ATLANTA — A history of Guillain-Barré syndrome is a precaution for administration of the tetravalent meningococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.
A precaution is a condition that might increase the risk for a serious adverse reaction or compromise the vaccine's ability to produce immunity, according to the CDC. However, the risk is less than that expected for a contraindication. Although vaccinations normally should be deferred in the case of a precaution, in some instances, the benefit of protection might outweigh the potential risk.
Guillain-Barré syndrome is a subacute-onset neuropathy involving bilateral, symmetric, flaccid paralysis. The condition has an autoimmune etiology, with vaccines accounting for some reported cases.
The most notable episode involved the 1976 “swine flu” vaccine, in which the attributable risk was 5–12 cases per million (Am. J. Epidemiol. 1979;110:105–23).
As of October 2007, VAERS has received 24 reports of Guillain-Barré syndrome following use of the tetravalent meningococcal conjugate vaccine (MCV4), marketed as Menactra by Sanofi Pasteur. There were 20 cases in 15- to 19-year-olds, 2 cases in 11- to 14-year-olds, and 2 cases in persons at least 19 years of age. Among the 22 adolescents, the onset of symptoms occurred 2–33 days after vaccination, with a cluster of 13 cases occurring at 9–16 days.
MCV4 thus is predicted to result in five excess cases of Guillain-Barré syndrome per million 11-year-olds vaccinated. The vaccine would prevent an estimated 359 cases of meningococcal disease and 35 associated deaths in the same group.
Dr. Thomas Clark, of the Meningitis and Vaccine Preventable Diseases Branch of the National Center for Immunizations and Respiratory Diseases, noted that this risk is comparable with that of influenza vaccine.