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Volume 21, Number 2—February 2015
Research

Simulation Study of the Effect of Influenza and Influenza Vaccination on Risk of Acquiring Guillain-Barré Syndrome

Steven Hawken, Jeffrey C. Kwong, Shelley L. Deeks, Natasha S. Crowcroft, Allison McGeer, Robin Ducharme, Michael A. Campitelli, Doug Coyle, and Kumanan WilsonComments to Author 
Author affiliations: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (S. Hawken, J.C. Kwong, R. Ducharme, M.A. Campitelli, K. Wilson); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (S. Hawken, R. Ducharme, K. Wilson); University of Ottawa, Ottawa (S. Hawken, D. Coyle, K. Wilson); Public Health Ontario, Toronto (J.C. Kwong, S.L. Deeks, N.S. Crowcroft); Dalla Lana School of Public Health, University of Toronto, Toronto (J.C. Kwong, S.L. Deeks, N.S. Crowcroft, A.J. McGeer); University of Toronto, Toronto (J.C. Kwong, N.S. Crowcroft, A.J. McGeer)

Main Article

Table 1

Decision tree model inputs in a simulated study of the effect of influenza and influenza vaccination on the risk of acquiring GBS*

Parameter Expected value (95% CI) Range of values modeled in sensitivity analyses References†
Relative risk for GBS from influenza vaccination
 1.52 (1.17–1.99)
 Fixed
 (11), online Technical Appendix Table 1
Relative risk for GBS from influenza illness
 15.81 (10.28–24.32)
 Fixed
 (11), online Technical Appendix Table 1
Joint risk of influenza vaccination and influenza illness
 17.33 (additive)
 15.81 (subadditive) to 24.03 (multiplicative)
 No available data
GBS incidence rate
 0.45–3.72 cases/100,000 person years‡
 0.45 in youngest girls to 3.72 in oldest men
 (23)
Influenza illness incidence rate
 10% (base case)
 2%–20%
 See online Technical Appendix Table 2
Vaccine effectiveness 20%–80% (3, 25–27)
<65 y of age 0.61 (0.30–0.52)
>65 y of age 0.50 (0.27–0.91)

*GBS, Guillain-Barré syndrome.
†The online Technical Appendix is available at http://wwwnc.cdc.gov/EID/article/2/21/13-1879-Techapp1.pdf.
‡Depending on age and sex.

