Use of the inactivated intranasal influenza vaccine and the risk of Bell's palsy in Switzerland

N Engl J Med. 2004 Feb 26;350(9):896-903. doi: 10.1056/NEJMoa030595.


Background: After the introduction of an inactivated intranasal influenza vaccine that was used only in Switzerland, 46 cases of Bell's palsy were reported.

Methods: We conducted a matched case-control study and a case-series analysis. All primary care physicians, ear, nose, and throat specialists, and neurologists in German-speaking regions of Switzerland were requested to identify cases of Bell's palsy diagnosed in adults between October 1, 2000, and April 30, 2001. Each physician was invited to select three control patients for each patient with Bell's palsy, with matching according to age, date of the clinic visit, and physician. Vaccination information was provided by the physicians.

Results: A total of 773 patients with Bell's palsy were identified. Of the 412 (53.3 percent) who could be evaluated, 250 (60.7 percent) were enrolled and matched with 722 control patients; the other 162 patients had no controls. In the case-control study, we found that 68 patients with Bell's palsy (27.2 percent) and 8 controls (1.1 percent) had received the intranasal vaccine (P<0.001). In contrast to parenteral vaccines, the intranasal vaccine significantly increased the risk of Bell's palsy (adjusted odds ratio, 84.0; 95 percent confidence interval, 20.1 to 351.9). Even according to conservative assumptions, the relative risk of Bell's palsy was estimated to be 19 times the risk in the controls, corresponding to 13 excess cases per 10,000 vaccinees within 1 to 91 days after vaccination. In the case-series analysis, the period of highest risk was 31 to 60 days after vaccination.

Conclusions: This study suggests a strong association between the inactivated intranasal influenza vaccine used in Switzerland and Bell's palsy. This vaccine is no longer in clinical use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intranasal
  • Bell Palsy / epidemiology
  • Bell Palsy / etiology*
  • Case-Control Studies
  • Female
  • Humans
  • Influenza Vaccines / administration & dosage
  • Influenza Vaccines / adverse effects*
  • Logistic Models
  • Male
  • Middle Aged
  • Risk Assessment
  • Risk Factors
  • Selection Bias
  • Switzerland / epidemiology
  • Vaccines, Inactivated / administration & dosage
  • Vaccines, Inactivated / adverse effects


  • Influenza Vaccines
  • Vaccines, Inactivated