Increased Risk of Guillain‐Barré Syndrome following Recent Herpes Zoster: A Population‐Based Study across Taiwan

Abstract

BACKGROUND: Guillain-Barré syndrome (GBS) has been sporadically reported to be associated with herpes zoster reactivation. However, the risk for developing GBS after herpes zoster reactivation remains unknown. This study aimed to establish epidemiological profiles regarding the frequency and risk for GBS following herpes zoster. METHODS: We extracted 315,595 patients with herpes zoster from a nationwide health registry in Taiwan during the period 2003-2005 and also randomly selected 946,785 matched control subjects. Each participant was individually tracked for 2 months from their index ambulatory care visit to identify those who developed GBS. Stratified Cox proportional hazard regressions were conducted to analyze the difference in the risk of GBS for patients with and without herpes zoster. RESULTS: Of the sample of 1,262,380 patients, 92 (0.01%) presented with GBS during the 2-month follow-up period, 78 from the study group (0.025% of the herpes zoster patients) and 14 from the comparison group (0.001% of patients without herpes zoster). Regression revealed that the adjusted hazard of GBS during the follow-up period was 18.37 times greater (95% confidence interval, 10.22-33.01 times greater; P < .001) for patients with herpes zoster than for those without. Furthermore, we found that patients who developed GBS after herpes zoster were more likely to have prior infection, compared with the likelihood of herpetic patients who did not develop GBS. CONCLUSIONS: The risk for GBS is significantly increased among people who have experienced a recent herpes zoster attack, compared with the risk of a matching population.