Increased rates of Guillain-Barré syndrome associated with Zika virus outbreak in the Salvador metropolitan area, Brazil

PLoS Negl Trop Dis. 2017 Aug 30;11(8):e0005869. doi: 10.1371/journal.pntd.0005869. eCollection 2017 Aug.

Abstract

In mid-2015, Salvador, Brazil, reported an outbreak of Guillain-Barré syndrome (GBS), coinciding with the introduction and spread of Zika virus (ZIKV). We found that GBS incidence during April-July 2015 among those ≥12 years of age was 5.6 cases/100,000 population/year and increased markedly with increasing age to 14.7 among those ≥60 years of age. We conducted interviews with 41 case-patients and 85 neighborhood controls and found no differences in demographics or exposures prior to GBS-symptom onset. A higher proportion of case-patients (83%) compared to controls (21%) reported an antecedent illness (OR 18.1, CI 6.9-47.5), most commonly characterized by rash, headache, fever, and myalgias, within a median of 8 days prior to GBS onset. Our investigation confirmed an outbreak of GBS, particularly in older adults, that was strongly associated with Zika-like illness and geo-temporally associated with ZIKV transmission, suggesting that ZIKV may result in severe neurologic complications.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Brazil / epidemiology
  • Disease Outbreaks*
  • Female
  • Guillain-Barre Syndrome / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Young Adult
  • Zika Virus Infection / complications*

Grants and funding

Funding for this investigation was provided by the Global Disease Detection Operations Center of the Centers for Disease Control and Prevention. All authors from the Centers for Disease Control and Prevention had direct involvement in the investigational design, data collection, analysis, interpretation, and writing of the report. No payment has been received from a pharmaceutical or other commercial company. ARS had full access to all the data in the study and had final responsibility for the decision to submit the report for publication. The funders provided input regarding study design but had no role in data collection and analysis, decision to publish, or preparation of the manuscript.