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Guillain-Barré Syndrome Surveillance during National Influenza Vaccination Campaign, New York, USA, 2009 - Vol. 19 No. 12 - December 2013 - Emerging Infectious Disease journal - CDC

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Guillain-Barré Syndrome Surveillance during National Influenza Vaccination Campaign, New York, USA, 2009 - Vol. 19 No. 12 - December 2013 - Emerging Infectious Disease journal - CDC

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Volume 19, Number 12—December 2013


Guillain-Barré Syndrome Surveillance during National Influenza Vaccination Campaign, New York, USA, 2009

Gregory P. Giambrone1Comments to Author , Shelley M. Zansky, Millicent Eidson, Pamela G. Duncan, Louise-Anne McNutt, and Guthrie S. Birkhead
Author affiliations: New York State Department of Health, Albany, New York, USA (G.P. Giambrone, S.M. Zansky, M. Eidson, P.G. Duncan, G.S. Birkhead); University at Albany School of Public Health, Rensselaer, New York, USA (L.-A. McNutt, G.S. Birkhead)
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The New York State Department of Health (NYSDOH) collected information about hospitalized patients with Guillain-Barré syndrome (GBS) during October 2009–May 2010, statewide (excluding New York City), to examine a possible relationship with influenza A(H1N1)pdm09 vaccination. NYSDOH established a Clinical Network of neurologists and 150 hospital neurology units. Hospital discharge data from the Statewide Planning and Research Cooperative System (SPARCS) were used to evaluate completeness of reporting from the Clinical Network. A total of 140 confirmed or probable GBS cases were identified: 81 (58%) from both systems, 10 (7%) from Clinical Network only, and 49 (35%) from SPARCS-only. Capture–recapture methods estimated that 6 cases might have been missed by both systems. Clinical Network median reporting time was 12 days versus 131 days for SPARCS. In public health emergencies in New York State, a Clinical Network may provide timely data, but in our study such data were less complete than traditional hospital discharge data.
In the fall of 1976, the outbreak of a swine-origin influenza virus prompted a mass vaccination campaign in the United States. Although an influenza epidemic did not occur, epidemiologic investigations demonstrated a small but significant risk for Guillain-Barré syndrome (GBS) among adult vaccine recipients within 6 weeks after vaccination (14). Some studies found that a relatively small risk extended slightly beyond the 6 weeks after vaccination (1,2). The estimated attributable risk for GBS after swine influenza vaccination was slightly less than 1 case per 100,000 persons vaccinated (1,3,4). Because of this association, GBS surveillance was established for the 3 subsequent influenza seasons; however, no increased risk for GBS was identified after influenza vaccination (5,6). The underlying reason for the association with the 1976 vaccination remains unknown.
In April 2009, influenza A(H1N1)pdm09 virus was first identified (79). Its emergence and rapid global spread prompted swift development of a new vaccine. The previous association of GBS with the 1976 vaccine raised concerns about the potential for a similar association with the new A(H1N1)pdm09 monovalent vaccines.
In June 2009, the Centers for Disease Control and Prevention (CDC) engaged the 10 CDC-funded Emerging Infection Program (EIP) sites (10,11), including New York State (NYS), to rapidly collect and report information about hospitalized persons with GBS during October 1, 2009–May 31, 2010, to examine a possible relationship with A(H1N1)pdm09 vaccines. Some participating sites had the capability to collect hospital discharge data in real time and used this method as a primary reporting source. However, NYS has inherently long delays in hospital discharge data reporting, so to conduct real-time surveillance, NYS established a network of practicing neurologists as primary reporters. Hospital discharge data were used to supplement and retrospectively evaluate the completeness of the active physician-based reporting system.
Results of the overall national EIP GBS surveillance system during the A(H1N1)pdm09 vaccination campaign, which includes NYS data from hospital discharge data and the physician-based reporting system, have been described (10,11). Because of the rarity of GBS and the small excess risk identified by multistate efforts associated with A(H1N1)pdm09 vaccines (10,11), the NYS Department of Health’s (NYSDOH) EIP did not attempt to study the association between vaccination and GBS. Presented here is a comprehensive evaluation of the NYSDOH EIP’s use of a neurologist-based reporting surveillance system. Capture–recapture was used to compare hospital discharge data with neurologist reports to evaluate the completeness of the overall NYSDOH surveillance system.


We thank Suzanne McGuire for her extraordinary work on the creation and maintenance of the internal database. We extend special thanks to all of our study nurses: Lisa Ayers, Casey Calabria, Mary Pat Boyle, Jennifer Hind, Gayle McNicholas, Katherine Montefusco, Brenda Naizby, Sandra Switzer, and Jeanine Woltmann, who tirelessly reviewed medical records to ensure the success of this surveillance activity. We also thank the neurology practices and hospital staff (primarily infection preventionists and medical records department staff) throughout NYS for their participation and patience.
This study was supported in part by CDC Cooperative Agreement no. U01-CI000311 and an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists and funded by CDCCooperative Agreement no. 1U38HM000414.


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Suggested citation for this article: Giambrone GP, Zansky SM, Eidson M, Duncan PG, McNutt L-A, Birkhead GS. Guillain-Barré syndrome surveillance during national influenza vaccination campaign, New York, USA, 2009. Emerg Infect Dis [Internet]. 2013 Dec [date cited]. Web Site Icon
DOI: 10.3201/eid1912.130643
1Current affiliation: Weill Cornell Medical College, New York, New York, USA.

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