Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009–2011

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Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009–2011

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dc.contributor.author Greene, Sharon K. en_US
dc.contributor.author Rett, Melisa D. en_US
dc.contributor.author Vellozzi, Claudia en_US
dc.contributor.author Li, Lingling en_US
dc.contributor.author Kulldorff, Martin en_US
dc.contributor.author Marcy, S. Michael en_US
dc.contributor.author Daley, Matthew F. en_US
dc.contributor.author Belongia, Edward A. en_US
dc.contributor.author Baxter, Roger en_US
dc.contributor.author Fireman, Bruce H. en_US
dc.contributor.author Jackson, Michael L. en_US
dc.contributor.author Omer, Saad B. en_US
dc.contributor.author Nordin, James D. en_US
dc.contributor.author Jin, Robert en_US
dc.contributor.author Weintraub, Eric S. en_US
dc.contributor.author Vijayadeva, Vinutha en_US
dc.contributor.author Lee, Grace M. en_US
dc.date.accessioned 2014-02-18T18:10:49Z
dc.date.issued 2013 en_US
dc.identifier.citation Greene, S. K., M. D. Rett, C. Vellozzi, L. Li, M. Kulldorff, S. M. Marcy, M. F. Daley, et al. 2013. “Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009–2011.” PLoS ONE 8 (6): e67185. doi:10.1371/journal.pone.0067185. http://dx.doi.org/10.1371/journal.pone.0067185. en
dc.identifier.issn 1932-6203 en
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:11717521
dc.description.abstract Background: Guillain-Barré Syndrome (GBS) can be triggered by gastrointestinal or respiratory infections, including influenza. During the 2009 influenza A (H1N1) pandemic in the United States, monovalent inactivated influenza vaccine (MIV) availability coincided with high rates of wildtype influenza infections. Several prior studies suggested an elevated GBS risk following MIV, but adjustment for antecedent infection was limited. Methods: We identified patients enrolled in health plans participating in the Vaccine Safety Datalink and diagnosed with GBS from July 2009 through June 2011. Medical records of GBS cases with 2009–10 MIV, 2010–11 trivalent inactivated influenza vaccine (TIV), and/or a medically-attended respiratory or gastrointestinal infection in the 1 through 141 days prior to GBS diagnosis were reviewed and classified according to Brighton Collaboration criteria for diagnostic certainty. Using a case-centered design, logistic regression models adjusted for patient-level time-varying sources of confounding, including seasonal vaccinations and infections in GBS cases and population-level controls. Results: Eighteen confirmed GBS cases received vaccination in the 6 weeks preceding onset, among 1.27 million 2009–10 MIV recipients and 2.80 million 2010–11 TIV recipients. Forty-four confirmed GBS cases had infection in the 6 weeks preceding onset, among 3.77 million patients diagnosed with medically-attended infection. The observed-versus-expected odds that 2009–10 MIV/2010–11 TIV was received in the 6 weeks preceding GBS onset was odds ratio = 1.54, 95% confidence interval (CI), 0.59–3.99; risk difference = 0.93 per million doses, 95% CI, −0.71–5.16. The association between GBS and medically-attended infection was: odds ratio = 7.73, 95% CI, 3.60–16.61; risk difference = 11.62 per million infected patients, 95% CI, 4.49–26.94. These findings were consistent in sensitivity analyses using alternative infection definitions and risk intervals for prior vaccination shorter than 6 weeks. Conclusions: After adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009–10 MIV/2010–11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated. en
dc.language.iso en_US en
dc.publisher Public Library of Science en
dc.relation.isversionof doi:10.1371/journal.pone.0067185 en
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694016/pdf/ en
dash.license LAA en_US
dc.subject Biology en
dc.subject Population Biology en
dc.subject Epidemiology en
dc.subject Infectious Disease Epidemiology en
dc.subject Medicine en
dc.subject Anatomy and Physiology en
dc.subject Neurological System en
dc.subject Clinical Immunology en
dc.subject Immunity en
dc.subject Vaccination en
dc.subject Vaccines en
dc.subject Drugs and Devices en
dc.subject Adverse Reactions en
dc.subject Pharmacoepidemiology en
dc.subject Epidemiological Methods en
dc.subject Infectious Diseases en
dc.subject Viral Diseases en
dc.subject Influenza en
dc.subject Gastrointestinal Infections en
dc.subject Neurology en
dc.subject Demyelinating Disorders en
dc.subject Public Health en
dc.subject Immunizations en
dc.subject Pulmonology en
dc.subject Respiratory Infections en
dc.title Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009–2011 en
dc.type Journal Article en_US
dc.description.version Version of Record en
dc.relation.journal PLoS ONE en
dash.depositing.author Rett, Melisa D. en_US
dc.date.available 2014-02-18T18:10:49Z

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