Background: To assess Guillain-Barré syndrome (GBS) incidence we relied on the Italian Network for the study of GBS (ITANG) established in 2010 in 7 Italian regions to analyse the association between influenza vaccination and GBS. Methods: All individuals aged ≥18 years, presenting with clinical manifestations that suggested GBS according to the universally accepted Asbury's diagnostic criteria (1990) were prospectively notified to a centralised database by ITANG neurologists over the period October 1, 2010-September 30, 2011. Through a telephone survey, 9 trained interviewers followed up the cases to diagnosis and then for 1 year since hospital discharge. Validation of case reporting was performed with the support of administrative data in 5 regions. Results: We found 365 cases fulfilling the definition for GBS or one of its variants over 19,846,068 population ≥18 years of age, yielding an annual incidence rate of 1.84 per 100,000 (95% CI 1.65-2.03), 2.30 (95% CI 1.99-2.60) in men and 1.41 (95% CI 1.18-1.64) in women. A highly significant peak of incidence was observed in February 2011 as compared to reference month (September 2011, rate ratio 3.3:1, p < 0.01). Conclusions: In Italy, GBS incidence was among the highest reported in Europe and higher than previously observed in Italian studies.

Yuki N, Hartung HP: Guillain-Barré syndrome. N Engl J Med 2012;366:2294-2304.
van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA: Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-482.
Sejvar JJ, Baughman AL, Wise M, Morgan OW: Population Incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology 2011;36:123-133.
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.
van Doorn PA, Ruts L, Jacobs BC: Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol 2008;7:939-950.
Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, et al: Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol 1998;44:780-788.
Salmon DA, Proschan M, Forshee R, et al; H1N1 GBS Meta-Analysis Working Group: Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis. Lancet 2013;381:1461-1468.
Galeotti F, Massari M, D'Alessandro R, et al; ITANG study group: Risk of Guillain-Barré syndrome after 2010-2011 influenza vaccination. Eur J Epidemiol 2013;28:433-444.
Asbury AK, Cornblath DR: Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27(suppl):S21-S24.
Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM: Controlled trial prednisolone in acute polyneuropathy. Lancet 1978;2:750-753.
Sejvar JJ, Kohl KS, Gidudu J, et al; Brighton Collaboration GBS Working Group: Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599-612.
Barnett AG, Dobson AJ: Analysing Seasonal Health Data. Berlin, Heidelberg, Springer, 2010.
A prospective study on the incidence and prognosis of Guillain-Barré syndrome in Emilia-Romagna region, Italy (1992-1993). Emilia-Romagna Study Group on Clinical and Epidemiological Problems in Neurology. Neurology 1997;48:214-221.
Chiò A, Cocito D, Leone M, et al; Piemonte and Valle d'Aosta Register for Guillain-Barré Syndrome: Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology 2003;60:1146-1150.
Bogliun G, Beghi E; Italian GBS Registry Study Group: Incidence and clinical features of acute inflammatory polyradiculoneuropathy in Lombardy, Italy, 1996. Acta Neurol Scand 2004;110:100-106.
Govoni V, Granieri E, Tola MR, Casetta I, Ruppi P, Vaghi L: The frequency of clinical variants of Guillain-Barré syndrome in Ferrara, Italy. J Neurol 1999;246:1010-1014.
Somnier FE: Increasing incidence of late-onset anti-AChR antibody-seropositive myasthenia gravis. Neurology 2005;65:928-930.
Egro FM: Why is type 1 diabetes increasing? J Mol Endocrinol 2013;51:R1-R13.
Leese GP, Flynn RV, Jung RT, et al: Increasing prevalence and incidence of thyroid disease in Tayside, Scotland: the Thyroid Epidemiology Audit and Research Study (TEARS). Clin Endocrinol 2008;68:311-316.
Chiò A, Cocito D, Bottacchi E, et al: Idiopathic chronic inflammatory demyelinating polyneuropathy: an epidemiological study in Italy. J Neurol Neurosurg Psychiatry 2007;78:1349-1353.
Hughes RA, Cornblath DR: Guillain-Barré syndrome. Lancet 2005;366:1653-1666.
Islam Z, Jacobs BC, van Belkum A, et al: Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh. Neurology 2010;74:581-587.
Markoula S, Giannopoulos S, Sarmas I, Tzavidi S, Kyritsis AP, Lagos G: Guillain-Barré syndrome in northwest Greece. Acta Neurol Scand 2007;115:167-173.
Peric S, Milosevic V, Berisavac I, Stojiljkovic O, et al: Clinical and epidemiological features of Guillain-Barré syndrome in the Western Balkans. J Peripher Nerv Syst 2014;19:317-321.
Kuwabara S: Axonal Guillain-Barré syndrome is underestimated in Europe? J Neurol Neurosurg Psychiatry 2010;81:1063.
Kuwabara S, Yuki N: Axonal Guillain-Barré syndrome: concepts and controversies. Lancet Neurol 2013;12:1180-1188.
Uncini A, Kuwabara S: Electrodiagnostic criteria for Guillain-Barrè syndrome: a critical revision and the need for an update. Clin Neurophysiol 2012;123:1487-1495.
Uncini A, Manzoli C, Notturno F, Capasso M: Pitfalls in electrodiagnosis of Guillain-Barré syndrome subtypes. J Neurol Neurosurg Psychiatry 2010;81:1157-1163.
Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC: Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain 2014;137:33-43.
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.
Shui IM, Rett MD, Weintraub E, et al: Guillain-Barré syndrome incidence in a large United States cohort (2000-2009). Neuroepidemiology 2012;39:109-115.
Hughes RA, Rees JH: Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis 1997;176(suppl 2):S92-S98.
Beghi E, Kurland LT, Mulder DW, Wiederholt WC: Guillain-Barré syndrome. Clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol 1985;42:1053-1057.
Cheng Q, Jiang GX, Fredrikson S, Link H, de Pedro-Cuesta J: Incidence of Guillain-Barré syndrome in Sweden 1996. Eur J Neurol 2000;7:11-16.
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.