Conclusion

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

There is no evidence bearing on a causal relation between IPV 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. The annual incidence of GBS appears to be approximately 1 per 100,000 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 relation between attenuated viral vaccines and demyelinating disease has been investigated for many years, as described in Chapter 3. Specific interest in the relation between GBS and polio vaccine was triggered by a report in 1976 of 10 cases of GBS in patients who had received IPV (Andersen and Eeg-Olofsson, 1976).

Evidence for Association

Biologic Plausibility

Chapter 3 contains a detailed discussion of the arguments that vaccines can cause demyelination, including GBS. There are no additional data demonstrating the biologic plausibility of a specific relation between polio vaccines and GBS.

Case Reports, Case Series, and Uncontrolled Observational Studies

Grose and Spigland (1976) describe a 10-month-old girl who developed GBS 4 to 7 days after receiving measles vaccine, DPT, and OPV. Poliovirus type 1 was isolated from a throat swab. The authors attributed the disease to the measles vaccine.



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