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BECOMING A

Your article concerning influenza vaccinations (Clinical, 15 October) states that Guillain Barre syndrome is an absolute contraindication to the vaccine.

This is contrary to the consensus group advice published this year (Arch Neurol. 2005;62:1194-1198) which states: 'Immunisations are not recommended during the acute phase of GBS and probably not during a period, possibly of one year, after the onset of disease. After that, immunisations need not be withheld, but the need for the immunisation should be reviewed on an individual basis.'

Dr Douglas Fleming replies:

There has been considerable discussion over many years about the risk for persons with GBS and the generally accepted guidelines have changed.

It has been accepted that there may be a risk of GBS recurrence as a result of vaccination, but our estimates of this risk are so small (probably around one in a million) that we now do not think persons in high-risk groups should be denied vaccination and this is the present position regarding NHS advice.

The recommendation of the US Advisory Committee on Immunisation Practices is also in favour of vaccinating persons at high risk from flu regardless of a history of GBS, and consider it safe to vaccinate persons at no increased risk from flu but with a history of GBS, provided they had not experienced GBS in the six weeks after a previous vaccination.

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