Lack of Association of Guillain-Barre Syndrome With Vaccinations
Lack of Association of Guillain-Barre Syndrome With Vaccinations
复制标题
DOI：
10.1093/cid/cit222
复制
发表时间：
2013-07-15
影响因子：
11.8
通讯作者：
Klein, Nicola P.
中科院分区：
文献类型：
--
作者：
Baxter, Roger;Bakshi, Nandini;Klein, Nicola P.
背景。格林-巴利综合征 (GBS) 是一种急性多发性神经根神经病，被认为是一种自身免疫过程。尽管已有多种疫苗接种后出现 GBS 病例的报告，但仅与 1976 年 H1N1 灭活流感疫苗建立了明确的关联。我们确定了 1995 年至 2006 年北加州凯撒医疗机构 (KPNC) 住院的 GBS 病例。每个疑似病例的医疗记录均根据 Brighton Collaboration GBS 病例定义进行了神经科医生审查；分析中仅纳入确诊病例，米勒·费希尔综合征病例被排除在外。采用以病例为中心的设计，我们将整个 KPNC 人群中所有接种疫苗的个体在 GBS 发病前 6 周和 10 周内接种疫苗的几率与相同时间间隔内接种疫苗的几率进行了比较。在研究期间（>3000 万人年），我们确认了 415 例 GBS 病例（包括布莱顿 1、2 和 3 级）。发病率在冬季达到高峰。与之前 9 个月相比，GBS 发生前 6 周内接种流感疫苗的优势比为 1.1（95% 置信区间 [CI]，0.4-3.1）。与之前 12 个月相比，破伤风白喉组合、23 价肺炎球菌多糖和所有疫苗组合的 6 周间隔风险分别为 1.4 (95% CI, 0.3-4.5)、0.7 (95% CI, 0.1-2.9) 和 1.3 (95% CI, 0.8-2.3)。结论。在这项大型回顾性研究中，我们没有发现任何证据表明接种任何类型的疫苗（包括流感疫苗）后 GBS 风险增加。
Background. Guillain-Barre 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.Methods. 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.Results. 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.Conclusions. In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.