tetano
Editor, Senior Moderator
Vaccine. 2019 Sep 9. pii: S0264-410X(19)31109-0. doi: 10.1016/j.vaccine.2019.08.045. [Epub ahead of print]
[h=1]Surveillance for Guillain-Barr? syndrome after 2015-2016 and 2016-2017 influenza vaccination of Medicare beneficiaries.[/h] Arya DP[SUP]1[/SUP], Said MA[SUP]2[/SUP], Izurieta HS[SUP]2[/SUP], Perez-Vilar S[SUP]2[/SUP], Zinderman C[SUP]2[/SUP], Wernecke M[SUP]3[/SUP], Alexander M[SUP]3[/SUP], White T[SUP]3[/SUP], Su IH[SUP]3[/SUP], Lufkin B[SUP]3[/SUP], MaCurdy T[SUP]4[/SUP], Kelman J[SUP]5[/SUP], Forshee R[SUP]2[/SUP].
[h=3]Author information[/h] 1 Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA. Electronic address: deepa.arya@fda.hhs.gov. 2 Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA. 3 Acumen, LLC, Burlingame, CA, USA. 4 Acumen, LLC, Burlingame, CA, USA; Stanford University, Stanford, CA, USA. 5 Centers for Medicare & Medicaid Services, Washington, DC, USA.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Guillain-Barr? syndrome (GBS) is a serious acute demyelinating disease, an increased risk of which was found after the 1976 swine flu vaccinations. The U.S. Food and Drug Administration, in collaboration with the Centers for Medicare & Medicaid Services, has been conducting active surveillance for GBS after influenza vaccinations of Medicare Fee-For-Service beneficiaries since 2009.
[h=4]METHODS:[/h] We conducted active surveillance for GBS claims in the 2015-2016 and 2016-2017 influenza seasons using the Updating Sequential Probability Ratio Test (USPRT) to monitor for signals of GBS risk. We performed self-controlled risk interval (SCRI) analyses at the end of both seasons, including chart confirmation in the 2015-2016 season, to estimate the odds ratio of GBS risk. We used 1-42 and 8-21 days post-vaccination as primary and secondary risk windows, respectively, and 43-84 days post-vaccination as the control window.
[h=4]RESULTS:[/h] Over 13 million beneficiaries were vaccinated in each season. USPRT found a low magnitude signal for GBS in both seasons. SCRI analyses did not find excess GBS risk following any influenza vaccine for days 1-42 post-vaccination in either season. In the 2015-2016 season, for the 8-21 day window, our chart-confirmation showed an attributable GBS risk of 0.87 (95% CI: 0.16, 1.49) and 1.68 (95% CI: 0.69, 2.41) cases per million vaccinees after all seasonal and high dose (HD) vaccines, respectively, an elevated GBS risk for beneficiaries aged ≥75 years following all seasonal vaccines (OR: 2.25; 95% CI: 1.15, 4.39) and HD vaccine (OR: 3.67, 95% CI: 1.52, 8.85), and an elevated GBS risk for males who received seasonal vaccines (OR: 2.18; 95% CI: 1.15, 4.15) and HD vaccine (OR: 3.33; 95% CI: 1.35, 8.20). The finding of elevated GBS risk with advancing age and in males is consistent with literature; however, a distinction between HD and SD was a new finding. In the 2016-17 season, for the 8-21 day window, attributed cases showed an attributable GBS risk of 0.87 (95% CI: 0.03, 1.61) and 1.11 (95% CI: 0.00, 2.01) cases per million vaccinees after all seasonal and HD vaccines, respectively. We found no excess GBS risk for standard dose vaccines in the 8-21 day window in either season.
[h=4]CONCLUSIONS:[/h] Our primary analysis finding of no excess GBS risk during both seasons was reassuring. The slightly elevated GBS risk, although in the expected range, in the 8-21 day window after all seasonal and high dose vaccines, but not after standard dose vaccines is hypothesis-generating because the difference may be due to vaccine factors such as antigen amount or strains in various seasons or due to host factors.
Copyright ? 2019 Elsevier Ltd. All rights reserved.
