Background/Aim: We describe the incidence of Guillain-Barré syndrome (GBS) in a large United States cohort. Methods: Between 2000 and 2009, we identified visits with an ICD-9 code for GBS (357.0) from all persons with continuous enrollment for at least 1 year. The primary case definition was restricted to emergency department and inpatient visits. We calculated age-standardized rates and used multivariate Poisson regression to assess variation in rates by sex, age, season and year of diagnosis. We tabulated descriptive characteristics and the positive predictive value (PPV) for a subset of the visits with available medical record review. Results: 1,619 visits with the GBS ICD-9 code were identified from 50,290,898 person-years of observation. After considering the PPV (55%) for record-reviewed visits, the age-standardized incidence rate was approximately 1.72/100,000 person-years. The rate was 40% higher for males and increased by 50% for every 10-year increase in age. The rate was 15% higher in winter and spring compared with summer. Rates were higher in more recent years. Conclusions: GBS rates are higher in males and increase considerably with age. The potential reasons for differences in rates by season and the increased rates in more recent years should be further investigated.

Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, Burwen D, Cornblath DR, Cleerbout J, Edwards KM, Heininger U, Hughes R, Khuri-Bulos N, Korinthenberg R, Law BJ, Munro U, Maltezou HC, Nell P, Oleske J, Sparks R, Velentgas P, Vermeer P, Wiznitzer M: Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599–612.
McGrogan A, Madle GC, Seaman HE, de Vries CS: The epidemiology of Guillain-Barré syndrome worldwide. A systematic literature review. Neuroepidemiology 2009;32:150–163.
Cheng Q, Jiang GX, Fredrikson S, Link H, Pedro-Cuesta J: Incidence of Guillain-Barré syndrome in Sweden 1996. Eur J Neurol 2000;7:11–16.
Koobatian TJ, Birkhead GS, Schramm MM, Vogt RL: The use of hospital discharge data for public health surveillance of Guillain-Barré syndrome. Ann Neurol 1991;30:618–621.
Hughes RA, Cornblath DR: Guillain-Barré syndrome. Lancet 2005;366:1653–1666.
Schonberger LB, Bregman DJ, Sullivan-Bolyai JZ, Keenlyside RA, Ziegler DW, Retailliau HF, Eddins DL, Bryan JA: Guillain-Barré syndrome following vaccination in the National Influenza Immunization Program, United States, 1976–1977. Am J Epidemiol 1979;110:105–123.
Lieu TA, Kulldorff M, Davis RL, Lewis EM, Weintraub E, Yih K, Yin R, Brown JS, Platt R: Real-time vaccine safety surveillance for the early detection of adverse events. Med Care 2007;45:S89–S95.
Yih WK, Nordin JD, Kulldorff M, Lewis E, Lieu TA, Shi P, Weintraub ES: An assessment of the safety of adolescent and adult tetanus-diphtheria-acellular pertussis (Tdap) vaccine, using active surveillance for adverse events in the Vaccine Safety Datalink. Vaccine 2009;27:4257–4262.
Kaplan JE, Katona P, Hurwitz ES, Schonberger LB: Guillain-Barré syndrome in the United States, 1979–1980 and 1980–1981. Lack of an association with influenza vaccination. JAMA 1982;248:698–700.
Stowe J, Andrews N, Wise L, Miller E: Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol 2009;169:382–388.
Hughes RA, Charlton J, Latinovic R, Gulliford MC: No association between immunization and Guillain-Barré syndrome in the United Kingdom, 1992 to 2000. Arch Intern Med 2006;166:1301–1304.
Haber P, Sejvar J, Mikaeloff Y, Destefano F: Vaccines and Guillain-Barré syndrome. Drug Saf 2009;32:309–323.
Roscelli JD, Bass JW, Pang L: Guillain-Barré syndrome and influenza vaccination in the US Army, 1980–1988. Am J Epidemiol 1991;133:952–955.
Juurlink DN, Stukel TA, Kwong J, Kopp A, McGeer A, Upshur RE, Manuel DG, Moineddin R, Wilson K: Guillain-Barré syndrome after influenza vaccination in adults: a population-based study. Arch Intern Med 2006;166:2217–2221.
Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash D, Clark S, Haber P, Stolley PD, Schonberger LB, Chen RT: The Guillain-Barré syndrome and the 1992–1993 and 1993–1994 influenza vaccines. N Engl J Med 1998;339:1797–1802.
Centers for Disease Control and Prevention (CDC): Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine – United States, 2009–2010. MMWR Morb Mortal Wkly Rep 2010;59:657–661.
Black S, Eskola J, Siegrist CA, Halsey N, Macdonald N, Law B, Miller E, Andrews N, Stowe J, Salmon D, Vannice K, Izurieta HS, Akhtar A, Gold M, Oselka G, Zuber P, Pfeifer D, Vellozzi C: Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines. Lancet 2009;374:2115–2122.
Destefano F: The Vaccine Safety Datalink project 151. Pharmacoepidemiol Drug Saf 2001;10:403–406.
Greene SK, Kulldorff M, Lewis EM, Li R, Yin R, Weintraub ES, Fireman BH, Lieu TA, Nordin JD, Glanz JM, Baxter R, Jacobsen SJ, Broder KR, Lee GM: Near real-time surveillance for influenza vaccine safety: proof-of-concept in the Vaccine Safety Datalink Project. Am J Epidemiol 2010;171:177–188.
Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M, Ray P, Baxter R, Hambidge S, Nordin J, Naleway A, Belongia EA, Lieu T, Baggs J, Weintraub E: Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics 2010;126:e1–e8.
van Koningsveld R, van Doorn PA, Schmitz PI, Ang CW, van der Meche FG: Mild forms of Guillain-Barré syndrome in an epidemiologic survey in The Netherlands. Neurology 2000;54:620–625.
Jones TF, McMillian M, Boothe E, Hanna S, Ingram LA: Hospital discharge data for Guillain-Barré syndrome and influenza A (H1N1) vaccine adverse events. Emerg Infect Dis 2010;16:1500–1501.
Klein NP, Ray P, Carpenter D, Hansen J, Lewis E, Fireman B, Black S, Galindo C, Schmidt J, Baxter R: Rates of autoimmune diseases in Kaiser Permanente for use in vaccine adverse event safety studies. Vaccine 2010;28:1062–1068.
Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978;3:565–566.
Bogliun G, Beghi E: Validity of hospital discharge diagnoses for public health surveillance of the Guillain-Barré syndrome. Neurol Sci 2002;23:113–117.
Tam CC, O’Brien SJ, Petersen I, Islam A, Hayward A, Rodrigues LC: Guillain-Barré syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database. PLoS One 2007;2:e344.
Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphael JC, Gaillard JL, Gault E: Guillain-Barré syndrome and influenza virus infection. Clin Infect Dis 2009;48:48–56.
Chroni E, Papapetropoulos S, Gioldasis G, Ellul J, Diamadopoulos N, Papapetropoulos T: Guillain-Barré syndrome in Greece: seasonality and other clinico-epidemiological features. Eur J Neurol 2004;11:383–388.
Winner SJ, Evans JG: Age-specific incidence of Guillain-Barré syndrome in Oxfordshire. Q J Med 1990;77:1297–1304.
Alshekhlee A, Hussain Z, Sultan B, Katirji B: Guillain-Barré syndrome: incidence and mortality rates in US hospitals. Neurology 2008;70:1608–1613.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.