Conclusion

The evidence is inadequate to accept or reject a causal relation between measles vaccine and transverse myelitis.

GUILLAIN-BARRÉ SYNDROME

Clinical Description

Guillain-Barré syndrome (GBS) is characterized by the rapid onset of flaccid motor weakness with depression of tendon reflexes and inflammatory demyelination of peripheral nerves (Asbury and Gibbs, 1990). The annual incidence of GBS appears to be approximately 1 per 100,000 people for adults. The data are not definitive, but the annual incidence of GBS in children under age 5 years appears to be approximately the same. The annual incidence of GBS in children over age 5 years and teenagers appears to be lower. Chapter 3 contains a detailed discussion of GBS.

History of Suspected Association

A possible relation between live attenuated viral vaccines and demyelinating disease has been investigated for many years, as described in Chapter 3. There is no specific information suggesting an association between measles vaccine and GBS. The committee was charged with investigating a possible causal relation between only measles vaccine and GBS.

Evidence for Association

Biologic Plausibility

Chapter 3 contains a detailed discussion of the arguments that vaccine can cause demyelination, including GBS. GBS has been described in a few patients following natural (wild-type) measles infection (Lidin-Janson and Straanegard, 1972). Thus, GBS appears to be a rare but possible sequela of measles.

Case Reports, Case Series, and Uncontrolled Observational Studies

Grose and Spigland (1976) reported two cases of GBS that developed in patients within 1 week after immunization with measles vaccine. One of these patients, a 19-month-old girl, was part of a study of 24 patients with GBS for whom serologic studies were performed as part of an effort by the authors to identify possible causal viral agents. She received a combined



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