Gulliance Barre Syndrome following vaccination with Hepatitis B vaccine
Seti, N.K.; Reddi, R.; Anand, I. and Sethi, P.K. (2002) Gulliance Barre Syndrome following vaccination with Hepatitis B vaccine. Journal of the Association of Physicians of India, 50.
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Acute symmetrical predominantly motor polyneuropathy also known as Gulliane Barre syndrome has various etiologies. Herpes group of viruses (CMY, EB virus), Campylobacter jejuni gastroenteritis have been associated with the illness. The disease can also occur on a background of Hodgkin's disease or lupus erythematous. GBS has been reported following vaccination (swine flu vaccination) and as a complication of viral hepatitis.1 A 14 years boy was admitted with complaints of weakness of both lower limbs for the past nine days and weakness of both upper limbs for the past seven days. There was no bladder and bowel involvement, no history of fever, diarrhoea, jaundice or upper respiratory infection preceeding this. The patient had been vaccinated for hepatitis B in school about a month and a half ago. (Third dose due to 4Vi months). On examination the patient was anicteric with no respiratory distress, respiratory rate 18/min and breath holding time 20 sec. He had flaccid quadriparesis (power 0-2/5) with universal areflexia. Plantars were bilaterally flexor with no sensory involvement. Cranial nerves including facial nerve were normal. Investigations showed a hemoglobin of 15.5, TLC 10100, ESR 5, liver and renal parameters were in the normal range. HBsAg was non-reactive and anti-Hbs titre was 80 IU/ L. CSF examination revealed cell count of 65 cells/cu mm (L98, P2), proteins 200.7 mg/dl and sugar 56 mg/dl. Nerve conduction study was suggestive of axonal neuropathy involving bilateral ulnar, left median and left tibial nerves with the H-reflex not been recorded bilaterally. F-waves could not be recorded in any of the nerves except the left peroneal nerve. The patient was given intravenous immunoglobulins (0.4 gm/kg/day for five days). He improved and was able to stand and walk a few steps aided by the time of discharge from the hospital. GBS has been rarely reported following vaccination with hepatitis B vaccine.2 Hepatitis B vaccine is relatively safe, the most frequent side effects been transient myalgias, arthralgias and skin rashes. GBS was reported in only two out of the first 200,000 recipients of hepatitis B vaccine.3 Possible mechanisms of vaccine associated polyneuropathy include virus mediated damage to myelin producing cells and molecular mimicry (similarity in the DNA sequence of HBV DNA and myelin basic protein). As of now evidence is still inadequate to accept or reject a causal relation of GBS and vaccination with hepatitis B. The Indian government's recent policy of universal hepatitis B vaccination makes it all the more imperative that this risk be kept in mind.
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