Drug Safety

, Volume 32, Issue 4, pp 309–323 | Cite as

Vaccines and Guillain-Barré Syndrome

  • Penina Haber
  • James Sejvar
  • Yann Mikaeloff
  • Frank DeStefano
Review Article


Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis in developed countries and is characterized by various degrees of weakness, sensory abnormalities and autonomic dysfunction. Although the underlying aetiology and pathophysiology of GBS are not completely understood, it is broadly believed that immune stimulation plays a role in its pathogenesis. Thus, since vaccines have an effect on the immune system it is biologically plausible that immunizations may be associated with subsequent GBS.

The objective of this article is to review the current body of evidence that either supports or does not support a causal, rather than just temporal, association between various vaccines and GBS, and to provide an evidence-based review of this issue. The scope of the article includes published reports that, regardless of method of case ascertainment, appeared in peer-reviewed literature between 1950 and 2008.

Our review indicates that, with rare exceptions, associations between vaccines and GBS have been only temporal. There is little evidence to support a causal association with most vaccines. The evidence for a causal association is strongest for the swine influenza vaccine that was used in 1976–77. Studies of influenza vaccines used in subsequent years, however, have found small or no increased risk of GBS.

Older formulations of rabies vaccine cultured in mammalian brain tissues have been found to have an increased risk of GBS, but newer formulations of rabies vaccine, derived from chick embryo cells, do not appear to be associated with GBS at a greater than expected rate.

In an earlier review, the Institute of Medicine concluded that the evidence favoured a causal association between oral polio vaccine and tetanus toxoid-containing vaccines and GBS. However, recent evidence from large epidemiological studies and mass immunization campaigns in different countries found no correlation between oral polio vaccine or tetanus toxoid-containing vaccines and GBS.

Spontaneous reports to the US Vaccine Adverse Events Reporting System shortly after the introduction of quadrivalent conjugated meningococcal vaccine (MCV4) raised concerns of a possible association with GBS. Comparisons with expected rates of GBS, however, were inconclusive for an increased risk, and lack of controlled epidemiological studies makes it difficult to draw conclusions about a causal association.

For other vaccines, available data are based on isolated case reports or very small clusters temporally related to immunizations, and no conclusion about causality can be drawn.

There are certain circumstances in which immunizing individuals, particularly those with a prior history of GBS, may require caution. However, the benefit of vaccines in preventing disease and decreasing morbidity and mortality, particularly for influenza, needs to be weighed against the potential risk of GBS.


Influenza Influenza Vaccine Oral Polio Vaccine Rabies Vaccine Vaccine Adverse Event Reporting System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank Claudia Vellozzi, Eric Weintraub and Elaine Miller for help providing useful VAERS data analysis on Meningococcal Polysaccharide Diphtheria Toxoid Conjugates Vaccine reports to VAERS, Barbara Slade and John Iskander for overall comments, Rick Colbert at CDC for his extensive help in searches and allocation of the relevant articles used for this review, and Alena Kromova from Sanofi Pasteur, for translating from French a case report on Haemophilus influenzaeType B Vaccines that is cited in this review. The preparation of this review has been funded by the US government. The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Penina Haber
    • 1
  • James Sejvar
    • 2
  • Yann Mikaeloff
    • 3
  • Frank DeStefano
    • 4
  1. 1.MPH, Immunization Safety Office, Office of the Chief Science OfficerCenters for Disease Control and PreventionAtlantaUSA
  2. 2.National Center for Zoonotic, Vectorborne, and Enteric Disease, Division of Viral and Rickettsial Diseases and Division of Vector-Borne Infectious DiseasesCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Pediatric Neurology Department and INSERM U822Bicêtre University HospitalParisFrance
  4. 4.Research Triangle Institute (RTI) InternationalAtlantaUSA

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