Population incidence of Guillain-Barré syndrome (GBS) is required to assess changes in GBS epidemiology, but published estimates of GBS incidence vary greatly depending on case ascertainment, definitions, and sample size. We performed a meta-analysis of articles on GBS incidence by searching Medline (1966–2009), Embase (1988–2009), Cinahl (1981–2009) and CABI (1973–2009) as well as article bibliographies. We included studies from North America and Europe with at least 20 cases, and used population-based data, subject matter experts to confirm GBS diagnosis, and an accepted GBS case definition. With these data, we fitted a random-effects negative binomial regression model to estimate age-specific GBS incidence. Of 1,683 nonduplicate citations, 16 met the inclusion criteria, which produced 1,643 cases and 152.7 million person-years of follow-up. GBS incidence increased by 20% for every 10-year increase in age; the risk of GBS was higher for males than females. The regression equation for calculating the average GBS rate per 100,000 person-years as a function of age in years was exp[–12.0771 + 0.01813(age in years)] × 100,000. Our findings provide a robust estimate of background GBS incidence in Western countries. Our regression model may be used in comparable populations to estimate the background age-specific rate of GBS incidence for future studies.
© 2011 S. Karger AG, Basel
- Guillain-Barré syndrome
- Guillain-Barré syndrome, incidence
- Guillain-Barré syndrome, meta-analysis
- Hughes RA, Cornblath DR: Guillain-Barre syndrome. Lancet 2005;366:1653–1666.
- Hughes RA, Hadden RD, Gregson NA, Smith KJ: Pathogenesis of Guillain-Barré syndrome. J Neuroimmunol 1999;100:74–97.
- Levin MC, Krichavsky M, Berk J, Foley S, Rosenfeld M, Dalmau J, Chang G, Posner JB, Jacobson S: Neuronal molecular mimicry in immune-mediated neurologic disease. Ann Neurol 1998;44:87–98.
- Nakamura T: Infectious agents as the triggers for the pathogenesis of the neuroimmunological disorders. Nippon Rinsho 2008;66:1056–1064.
- Rees JH, Soudain SE, Gregson NA, Hughes RA: Campylobacter jejuni infection and Guillain-Barré syndrome. N Engl J Med 1995;333:1374–1379.
- Hemachudha T, Griffin DE, Chen WW, Johnson RT: Immunologic studies of rabies vaccination-induced Guillain-Barré syndrome. Neurology 1988;38:375–378.
- Fenichel GM: Neurological complications of immunization. Ann Neurol 1982;12:119–128.
- Schonberger LB, Bregman DJ, Sullivan-Bolyai JZ, Keenlyside RA, Ziegler DW, Retailliau HF, Eddins DL, Bryan JA: Guillain-Barré syndrome following vaccination in the National Influenza Immunization Program, United States, 1976–1977. Am J Epidemiol 1979;110:105–123.
- Black S, Eskola J, Siegrist CA, Halsey N, Macdonald N, Law B, Miller E, Andrews N, Stowe J, Salmon D, Vannice K, Izurieta HS, Akhtar A, Gold M, Oselka G, Zuber P, Pfeifer D, Vellozzi C: Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines. Lancet 2009;374:2115–2122.
- McGrogan A, Madle GC, Seaman HE, de Vries CS: The epidemiology of Guillain- Barré syndrome worldwide. A systematic literature review. Neuroepidemiology 2009;32:150–163.
- Griffin JW, Li CY, Ho TW, Xue P, Macko C, Gao CY, Yang C, Tian M, Mishu B, Cornblath DR: Guillain-Barré syndrome in northern China. The spectrum of neuropathological changes in clinically defined cases. Brain 1995;118:577–595.
- Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978;3:565–566.
- Asbury AK, Cornblath DR: Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27(suppl): S21–S24.
- Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, Burwen DR, Cornblath DR, Cleerbout J, Edwards KM, Heininger U, Hughes R, Khuri-Bulos N, Korinthenberg R, Law BJ, Munro U, Maltezou HC, Nell P, Oleske J, Sparks R, Velentgas P, Vermeer P, Wiznitzer M, Brighton Collaboration GBS Working Group: Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599–612.
- Bagos P, Nikolopoulos G: Mixed-effects poisson regression models for meta-analysis of follow-up studies with constant or varying durations. Int J Biostat http://works.bepress.com/pbagos/19.
- Higgins JP, Thompson SG, Spiegelhalter DJ: A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009;172:137–159.
- Guillain-Barré syndrome variants in Emilia-Romagna, Italy, 1992–3: incidence, clinical features, and prognosis. Emilia-Romagna Study Group on Clinical and Epidemiological Problems in Neurology. J Neurol Neurosurg Psychiatry 1998;65:218–224.
- Aladro-Benito Y, Conde-Sendin MA, Muñoz-Fernández C, Pérez-Correa S, Alemany-Rodríguez MJ, Fiuza-Pérez MD, Alamo-Santana F: Guillain-Barré syndrome in the northern area of Gran Canaria and the island of Lanzarote (in Spanish). Rev Neurol 2002;35:705–710.
