Guillain-Barre' and Vaccines (What Your Doctor WANTS You to Know)

Guillain-Barre' sounds like a fancy Frenchman, the type of guy you'd invite to a party to impress your friends. In reality, Guillain-Barre' (GBS) is a syndrome that can occur without warning, it causes the insulation around the nerves (myelin) to fall apart. Patients often complain of ascending weakness, tingling that starts in the feet or genitals and climbs up their body. If left unchecked, GBS can cause significant disability and even death from paralysis. Prompt diagnosis and treatment are critical to ensuring good outcomes.

So what triggers GBS? A lot of people will tell you it's vaccines. Are they wrong? Not exactly.

All GBS needs is something provocative to get it going. Last week I met a young woman who caught the common cold and this led to GBS. Today I admitted an elderly man who had his GBS triggered by a urinary tract infection. And yes, I've met people who developed GBS after receiving a vaccine.

There, I admitted it, there can be negative side-effects from getting a vaccine. *record screech*

I've said it before, and I'll say it again: This doctor happens to think that if the medical community were to be more open about potential side-effect from vaccines we wouldn't be losing thousands of people to misinformed bloggers leading them astray with a sliver of truth. All it takes is for someone to click on "What Your Doctor Doesn't Want You to Know," learn that - though exceedingly rare - there ARE in fact risks with vaccines, and from then on their trust in modern medicine is broken. They return to the blogs of self-taught internet "scholars" believing they've got the real scoop. And I say we can hardly blame them when doctors continue to take a Wizard of Oz approach: "Pay no attention to those potential side-effects behind the curtain!"

That's one way to practice medicine.

Am I traitor for saying those things? Only if you believe strict paternalism is woven into the fabric of medicine. As you can see, my preference is for more education, presenting the facts and letting people make informed decisions. With so much information (good and bad) available at one's finger tips on the internet, I find this to also be a matter of adaptation and necessity.

Going back to the subject at hand, I wanted to know what's riskier, getting GBS from say, the flu shot, or from the flu itself? I checked the CDC site first and, honestly, it seemed to tiptoe around this. Finally, I found this article in The Lancet that got right down to it. Check out the methods section to see how researchers worked backwards from GBS cases to obtain the data. Suffice it to say, they found that if you're going to develop GBS after getting the flu shot, it will likely happen 2-6 weeks post-injection. In that same amount of time, people who get the flu itself may develop GBS afterward with greater likelihood compared to those who develop it post-vaccination.

What does it all mean? The article suggests that getting the flu is riskier, even ~17x more than receiving the vaccine in terms of getting GBS. That's good news for modern medicine. The trouble is, of course, that the flu vaccine's efficacy (how well it works) changes year to year, and as I understand it this year's strain is coming up short. It follows that you could get the flu shot, still come down with the flu, and yes, develop GBS from either one of those events (though the odds are very much against that).

So, as one with autoimmune disease, what did I do? I simply got the flu vaccine. I took the very remote chance I'd get GBS because to me, the potential benefits far outweighed any risk. Again, I know this year's vaccine efficacy isn't great, but I wanted to make sure I did everything I could to not infect my family and patients. The flu can kill young children, the immuno-compromised, and the elderly. - All of that happens with MUCH more frequency than any lasting vaccine side-effect. And I share that, even as one who is personally taking care of GBS patients right now and watching them struggle to regain strength.

This is a brave new world we're in. We're more closely connected and our decisions don't just affect ourselves. We also no longer have the untouchable, erudite physician entering our homes with the leather tool-case telling us what to do. We have greater access to knowledge now and how we process all that information will determine the medical decisions we make.  I hope whoever's reading this, if they're on the fence about what to do regarding vaccines, will find a physician who will partner with him/her to make informed decisions s/he can feel good about.

Bonne chance!