Main Article

References
  1. Kwong  JC, Stukel  TA, Lim  J, McGeer  AJ, Upshur  REG, Johansen  H, The effect of universal influenza immunization on mortality and health care use. PLoS Med. 2008;5:e211. DOIPubMedGoogle Scholar
  2. Manzoli  L, Ioannidis  JPA, Flacco  ME, De Vito  C, Villari  P. Effectiveness and harms of seasonal and pandemic influenza vaccines in children, adults and elderly: a critical review and re-analysis of 15 meta-analyses. Hum Vaccin Immunother. 2012;8:851–62. DOIPubMedGoogle Scholar
  3. Osterholm  MT, Kelley  NS, Sommer  A, Belongia  EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:36–44. DOIPubMedGoogle Scholar
  4. Lasky  T, Terracciano  GJ, Magder  L, Koski  CL, Ballesteros  M, Nash  D, The Guillain-Barré syndrome and the 1992–1993 and 1993–1994 influenza vaccines. N Engl J Med. 1998;339:1797–802. DOIPubMedGoogle Scholar
  5. Juurlink  DN, Stukel  TA, Kwong  J, Kopp  A, McGeer  A, Upshur  RE, Guillain-Barré syndrome after influenza vaccination in adults: a population-based study. Arch Intern Med. 2006;166:2217–21. DOIPubMedGoogle Scholar
  6. Hughes  RA, Charlton  J, Latinovic  R, Gulliford  MC. No association between immunization and Guillain-Barré syndrome in the United Kingdom, 1992 to 2000. Arch Intern Med. 2006;166:1301–4. DOIPubMedGoogle Scholar
  7. Tam  CC, O'Brien  SJ, Petersen  I, Islam  A, Hayward  A, Rodrigues  LC. Guillain-Barré syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PLoS ONE. 2007;2:e344. DOIPubMedGoogle Scholar
  8. Stowe  J, Andrews  N, Wise  L, Miller  E. Investigation of the temporal association of Guillain- Barré syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol. 2009;169:382–8. DOIPubMedGoogle Scholar
  9. Greene  SK, Rett  M, Weintraub  ES, Li  L, Yin  R, Amato  AA, Risk of confirmed Guillain- Barré syndrome following receipt of monovalent inactivated influenza A (H1N1) and seasonal influenza vaccines in the Vaccine Safety Datalink Project, 2009–2010. Am J Epidemiol. 2012;175:1100–9. DOIPubMedGoogle Scholar
  10. Wise  ME, Viray  M, Sejvar  JJ, Lewis  P, Baughman  AL, Connor  W, Guillain- Barré syndrome during the 2009–2010 H1N1 influenza vaccination campaign: population-based surveillance among 45 million Americans. Am J Epidemiol. 2012;175:1110–9. DOIPubMedGoogle Scholar
  11. Kwong  JC, Vasa  P, Campitelli  MA, Hawken  S, Wilson  K, Rosella  LC, Risk of Guillain-Barré syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study. Lancet Infect Dis. 2013;13:769–76. DOIPubMedGoogle Scholar
  12. Galeotti  F, Massari  M, D’alessandro  R, Beghi  E, Chiò  A, Logroscino  G, Risk of Guillain-Barré syndrome after 2010–2011 influenza vaccination. Eur J Epidemiol. 2013;28:433–44. DOIPubMedGoogle Scholar
  13. Baxter  R, Bakshi  N, Fireman  B, Lewis  E, Ray  P, Vellozzi  C, Lack of association of Guillain- Barré syndrome with vaccinations. Clin Infect Dis. 2013;57:197–204. DOIPubMedGoogle Scholar
  14. Vellozzi  C, Iqbal  S, Broder  K. Guillain-Barré syndrome, influenza, and influenza vaccination: the epidemiologic evidence. Clin Infect Dis. 2014;58:1149–55. DOIPubMedGoogle Scholar
  15. Hughes  RAC, Cornblath  DR. Guillain-Barré syndrome. Lancet. 2005;366:1653–66. DOIPubMedGoogle Scholar
  16. Yuki  N, Hartung  H-P. Guillain-Barré syndrome. N Engl J Med. 2012;366:2294–304. DOIPubMedGoogle Scholar
  17. Hughes  RA, Rees  JH. Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis. 1997;176(Suppl 2):S92–8. DOIPubMedGoogle Scholar
  18. Sejvar  JJ, Baughman  AL, Wise  M, Morgan  OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology. 2011;36:123–33. DOIPubMedGoogle Scholar
  19. Zhang  J, While  AE, Norman  IJ. Nurses’ knowledge and risk perception towards seasonal influenza and vaccination and their vaccination behaviours: a cross-sectional survey. Int J Nurs Stud. 2011;48:1281–9. DOIPubMedGoogle Scholar
  20. Chor  JSY, Pada  SK, Stephenson  I, Goggins  WB, Tambyah  PA, Clarke  TW, Seasonal influenza vaccination predicts pandemic H1N1 vaccination uptake among healthcare workers in three countries. Vaccine. 2011;29:7364–9. DOIPubMedGoogle Scholar
  21. Prematunge  C, Corace  K, McCarthy  A, Nair  RC, Pugsley  R, Garber  G. Factors influencing pandemic influenza vaccination of healthcare workers—a systematic review. Vaccine. 2012;30:4733–43. DOIPubMedGoogle Scholar
