Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barr syndrome) after immunization with Haemophilus influenzae type b conjugate vaccine

Guillain-Barr syndrome is a neurological condition characterized by paralysis, which becomes progressively worse. Although its cause is unknown, the condition usually becomes manifest after a viral infection, surgery, cancer and vaccination. Three children developed Guillain-Barr syndrome after routine Haemophilus influenzae vaccination. A 19-month-old girl with difficulty walking had a polyribosylribitol phosphate linked to diphtheria toxoid (PRP-D) vaccine, the vaccine given to prevent Haemophilus influenzae type b infections, at a well-child care visit. Although she had received other vaccines without incident, her inability to walk a few steps was investigated further. Examination of the patient's brain by computerized tomography (CT), the use of detailed cross-sectional X-rays used to visualize internal structures, yielded nothing unusual. Electromyography, recording the electrical activity in the muscle, revealed abnormal nerve functioning. The patient was discharged after three treatments with plasmapheresis, a process of removing the plasma portion of blood and replacing it with other fresh or frozen plasma, which improved nerve functioning somewhat. In a second case, a 20-month-old girl had a well-child visit, received routine vaccination, and several days later developed progressive muscle incoordination, and had episodes of screaming during sleep, coughing, gagging and difficulty swallowing. Test results were normal, but difficulty walking and swallowing continued. Two months later she was able to walk and run. In a third case report, a 33-month-old girl with leg weakness and uncoordinated muscle movements reported unusual crying during sleep after routine PRP- D vaccination. Two months later neurological evaluation was normal. The association between the PRP-D vaccine and Guillain- Barr syndrome has not been clearly established in this study and results should be conservatively interpreted. The incidence is assumed to be rare given the large number of vaccinations currently administered.