Guillain–Barré syndrome (GBS) is a rare neurological autoimmune disease in which a person’s immune system attacks parts of the peripheral nervous system, the nerves that branch out from the brain and spinal cord and carry messages from the central nervous system to the rest of the body. GBS is relevant for infectious disease reporting because it’s a possible, if rare, complication from a variety of infectious diseases, particularly viral infections. Even more rarely, GBS is a possible adverse event from some vaccines.
Deeper Dive
GBS cases can range from mild to very severe and life-threatening, though the latter is rare. The main symptoms are weakness and tingling, often felt first in the legs and then spreading. These symptoms can develop over hours, days or weeks, but recovery can range from a few weeks to years. Although most people recover fully from GBS, severe cases can lead to near-total paralysis and difficulty breathing, and permanent nerve damage can occur from a serious case. In extremely rare circumstances, people have died from GBS.
The most common cause of GBS is a diarrhea or respiratory illness, reported by two out of three people diagnosed with GBS, but other viral or bacterial infections can also cause GBS. The most common pathogen to cause GBS is campylobacter, a bacteria in raw or undercooked poultry that causes food poisoning. Other pathogens linked to GBS include influenza, cytomegalovirus, Epstein-Barr virus, Zika virus, hepatitis A, B, C and E, HIV, mycoplasma pneumonia, and SARS-CoV-2 (COVID-19). Rarer causes of GBS include surgery, trauma and Hodgkin’s lymphoma.
The rarest cause of GBS is vaccination from a handful of vaccines. The only two vaccines that have been clearly linked to GBS in the research are influenza and COVID-19 vaccines, particularly the adenovirus-vector vaccines (Johnson & Johnson and AstraZeneca).
The link to influenza vaccines has been investigated since 1976, when excess cases showed up following administration of that year’s “swine flu” H1N1 vaccine and contributed to the failure of the vaccination program. Studies since then have both shown an association and not shown an association, with some meta-analyses concluding there is no increased risk. The studies finding an association have also found the risk from influenza infection to be multiple times greater than the risk from influenza vaccination. However, GBS remains on the Vaccine Injury Compensation Program’s Vaccine Injury Table of automatically compensated injuries.
Research has never found a clear link between GBS and any other childhood or adult vaccines, but it is tracked in vaccine clinical trials.
For more on GBS aside from the links above, see the fact sheets from the National Institute of Neurological Disorders and Stroke and the World Health Organization.