  22. Jefferson  T, Di Pietrantonj  C, Rivetti  A, Bawazeer  GA, Al-Ansary  LA, Ferroni  E. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2010;CD001269 .PubMedGoogle Scholar
  23. Jefferson  T, Di Pietrantonj  C, Al-Ansary  LA, Ferroni  E, Thorning  S, Thomas  RE. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2010;CD004876 .PubMedGoogle Scholar
  24. Eschenbach  T. Technical note: constructing tornado diagrams with spreadsheets. Eng Economist. 2006;51:195–204. DOIGoogle Scholar
  25. Janjua  NZ, Skowronski  DM, De Serres  G, Dickinson  J, Crowcroft  NS, Taylor  M, Estimates of influenza vaccine effectiveness for 2007–2008 from Canada's sentinel surveillance system: cross-protection against major and minor variants. J Infect Dis. 2012;205:1858–68. DOIPubMedGoogle Scholar
  26. Pebody  R, Andrews  N, McMenamin  J, Durnall  H, Ellis  J, Thompson  CI, Vaccine effectiveness of 2011/12 trivalent seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: evidence of waning intra-seasonal protection. Euro Surveill. 2013;18:20389 .PubMedGoogle Scholar
  27. Greene  SK, Rett  MD, Vellozzi  C, Li  L, Kulldorff  M, Marcy  SM, Guillain-Barré syndrome, influenza vaccination, and antecedent respiratory and gastrointestinal infections: a case-centered analysis in the Vaccine Safety Datalink, 2009–2011. PLoS ONE. 2013;8:e67185. DOIPubMedGoogle Scholar
  28. World Health Organization. International travel and health: seasonal influenza [cited 2013 Sep 9]. http://www.who.int/ith/diseases/influenza_seasonal/en
  29. Kuster  SP, Shah  PS, Coleman  BL, Lam  P-P, Tong  A, Wormsbecker  A, Incidence of influenza in healthy adults and healthcare workers: a systematic review and meta-analysis. PLoS ONE. 2011;6:e26239. DOIPubMedGoogle Scholar
  30. Skowronski  DM, De Serres  G, Dickinson  J, Petric  M, Mak  A, Fonseca  K, Component-specific effectiveness of trivalent influenza vaccine as monitored through a sentinel surveillance network in Canada, 2006–2007. J Infect Dis. 2009;199:168–79. DOIPubMedGoogle Scholar
  31. Skowronski  DM, Janjua  NZ, De Serres  G, Winter  AL, Dickinson  JA, Gardy  JL, A Sentinel platform to evaluate influenza vaccine effectiveness and new variant circulation, Canada 2010–2011 season. Clin Infect Dis. 2012;55:332–42 and. DOIPubMedGoogle Scholar
  32. Skowronski  DM, De Serres  G, Crowcroft  NS, Janjua  NZ, Boulianne  N, Hottes  TS, Association between the 2008–09 seasonal influenza vaccine and pandemic H1N1 illness during spring–summer 2009: four observational studies from Canada. PLoS Med. 2010;7:e1000258. DOIPubMedGoogle Scholar
  33. Treanor  JJ, Talbot  HK, Ohmit  SE, Coleman  LA, Thompson  MG, Cheng  P-Y, Effectiveness of seasonal influenza vaccines in the United States during a season with circulation of all three vaccine strains. Clin Infect Dis. 2012;55:951–9. DOIPubMedGoogle Scholar
  34. Kissling  E, Valenciano  MM, Larrauri  AA, Oroszi  BB, Cohen  JJ, Nunes  BB, Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: results from the I-MOVE multicentre case-control study. Euro Surveill. 2013;18:20390 .PubMedGoogle Scholar
  35. Grimaldi-Bensouda  L, Alpérovitch  A, Besson  G, Vial  C, Cuisset  J-M, Papeix  C, Guillain- Barré syndrome, influenzalike illnesses, and influenza vaccination during seasons with and without circulating A/H1N1 viruses. Am J Epidemiol. 2011;174:326–35. DOIPubMedGoogle Scholar
  36. Dieleman  J, Romio  S, Johansen  K, Weibel  D, Bonhoeffer  J, Sturkenboom  M, Guillain- Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccine: multinational case-control study in Europe. BMJ. 2011;343:d3908. DOIPubMedGoogle Scholar
  37. Jefferson  T, Rivetti  A, Di Pietrantonj  C, Demicheli  V, Ferroni  E. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2012;8:CD004879 .PubMedGoogle Scholar
  38. Tam  CC, O'Brien  SJ, Rodrigues  LC. Influenza, Campylobacter and Mycoplasma infections, and hospital admissions for Guillain-Barré syndrome, England. Emerg Infect Dis. 2006;12:1880–7 . DOIPubMedGoogle Scholar

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Page created: January 20, 2015
Page updated: January 20, 2015
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