Measles Vaccination and Guillain-Barré Syndrome?

ABSTRACT & COMMENTARY

Synopsis: A mass measles-immunization program in four South American countries involving 70 million children coupled with the extensive surveillance of cases of paralysis showed no temporal increase in the baseline rates of Guillian-Barré syndrome following measles immunization.

Source: Da Silveira CM, et al. Measles vaccination and Guillain-Barré syndrome. Lancet 1997;349:14-16.

Guillain-barré syndrome (gbs) has been associated with several infectious agents including varicella-zoster virus and Campylobacter jejunum.1 Because of a temporal association of several cases of GBS and measles immunization,2 the product information leaflets for measles and MMR vaccines list these as possibly linked. In 1992 and 1993, more than 70 million nine-month- to 14-year-old children received measles vaccine as part of a mass immunization program in Argentina, Brazil, Chile, and Columbia. Between 1990-1994, all cases of flaccid paralysis, including GBS, in these countries were systematically reported and evaluated by the Poliomyelitis Eradication Surveillance System (PESS) of the Pan American Health Organization. This permitted a determination of the frequency of GBS during and 42 days after the vaccination campaigns. There was no statistically significant association between measles vaccination and subsequent GBS.

COMMENT BY ROBERT BALTIMORE, MD, FAAP

When I first saw the title of this article, I wondered why it was written because I did not know of any association between GBS and measles vaccination. In fact, the only possible association of immunization and GBS that I was aware of arose in adults during the national immunization program for swine influenza some years ago. Nevertheless, the package inserts for measles and MMR vaccines do, in fact, note a possible linkage with GBS. During a national measles immunization program in the United Kingdom in 1994, several cases of GBS were reported. When a rare event, such as paralysis, follows vaccination, parents, and the public, may have difficulty in accepting that the relation is not a causal one. Furthermore, immunization during childhood is very common. The U.S. Vaccine Safety Committee estimated that at any time, 6% of children under five years are within 42 days of their most recent immunization.3

Da Silveira et al from the Pan American Health Organization were able to use data from PESS to precisely calculate age-related incidences of GBS over a five-year period in four countries because every individual with flaccid paralysis was assessed. During that same five years there were two, month long, mass measles-immunization campaigns that vaccinated more than seventy million children. If there was a causal relationship between GBS and measles immunization, the frequency should have increased during or immediately after the immunization periods. No statistically increased number of cases were noted. The authors conclude that "in the future, manufacturers product information leaflets for measles vaccines do not need to mention GBS ‘as a possible complication.’"

References

1. Korenthenberg R, Schulte MJ. Natural history and treatment effects in Guillain-Barré syndrome: A multi-center study. Arch Dis Child 1996;74:281-287.

2. Medicines Control Agency. Adverse reactions and measles rubella vaccines. Curr Prob Pharmaco Vigilance 1995;21:9-10.

3. Institute of Medicine. Neurologic disorders. In: Stratton KR, et al. Eds. Adverse events associated with childhood vaccines: Evidence bearing on causality. Washington DC: National Academy Press; 1994:34-58.