One patient wonders: Should I have any concerns about getting—or having my children get—the seasonal influenza and/or the H1N1 (swine flu) vaccine if an immediate family member developed Guillain-Barré syndrome after receiving an injection last year?
A patient called me on September 17 wondering if she should get the trivalent flu shot currently available and/or the H1N1 vaccine when it becomes available for herself, her husband, and her children, who are 2½ and 7 months old. Her father developed severe Guillain-Barré syndrome a week after getting a flu shot last year.
Guillain-Barré syndrome is an autoimmune process that attacks peripheral nerves to skeletal muscles. It can be so severe that patients become bedridden, cannot move their arms or legs, and even may require a mechanical ventilator to breathe. A tiny fraction of 1 percent of patients who receive flu shots (and other immunizations) may develop this syndrome, and most recover almost completely.
This is the sort of decision that everyone should make in conversations with his or her own doctor. In my patient's case, because her father took many months to recover, and because the H1N1 appears quite infectious but not exceptionally lethal, she and I reasoned that it seems best not to immunize her because of her genetic relationship to her father. It does seem reasonable to check in with her pediatrician about immunizing both of her children, who are less likely to get Guillain-Barré and are more likely to have a severe illness if they get H1N1 flu. It also seems reasonable for her husband to be immunized, as he would be genetically distinct from her and would help contribute to improving the immunity of that family.
I would recommend giving flu shots (trivalent and H1N1) to everyone who has frequent contact with her father, but I would not give him any flu shots in the future. If he does develop influenza, he could be treated with oseltamivir (Tamiflu) and/or zanamivir (Relenza inhaler).
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