Are Flu Shots Safe for Patients With a History of Guillain-Barré Syndrome?

A 51-year-old patient asked me whether she should receive the influenza vaccine. She was last vaccinated in 1976; symptoms that resemble Guillain-Barré syndrome (GBS) (paralysis of her left leg that lasted several months) developed shortly afterwards. She has not received the vaccine since then; however, because she teaches schoolchildren, she wondered whether she should be vaccinated.

Most references I have consulted list GBS as a relative contraindication. Is a flu shot advisable for this patient?

- Nate Hitzeman, MD
   Sacramento, Calif

According to the CDC, the incidence of GBS in the general population is low; however, persons with a history of GBS are much more likely to "coincidentally" experience GBS after influenza vaccination than those without such a history.^1,2 Whether influenza vaccination increases the risk of GBS recurrence is not known. Thus, the CDC cautions against "vaccinating persons who are not at high risk for severe influenza complications and who are known to have experienced GBS within 6 weeks after a previous influenza vaccination."

For most persons who have a history of GBS but are at high risk for severe complications, the established benefits of the influenza vaccine justify yearly vaccination.¹ However, if your patient is healthy and has no risk factors for severe complications of influenza, I would probably advise against vaccination--even though I am a strong proponent of influenza vaccination in general.

- Richard K. Zimmerman, MD, MPH
   Professor of Family Medicine and
      Clinical Epidemiology
   University of Pittsburgh

References:

REFERENCES:

1.

Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).

MMWR.

2005;54(RR-8):15-16.

2.

Hurwitz ES, Schonberger LB, Nelson DB, et al. Guillain-Barré syndrome and the 1978-1979 influenza vaccine.

N Engl J Med.

1981;304:1557-1561.