Alt om Guillain-Barré Syndrom: Dr. Gareth Parry on the issue of vaccinations.

- The on-going debate on flu injections -
Dr. Gareth J. Parry
Professor of Neurology, University of Minnesota
Published in the Sept. 2003 newsletter of the GBS support group of New Zealand

This is an issue that will never go away.

The evidence on GBS and vaccines is quite clear. Only one vaccination program for anything has ever been PROVEN to have resulted in an increased number of GBS cases and that was the US national swine 'flu vaccination program ordered by President Ford in early 1976. That resulted in about a 25-fold increase in the number of GBS cases.

There have been many smaller reports of GBS following other 'flu vaccines and following vaccines of other kinds (polio for example) but a causitive relationship has never been established.

A recent study from the Mayo Clinic here in Minnesota showed that patients who had previously had GBS had no increased risk of getting another attack if they received vaccinations.
That is the data.
My opinion is that many different events and occurrences can precipitate GBS, including countless viral and bacterial infections, surgery and vaccinations. That is, in a particular individual it is impossible to predict what event or occurrence will precipitate GBS. Nor is it possible to predict which vaccine might precipitate an attack.

Each individual has a nearly unique immunological make up and what might lead to GBS in one individual is unlikely to do so in someone else. The great majority of vaccines are safe but a tiny proportion of individuals do get complications and one of those complications is GBS. The risk of getting GBS following a vaccine is not zero but the risk in general population of getting GBS following a vaccine is not increased. It is still possible that some future vaccine will have the same effect as the 1976 'flu vaccine since there is no way to predict in advance.

However, there are two very important points to make. One is that in most individuals the risk of not getting the vaccine probably outweighs any risk from the vaccine. In particular, in anyone over the age of 70 and in younger people with chronic diseases such as diabetes, bronchitis and emphysema or heart disease, the benefits of the 'flu vaccine far outweigh any risk.
The second point is that people who have had a prior attack of GBS almost never get it again. It does occur but is extremely rare. Thus, people who have had GBS are not at increased risk from subsequent vaccines.

The issue with CIDP is less clear. Because the disease is very rare it is difficult to make dogmatic statements. However, it does appear that vaccines as well as the viral and bacterial infections that vaccines are given to prevent can result in temporary deterioration in patients with CIDP. I generally recommend that my CIDP patients DO NOT get vaccinations although even there I weigh the risk against the benefit. If someone is travelling to a yellow fever endemic area, for example, I still recommend vaccination because the risk of yellow fever far outweighs the risk of the vaccine. Also, I usually recommend that the patients with the chronic diseases as noted above get vaccinated.

Finally, I usually also recommend that health care workers with CIDP get vaccinated because they tend to get exposed to infections in the course of their work and are therefore at a higher risk than the general population of getting an infection.

There is no doubt that getting the infection poses a greater risk than getting the vaccination so if, by refusing the vaccine, an individual gets the 'flu or some other infection then deterioration or relapse is much more likely than it would have been had they received the vaccine.

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