Background: The Guillain-Barré syndrome (GBS) occurs after infections and as an adverse reaction to vaccines. No detailed information on incidence rates (IRs) in Germany is available. Methods: This retrospective cohort study estimated age- and sex-specific IRs of GBS in Germany in the years 2007-2009 based on electronic healthcare data from the German Pharmacoepidemiological Research Database (GePaRD). Two case definitions were applied. GBS cases had a main discharge diagnosis of GBS. GBS_PROCEDURE cases in addition had codes for relevant diagnostic procedures. Crude and standardized IRs (SIRs) with 95% confidence intervals were stratified by year, age group, sex, region and season. IR ratios (IRRs) for each stratification factor were calculated by multivariable Poisson regression. Results: Among 13,297,678 persons, 889 (693) incident GBS (GBS_PROCEDURE) cases were identified. Overall SIRs per 100,000 person years were 2.4 (2.2-2.5) for GBS and 1.8 (1.7-2.0) for GBS_PROCEDURE. (S)IRs increased with age, peaking in the age group 70-79 years (IR GBS: 5.5 (4.7-6.5)) and were higher in males than in females (e.g., IR GBS: IRR = 1.5 (1.3-1.7)) and in February-April, as compared to the rest of the year. No regional pattern was observed. Conclusion: (S)IRs of GBS in Germany differed by age, sex and season and were comparable to those found in other studies. Results might be used as a comparator in vaccine safety monitoring.

1.
Yuki N, Hartung HP: Guillain-Barre syndrome. N Engl J Med 2012;366:2294-2304.
2.
Hughes RA, Cornblath DR: Guillain-Barre syndrome. Lancet 2005;366:1653-1666.
3.
Hadden RD, Karch H, Hartung HP, Zielasek J, Weissbrich B, Schubert J, et al: Preceding infections, immune factors, and outcome in Guillain-Barre syndrome. Neurology 2001;56:758-765.
4.
Hartung HP, Keller-Stanislawski B, Hughes RA, Lehmann HC: [Guillain-Barre syndrome after exposure to influenza]. Nervenarzt 2012;83:714-730.
5.
Jacobs BC, Rothbarth PH, van der Meche FG, Herbrink P, Schmitz PI, de Klerk MA, et al: The spectrum of antecedent infections in Guillain-Barre syndrome: a case-control study. Neurology 1998;51:1110-1115.
6.
Kang JH, Sheu JJ, Lin HC: Increased risk of Guillain-Barre Syndrome following recent herpes zoster: a population-based study across Taiwan. Clin Infect Dis 2010;51:525-530.
7.
Poropatich KO, Walker CL, Black RE: Quantifying the association between Campylobacter infection and Guillain-Barre syndrome: a systematic review. J Health Popul Nutr 2010;28:545-552.
8.
Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, et al: Guillain-Barre syndrome and influenza virus infection. Clin Infect Dis 2009;48:48-56.
9.
Winner SJ, Evans JG: Age-specific incidence of Guillain-Barre syndrome in Oxfordshire. Q J Med 1990;77:1297-1304.
10.
Bardage C, Persson I, Ortqvist A, Bergman U, Ludvigsson JF, Granath F: Neurological and autoimmune disorders after vaccination against pandemic influenza A (H1N1) with a monovalent adjuvanted vaccine: population based cohort study in Stockholm, Sweden. BMJ 2011;343:d5956.
11.
De Wals P, Deceuninck G, Toth E, Boulianne N, Brunet D, Boucher RM, et al: Risk of Guillain-Barre syndrome following H1N1 influenza vaccination in Quebec. JAMA 2012;308:175-181.
12.
Dieleman J, Romio S, Johansen K, Weibel D, Bonhoeffer J, Sturkenboom M: Guillain-Barre syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccine: multinational case-control study in Europe. BMJ 2011;343:d3908.
13.
Gee J, Naleway A, Shui I, Baggs J, Yin R, Li R, et al: Monitoring the safety of quadrivalent human papillomavirus vaccine: findings from the Vaccine Safety Datalink. Vaccine 2011;29:8279-8284.
14.
Nelson KE: Invited commentary: influenza vaccine and Guillain-Barre syndrome - is there a risk? Am J Epidemiol 2012;175:1129-1132.
15.
Paul Ehrlich Institut: Zusammenhang zwischen pandemischer Influenza A/H1N1v-Impfung und Guillain-Barré-Syndrom/Miller-Fisher-Syndrom in Deutschland. http://www.pei.de/cln_101/nn_2248804/DE/arzneimittelsicherheit-vigilanz/pharmakovigilanz/forschung/gbs-studie/gbs-guillan-barre-syndrom-studie-node.html?__nnn=true#doc2338784bodyText3 (accessed June 26, 2014).
16.
Souayah N, Nasar A, Suri MF, Qureshi AI: Guillain-Barre syndrome after vaccination in United States a report from the CDC/FDA Vaccine Adverse Event Reporting System. Vaccine 2007;25:5253-5255.
17.
Souayah N, Nasar A, Suri MF, Qureshi AI: Guillain-Barre syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). J Clin Neuromuscul Dis 2009;11:1-6.
18.
Souayah N, Michas-Martin PA, Nasar A, Krivitskaya N, Yacoub HA, Khan H, et al: Guillain-Barre syndrome after Gardasil vaccination: data from Vaccine Adverse Event Reporting System 2006-2009. Vaccine 2011;29:886-889.
