Flu shot with hx GBS

[KHE]

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had a patient yeaterday tell me their doctor prohibited them from getting the flu shot due to a history of guillain barre syndrome. The patient reports that they did not get GBS from a flu shot but their pcp tells them not to risk it.

What’s the current thinking on this?

 

[Postictal Raiden]

Absence of associations between influenza vaccines and increased risks of seizures, Guillain-Barré syndrome, encephalitis, or anaphylaxis in the 20... - PubMed - NCBI

there's no associated risk between shots (killed virus) vaccines and GBS.

the risk associated between GBS and nasal spray (live attenuated) is ~ 1 in 100K.

you're patient's likelihood of contracting the flu and going on an ECMO are much higher than getting GBS from the flu shot.

 

[Thama]

The evidence you cited regarding the exceptionally low, possibly nonexistent risk of flu shots causing GBS is accurate, though we should note that it does not focus on the much smaller subgroup of people who already have a history of GBS. AFAIK, we don't know what the risk of flu shots in that population is, although we would presume it would be low given the small signal of GBS after flu shots in the general population as well as the strong tendency for GBS not to recur.

That said, it's not totally unreasonable to exercise caution especially with live virus vaccines in this situation given what we don't know.