J Korean Med Sci.  2017 Jul;32(7):1154-1159. 10.3346/jkms.2017.32.7.1154.

Clinical Features of Post-Vaccination Guillain-Barré Syndrome (GBS) in Korea

• Park YS
• Lee KJ
• Kim SW
• Kim KM
• Suh BC

• KMID: 2379611
• DOI: http://doi.org/10.3346/jkms.2017.32.7.1154

Abstract

Guillain-Barré syndrome (GBS) is the most common immune-mediated polyradiculoneuropathy and it is also the most commonly reported severe adverse event following immunization in adults. To evaluate the results of clinical and laboratory features of GBS after vaccination in Korea, we analyzed the claims-based data from 2002 to 2014 using materials collected for the Advisory Committee Vaccination Injury Compensation (ACVIC) meeting including, clinical features, nerve conduction studies (NCSs), cerebrospinal fluid (CSF) profiles, treatment, and outcomes. Forty-eight compensated GBS cases (median age, 15 years; interquartile range [IQR], 13-51; male:female ratio, 1:1) of 68 suspected GBS were found following immunization and all of them with influenza immunizations with either monovalent (n = 35) or trivalent (n = 13). Among them, 30 cases fulfilled the Brighton criteria level 1-3 (62.5%). The median duration between the onset of symptoms to nadir, duration of the nadir, and total admission period were 3 (IQR, 2-7 days), 2 (IQR, 1-5 days), and 14 (IQR, 6-33 days) days, respectively. The most frequently reported symptom was quadriparesis which was present in 36 cases (75%) at nadir. CSF examination revealed albuminocytologic dissociation in 25.0% and NCS was abnormal in 61.8%. After treatment, most of them showed improvement. Clinical features were similar to typical post-infectious GBS and there were both demyelinating and axonal forms suggesting heterogeneous pathogenic mechanism. In order to improve the diagnostic certainty of post-vaccination GBS, careful documentation of clinical features and timely diagnostic work-up with follow-up studies are needed.

Keyword

Guillain-Barré Syndrome; Vaccination; Adverse Events; Brighton Criteria; Korea

MeSH Terms

Adult
Advisory Committees
Axons
Cerebrospinal Fluid
Compensation and Redress
Follow-Up Studies
Guillain-Barre Syndrome*
Humans
Immunization
Influenza, Human
Korea*
Neural Conduction
Polyradiculoneuropathy
Quadriplegia
Vaccination

Figure

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  Fig. 1 The relationship between the number of GBS cases and the interval between vaccination and the onset of symptoms. Majority (97.9%) of cases developed symptoms within 3 weeks after vaccination. Particularly, more than half of cases (54.2%) occurred were within 2 days after vaccination. GBS = Guillain-Barré syndrome.

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  Fig. 2 GBS progression according to age groups. Young age group (0–19) showed more rapid recovery than adult age group (≥ 20). GBS = Guillain-Barré syndrome.

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  Fig. 3 The number of cases and percentages with elevated protein concentration in CSF analysis and the timing of lumbar puncture after symptom onset. During the first week, most of CSF examinations were performed (86.8%) but albuminocytologic dissociation was found in less than 20%. In the second week, positive rate of albuminocytologic dissociation increased up to 75%. CSF = cerebrospinal fluid.

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