19.
Tokars JI, Lewis P, Destefano F, Wise M, Viray M, Morgan O, et al: The risk of Guillain-Barre syndrome associated with influenza A (H1N1) 2009 monovalent vaccine and 2009-2010 seasonal influenza vaccines: results from self-controlled analyses. Pharmacoepidemiol Drug Saf 2012;21:546-552.
20.
Velentgas P, Amato AA, Bohn RL, Chan KA, Cochrane T, Funch DP, et al: Risk of Guillain-Barre syndrome after meningococcal conjugate vaccination. Pharmacoepidemiol Drug Saf 2012;21:1350-1358.
21.
Wise ME, Viray M, Sejvar JJ, Lewis P, Baughman AL, Connor W, et al: Guillain-Barre syndrome during the 2009-2010 H1N1 influenza vaccination campaign: population-based surveillance among 45 million Americans. Am J Epidemiol 2012;175:1110-1119.
22.
Sejvar JJ, Baughman AL, Wise M, Morgan OW: Population incidence of Guillain-Barre syndrome: a systematic review and meta-analysis. Neuroepidemiology 2011;36:123-133.
23.
Lehmann HC, Kohne A, Meyer zu Horste G, Kieseier BC: Incidence of Guillain-Barre syndrome in Germany. J Peripher Nerv Syst 2007;12:285.
24.
Black S, Eskola J, Siegrist CA, Halsey N, Macdonald N, Law B, et al: Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines. Lancet 2009;374:2115-2122.
25.
Garbe E, Suling M, Kloss S, Lindemann C, Schmid U: Linkage of mother-baby pairs in the German Pharmacoepidemiological Research Database. Pharmacoepidemiol Drug Saf 2011;20:258-264.
26.
Kraut AA, Schink T, Schulze-Rath R, Mikolajczyk RT, Garbe E: Incidence of anogenital warts in Germany: a population-based cohort study. BMC Infect Dis 2010;10:360.
27.
Lindemann C, Langner I, Kraut AA, Banaschewski T, Schad-Hansjosten T, Petermann U, et al: Age-specific prevalence, incidence of new diagnoses, and drug treatment of attention-deficit/hyperactivity disorder in Germany. J Child Adolesc Psychopharmacol 2012;22:307-314.
28.
Pigeot I, Ahrens W: Establishment of a pharmacoepidemiological database in Germany: methodological potential, scientific value and practical limitations. Pharmacoepidemiol Drug Saf 2008;17:215-223.
29.
Daly LE: Confidence limits made easy: interval estimation using a substitution method. Am J Epidemiol 1998;147:783-790.
30.
Gesundheitsberichterstattung des Bundes. Standardbevölkerung. http://www.gbe-bund.de (accessed June 26, 2014).
31.
Rasmussen TA, Jorgensen MR, Bjerrum S, Jensen-Fangel S, Stovring H, Ostergaard L, et al: Use of population based background rates of disease to assess vaccine safety in childhood and mass immunisation in Denmark: nationwide population based cohort study. BMJ 2012;345:e5823.
32.
McLean M, Duclos P, Jacob P, Humphreys P: Incidence of Guillain-Barre syndrome in Ontario and Quebec, 1983-1989, using hospital service databases. Epidemiology 1994;5:443-448.
33.
Criteria for diagnosis of Guillain-Barre syndrome. Ann Neurol 1978;3:565-566.
34.
Asbury AK, Cornblath DR: Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 1990;27(suppl):S21-S24.
35.
Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, et al: Guillain-Barre syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599-612.
36.
Funch D, Holick C, Velentgas P, Clifford R, Wahl PM, McMahill-Walraven C, et al: Algorithms for identification of Guillain-Barre Syndrome among adolescents in claims databases. Vaccine 2013;31:2075-2079.
37.
van der Maas NA, Kramer MA, Jacobs BC, van Soest EM, Dieleman JP, Kemmeren JM, et al: Guillain-Barre syndrome: background incidence rates in The Netherlands. J Peripher Nerv Syst 2011;16:243-249.
38.
Arbeitsgemeinschaft Influenza: Abschlussbericht der Influenzasaison 2006/2007. Robert Koch Institut, 2007.
39.
Arbeitsgemeinschaft Influenza: Abschlussbericht der Influenzasaison 2007/2008. Robert Koch Institut, 2008.
40.
Arbeitsgemeinschaft Influenza: Abschlussbericht der Influenzasaison 2008/2009. Robert Koch Institut, 2009.
41.
Epidemiologisches Bulletin 21/2010: Rückblick: Epidemiologie und Infektionsschutz im zeitlichen Verlauf der Influenzapandemie (H1N1) 2009 Robert Koch Institut. http://www.rki.de/DE/Content/InfAZ/I/Influenza/Pandemie/Pandemie_Node.html (accessed June 26, 2014).
42.
Frenzen PD: Economic cost of Guillain-Barre syndrome in the United States. Neurology 2008;71:21-27.
43.
Korinthenberg R, Gold R, Felderhoff-Müser U: Leitlinie der Gesellschaft für Neuropädiatrie: Guillain-Barré Syndrom im Kindes-und Jugendalter. http://www.awmf.org/leitlinien/detail/ll/022-008.html (accessed June 26, 2014).
44.
Rees JH, Hughes RA: Campylobacter jejuni infection and childhood Guillain-Barre syndrome. Ann Neurol 1994;35:248-249.
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