Should I have an H1N1 flu vaccination after Guillain-Barré syndrome?

I have found myself asking the difficult question of whether to be vaccinated against H1N1 flu when I return to work as a hospital doctor this autumn. In December 2008 I developed severe Guillain-Barré syndrome but am making a good recovery.

I presented with foot drop one week after an episode of food poisoning. Nerve conduction studies showed patchy motor nerve demyelination and marked conduction block. I was admitted to the intensive care unit for invasive ventilation and supportive care for three months. During this time I had marked neuropathic pain (with “burning” skin) and also haemodynamic instability and adynamic ileus as a result of autonomic dysfunction. Serology testing was positive for Campylobacter jejuni. I had no other relevant past medical history and had had one previous seasonal flu vaccine without adverse effects.

My concern stems from the “swine influenza” vaccination programme in the United States in 1976, when 45 million people were given the influenza A(H1N1)/New Jersey/1976 vaccine. Vaccinations were suspended after 10 weeks mainly because 532 new cases of Guillain-Barré syndrome, or just under one case per 100 000 vaccinations, were reported, with a peak relative risk exceeding 12 in the two to three weeks after vaccination.1 To …