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Open Access Research article

Estimating background rates of Guillain-Barré Syndrome in Ontario in order to respond to safety concerns during pandemic H1N1/09 immunization campaign

Shelley L Deeks12*, Gillian H Lim1, Mary Anne Simpson3, Laura Rosella12, Christopher O Mackie45, Camille Achonu1 and Natasha S Crowcroft126

Author Affiliations

1 Ontario Agency for Health Protection and Promotion, Toronto, Ontario, Canada

2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

3 Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada

4 City of Hamilton Public Health Services, Hamilton, Ontario, Canada

5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

6 Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada

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BMC Public Health 2011, 11:329  doi:10.1186/1471-2458-11-329

Published: 17 May 2011

Abstract

Background

The province of Ontario, Canada initiated mass immunization clinics with adjuvanted pandemic H1N1 influenza vaccine in October 2009. Due to the scale of the campaign, temporal associations with Guillain-Barré syndrome (GBS) and vaccination were expected. The objectives of this analysis were to estimate the number of background GBS cases expected to occur in the projected vaccinated population and to estimate the number of additional GBS cases which would be expected if an association with vaccination existed. The number of influenza-associated GBS cases was also determined.

Methods

Baseline incidence rates of GBS were determined from published Canadian studies and applied to projected vaccine coverage data to estimate the expected number of GBS cases in the vaccinated population. Assuming an association with vaccine existed, the number of additional cases of GBS expected was determined by applying the rates observed during the 1976 Swine Flu and 1992/1994 seasonal influenza campaigns in the United States. The number of influenza-associated GBS cases expected to occur during the vaccination campaign was determined based on risk estimates of GBS after influenza infection and provincial influenza infection rates using a combination of laboratory-confirmed cases and data from a seroprevalence study.

Results

The overall provincial vaccine coverage was estimated to be between 32% and 38%. Assuming 38% coverage, between 6 and 13 background cases of GBS were expected within this projected vaccinated cohort (assuming 32% coverage yielded between 5-11 background cases). An additional 6 or 42 cases would be expected if an association between GBS and influenza vaccine was observed (assuming 32% coverage yielded 5 or 35 additional cases); while up to 31 influenza-associated GBS cases could be expected to occur. In comparison, during the same period, only 7 cases of GBS were reported among vaccinated persons.

Conclusions

Our analyses do not suggest an increased number of GBS cases due to the vaccine. Awareness of expected rates of GBS is crucial when assessing adverse events following influenza immunization. Furthermore, since individuals with influenza infection are also at risk of developing GBS, they must be considered in such analyses, particularly if the vaccine campaign and disease are occurring concurrently.