Is it okay for a person with a history of Guillain-Barré Syndrome (GBS) to have sex with someone who just received the yellow fever and typhoid vaccines?

Sexual Contact Safety for Individuals with History of Guillain-Barré Syndrome and Partners Recently Vaccinated with Yellow Fever and Typhoid Vaccines

It is generally safe for a person with a history of Guillain-Barré Syndrome (GBS) to have sexual contact with someone who recently received yellow fever and typhoid vaccines, as these vaccines are not transmitted through sexual contact.

Understanding the Concern

Individuals with a history of GBS may be concerned about potential triggers for recurrence. This concern stems from the known association between certain vaccines and GBS, though this relationship is complex:

• GBS is an autoimmune condition characterized by inflammatory infiltrates and segmental demyelination of peripheral nerves
• The background incidence of GBS in the general population is approximately 1.2-3.1 cases per 100,000 person-years 1
• Persons with a history of GBS have a substantially greater likelihood of subsequently developing GBS than those without such history 2

Vaccine-Related GBS Risk

While some vaccines have been associated with a small increased risk of GBS:

• The 1976 swine influenza vaccine showed a clear association with GBS
• For seasonal influenza vaccines, the risk is estimated at approximately 1 additional case per 1 million vaccinations 2
• A recent study found influenza vaccination was associated with a slightly elevated risk of GBS (adjusted odds ratio 1.9) within 1 month after vaccination 3
• Historically, the very first case of vaccine-associated GBS was actually described following typhoid vaccination during World War I 4

Transmission Risk Assessment

The key factor in this situation is that vaccine components from yellow fever and typhoid vaccines are not sexually transmitted:

• Live attenuated vaccines (like yellow fever) contain weakened forms of the virus that cannot be transmitted through sexual contact
• Typhoid vaccines (either injectable or oral) contain either inactivated bacteria or attenuated bacteria that are not sexually transmissible
• Neither vaccine creates a situation where viral or bacterial shedding occurs in a manner that could be transmitted through sexual contact

Clinical Decision Algorithm

1. Assess GBS history:

   • When did the GBS episode occur?
   • Was it previously associated with vaccination or infection?
   • Has the person fully recovered from GBS?

2. Consider partner's vaccination details:

   • When exactly were the vaccines administered?
   • Any symptoms of vaccine reaction in the partner?

3. Evaluate risk based on transmission pathway:

   • Yellow fever and typhoid vaccines do not create transmissible infections through sexual contact
   • The risk of GBS recurrence from sexual contact with a vaccinated individual is effectively zero

Important Considerations

• The primary trigger for GBS is often a preceding infection, particularly Campylobacter jejuni and upper respiratory infections 2
• While vaccines can rarely trigger GBS, this occurs through direct immune response in the vaccinated individual
• The ACIP guidelines specifically address GBS risk in relation to receiving vaccines directly, not through contact with vaccinated individuals 2

Common Pitfalls to Avoid

1. Confusing direct vaccination with exposure to a vaccinated person: The small risk of GBS applies only to the person receiving the vaccine, not their contacts.

2. Overestimating transmission risk: Unlike some live vaccines that require temporary precautions (e.g., oral polio vaccine), yellow fever and typhoid vaccines do not create a transmission risk through intimate contact.

3. Unnecessary avoidance: Recommending abstinence or protected sex is not evidence-based in this scenario and could create unwarranted anxiety.

The evidence strongly supports that sexual contact between a person with history of GBS and a partner recently vaccinated with yellow fever and typhoid vaccines poses no specific risk for GBS recurrence.