller b
In 1976, the US National Influenza Immunization Programme (against swine influenza) was discontinued because of an increased risk of Guillain-Barr? syndrome within 6 weeks of vaccination.1 Guillain-Barr? syndrome surveillance was therefore imperative for pandemic H1N1 (swine) influenza vaccines and was fast-tracked for UK children younger than 17 years by use of the British Paediatric Surveillance Unit (BPSU) system. Fisher's syndrome is related to Guillain-Barr? syndrome, so both disorders were included. Follow-up clinical questionnaires were sent to paediatricians who reported cases via the BPSU. Histories of H1N1 and seasonal influenza vaccination were obtained from general practitioners.
Between September, 2009, and August, 2010, 55 children developed symptoms of Guillain-Barr? syndrome and two of Fisher's syndrome. Of these, 49 had clinical or laboratory evidence (or both) of an infection in the 3 months before the neurological symptoms started?22 had respiratory infections, 13 gastroenteritis, seven H1N1 influenza (five laboratory-confirmed), two seasonal influenza (one laboratory confirmed), two Epstein-Barr virus, one chickenpox, and two had unexplained fevers. Three children with Guillain-Barr? syndrome had received H1N1 or seasonal influenza vaccines. One child had two H1N1 doses of a whole-virion unadjuvanted vaccine at 5 weeks and 10 days before onset?the only case with an interval potentially indicating a causal relation with Guillain-Barr? syndrome.1 Another had received one dose of H1N1 vaccine 6 months before and the third a seasonal influenza vaccine 4 months before onset.
Between October, 2009, and March 31, 2010, an estimated 855 378 children in England received H1N1 vaccine,2 most with an AS03B adjuvanted split-virion vaccine. Additional children were vaccinated elsewhere in the UK (which our study covers). A single case of Guillain-Barr? syndrome with onset within 6 weeks of H1N1 vaccination is what would be expected by chance in the vaccinated cohort given the background rate of Guillain-Barr? syndrome in this age group.3
Of the 57 cases of Guillain-Barr? syndrome or Fisher's syndrome, nine had influenza (six laboratory-confirmed). This finding is consistent with that of a recent study that found no association between Guillain-Barr? syndrome and seasonal influenza vaccination but a 16-fold increased risk within 1 month of an influenza-like illness.4 The peak in the number of children with Guillain-Barr? syndrome or Fisher's syndrome shortly after the peak of the second wave of H1N1 infection in November, 2009, might reflect this causal association (figure). Given the proven effectiveness of pandemic influenza vaccine used in UK children,5 the vaccination programme might have had an overall protective effect against Guillain-Barr? syndrome.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61665-6/fulltext?rss=yes