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Is guillain barré syndrome/fisher syndrome associated with swine ‘flu vaccination in children? results from a UK-wide epidemiological study
  1. C Verity1,
  2. L Stellitano1,
  3. A Winstone1,
  4. N Andrews2,
  5. J Stowe2,
  6. E Miller2
  1. 1The PIND/GBS Research Group, Addenbrookes Hospital, Cambridge, UK
  2. 2Communicable Disease Surveillance Centre, Health Protection Agency, Colindale, UK

Abstract

Aims To report results after 13 months of prospective UK surveillance for Guillain-Barré/Fisher (GBS/FS) syndrome via the British Paediatric Surveillance Unit (BPSU) system.

Methods ‘Fast-track’ surveillance commenced in September 2009 using the BPSU monthly surveillance card. Consent was obtained to share identifying information about cases with the Health Protection Agency (HPA), thus obtaining vaccination details (type, batch number etc.) and laboratory results from General Practitioners and other sources.

Results Data from notifying paediatricians is corroborated by the HPA. There were 115 notifications between September 2009 and the end of October 2010 with 16 duplications. So far information is available for 59 cases that meet the case definitions; 57 had GBS and 2 FS. There was a peak of confirmed cases developing symptoms in December 2009. In 43 of the 59 cases there was a suspected or proven infection in the previous 3 months – 4 laboratory proven H1N1, 2 suspected H1N1, 19 upper respiratory tract infection, 12 gastroenteritis (1 campylobacter, 2 norovirus), 1 chickenpox contact, 1 impetigo, 1 infectious mononucleosis, 3 nonspecific systemic illnesses. In eight cases there was a reported vaccination in the 3 months before symptoms as follows: 2 HPV (human papillomavirus), 2 Travel, 1 MMR, 1 MMR and MenC and pneumococcal, 1 diphtheria/tetanus/pertussis/polio/Hib and MenC and pneumococcal, 1 Baxter H1N1 (two doses) and varicella.

Conclusion Despite the concern that swine ‘flu vaccination might cause GBS we have so far detected a temporal association with H1N1 vaccination in only one case. There is a clear temporal association between preceding infections (including H1N1) and the onset of illness in the GBS/FS cases, with a peak of onset in December 2009. The response from paediatricians is encouraging – in a previous BPSU study of acute flaccid paralysis just 20 cases of GBS were identified per year, probably because of under-reporting. These results are preliminary, as in some cases we await confirmation of the vaccination details from General Practitioners via the HPA.

Acknowledgement Thanks to the Department of Health for our funding [PRP: 0190047], to Richard Lynn, Scientific Co-ordinator of the BPSU, and the paediatricians who report cases.

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