[h=4]KEYWORDS:[/h] Flu; Guillain-Barr? syndrome; High dose influenza vaccine; Immunization; Influenza; Vaccine
PMID: 31515146 DOI: 10.1016/j.vaccine.2019.08.045
[h=1]Surveillance for Guillain-Barr? syndrome after 2015-2016 and 2016-2017 influenza vaccination of Medicare beneficiaries.[/h] Arya DP[SUP]1[/SUP], Said MA[SUP]2[/SUP], Izurieta HS[SUP]2[/SUP], Perez-Vilar S[SUP]2[/SUP], Zinderman C[SUP]2[/SUP], Wernecke M[SUP]3[/SUP], Alexander M[SUP]3[/SUP], White T[SUP]3[/SUP], Su IH[SUP]3[/SUP], Lufkin B[SUP]3[/SUP], MaCurdy T[SUP]4[/SUP], Kelman J[SUP]5[/SUP], Forshee R[SUP]2[/SUP].
[h=3]Author information[/h] 1 Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA. Electronic address: deepa.arya@fda.hhs.gov. 2 Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA. 3 Acumen, LLC, Burlingame, CA, USA. 4 Acumen, LLC, Burlingame, CA, USA; Stanford University, Stanford, CA, USA. 5 Centers for Medicare & Medicaid Services, Washington, DC, USA.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Guillain-Barr? syndrome (GBS) is a serious acute demyelinating disease, an increased risk of which was found after the 1976 swine flu vaccinations. The U.S. Food and Drug Administration, in collaboration with the Centers for Medicare & Medicaid Services, has been conducting active surveillance for GBS after influenza vaccinations of Medicare Fee-For-Service beneficiaries since 2009.
[h=4]METHODS:[/h] We conducted active surveillance for GBS claims in the 2015-2016 and 2016-2017 influenza seasons using the Updating Sequential Probability Ratio Test (USPRT) to monitor for signals of GBS risk. We performed self-controlled risk interval (SCRI) analyses at the end of both seasons, including chart confirmation in the 2015-2016 season, to estimate the odds ratio of GBS risk. We used 1-42 and 8-21 days post-vaccination as primary and secondary risk windows, respectively, and 43-84 days post-vaccination as the control window.
[h=4]RESULTS:[/h] Over 13 million beneficiaries were vaccinated in each season. USPRT found a low magnitude signal for GBS in both seasons. SCRI analyses did not find excess GBS risk following any influenza vaccine for days 1-42 post-vaccination in either season. In the 2015-2016 season, for the 8-21 day window, our chart-confirmation showed an attributable GBS risk of 0.87 (95% CI: 0.16, 1.49) and 1.68 (95% CI: 0.69, 2.41) cases per million vaccinees after all seasonal and high dose (HD) vaccines, respectively, an elevated GBS risk for beneficiaries aged ≥75 years following all seasonal vaccines (OR: 2.25; 95% CI: 1.15, 4.39) and HD vaccine (OR: 3.67, 95% CI: 1.52, 8.85), and an elevated GBS risk for males who received seasonal vaccines (OR: 2.18; 95% CI: 1.15, 4.15) and HD vaccine (OR: 3.33; 95% CI: 1.35, 8.20). The finding of elevated GBS risk with advancing age and in males is consistent with literature; however, a distinction between HD and SD was a new finding. In the 2016-17 season, for the 8-21 day window, attributed cases showed an attributable GBS risk of 0.87 (95% CI: 0.03, 1.61) and 1.11 (95% CI: 0.00, 2.01) cases per million vaccinees after all seasonal and HD vaccines, respectively. We found no excess GBS risk for standard dose vaccines in the 8-21 day window in either season.
[h=4]CONCLUSIONS:[/h] Our primary analysis finding of no excess GBS risk during both seasons was reassuring. The slightly elevated GBS risk, although in the expected range, in the 8-21 day window after all seasonal and high dose vaccines, but not after standard dose vaccines is hypothesis-generating because the difference may be due to vaccine factors such as antigen amount or strains in various seasons or due to host factors.
Copyright ? 2019 Elsevier Ltd. All rights reserved.
[h=4]KEYWORDS:[/h] Flu; Guillain-Barr? syndrome; High dose influenza vaccine; Immunization; Influenza; Vaccine
PMID: 31515146 DOI: 10.1016/j.vaccine.2019.08.045