- Beghi E, Bogliun G: The Guillain-Barré syndrome (GBS). Implementation of a register of the disease on a nationwide basis. Italian GBS Study Group. Ital J Neurol Sci 1996;17:355–361.
- Beghi E, Kurland LT, Mulder DW, Wiederholt WC: Guillain-Barré syndrome. Clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol 1985;42:1053–1057.
- Bogliun G, Beghi E: Incidence and clinical features of acute inflammatory polyradiculoneuropathy in Lombardy, Italy, 1996. Acta Neurol Scand 2004;110:100–106.
- Cheng Q, Jiang GX, Fredrikson S, Link H, De Pedro-Cuesta J: Incidence of Guillain-Barré syndrome in Sweden 1996. Eur J Neurol 2000;7:11–16.
- Chio A, Cocito D, Leone M, Giordana MT, Mora G, Mutani R, Piemonte, and Valle d’Aosta Register for Guillain-Barré Syndrome: Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology 2003;60:1146–1150.
- Cuadrado JI, de Pedro-Cuesta J, Ara JR, Cemillán CA, Díaz M, Duarte J, Fernández MD, Fernández O, García-López F, García-Merino A, García-Montero R, Martínez-Matos JA, Palomo F, Pardo J, Tobías A, Spanish GBS Epidemiological Study Group: Guillain-Barré syndrome in Spain, 1985–1997: epidemiological and public health views. Eur Neurol 2001;46:83–91.
- Cuadrado JI, de Pedro-Cuesta J, Ara JR, Cemillán CA, Díaz M, Duarte J, Fernández MD, Fernandez O, García-López F, García-Merino A, Velasquez JM, Martínez-Matos JA, Palomo F, Pardo J, Tobías A, Spanish GBS Epidemiological Study Group: Public health surveillance and incidence of adulthood Guillain-Barré syndrome in Spain, 1998–1999: the view from a sentinel network of neurologists. Neurol Sci 2004;25:57–65.
- Deceuninck G, Boucher RM, De Wals P, Ouakki M: Epidemiology of Guillain-Barré syndrome in the province of Quebec. Can J Neurol Sci 2008;35:472–475.
- Govoni V, Granieri E, Manconi M, Capone J, Casetta I: Is there a decrease in Guillain-Barré syndrome incidence after bovine ganglioside withdrawal in Italy? A population-based study in the Local Health District of Ferrara, Italy. J Neurol Sci 2003;216:99–103.
- Rees JH, Thompson RD, Smeeton NC, Hughes RA: Epidemiological study of Guillain-Barré syndrome in south east England. J Neurol Neurosurg Psychiatry 1998;64:74–77.
- Sedano MJ, Calleja J, Canga E, Berciano J: Guillain-Barré syndrome in Cantabria, Spain. An epidemiological and clinical study. Acta Neurol Scand 1994;89:287–292.
- Van Koningsveld R, Van Doorn PA, Schmitz PI, Ang CW, Van der Meché FG: Mild forms of Guillain-Barré syndrome in an epidemiologic survey in The Netherlands. Neurology 2000;54:620–625.
- Winner SJ, Evans JG: Age-specific incidence of Guillain-Barré syndrome in Oxfordshire. Q J Med 1990;77:1297–1304.
- Langmuir AD, Bregman DJ, Kurland LT, Nathanson N, Victor M: An epidemiologic and clinical evaluation of Guillain-Barré syndrome reported in association with the administration of swine influenza vaccines. Am J Epidemiol 1984;119:841–879.
- Bogliun G, Beghi E: Validity of hospital discharge diagnoses for public health surveillance of the Guillain-Barré syndrome. Neurol Sci 2002;23:113–117.
- Koobatian TJ, Birkhead GS, Schramm MM, Vogt RL: The use of hospital discharge data for public health surveillance of Guillain-Barré syndrome. Ann Neurol 1991;30:618–621.
- Hicks CW, Kay B, Worley SE, Moodley M: A clinical picture of Guillain-Barré syndrome in children in the United States. J Child Neurol 2010;25:1504–1510.
- Pier DB, Hallbergson A, Peters JM: Guillain-Barré syndrome in a child with pain: lessons learned from a late diagnosis. Acta Paediatr 2010;99:1589–1591.
- Voskuhl RR: Sex differences in autoimmune disease. Biol Sex Differ 2011;2:1.
- Mao ZF, Yang LX, Mo XA, Qin C, Lai YR, He NY, Li T, Hackett ML: Frequency of autoimmune diseases in myasthenia gravis: a systematic review. Int J Neurosci 2010;121:121–129.
Dr. James Sejvar, Division of High-Consequence Pathogens and Pathology and
Division of Vector-Borne Infectious Diseases
Centers for Disease Control and Prevention (CDC)
1600 Clifton Road, Mailstop A-39, Atlanta, GA 30333 (USA)
Tel. +1 404 639 4657, E-Mail email@example.com
Received: December 7, 2010
Accepted: January 27, 2011
Published online: March 21, 2011
Number of Print Pages : 11
Number of Figures : 3, Number of Tables : 3, Number of References : 38
Vol. 36, No. 2, Year 2011 (Cover Date: April 2011)
Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)
For additional information: http://www.karger.com/NED
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.