Incidence of Guillain-Barré Syndrome (GBS) in Latin America and the Caribbean Before and During the 2015-2016 Zika Virus Epidemic: A Systematic Review and Meta-Analysis

Abstract

BackgroundA severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015-2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS. Methods and findingsFor this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29-2.12, I 2 <0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3-2.9) times during ZIKV and 1.9 (95% CI 1.1-3.4) times during chikungunya outbreaks over background rates. ConclusionsBackground IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics. Trial registrationRegistered with PROSPERO: CRD42018086659. Author summaryA severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. This is the first systematic review on GBS incidence in Latin America and the Caribbean before and during arboviral disease outbreaks. There is a large subregional and annual fluctuation in the incidence of GBS. Background annual GBS incidence rates (IRs) in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29-2.12, I 2 <0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 times during ZIKV and 1.9 times during chikungunya outbreaks over background rates. GBS is a costly disease, which can result in long-term disability and high mortality rates in resource constrained healthcare settings. Because GBS can be triggered by arboviral infections, baseline incidence of GBS is critical for detecting neglected tropical disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness.Incidence of Guillain-Barré Syndrome in LAC and arboviral disease outbreaks PLOS Neglected Tropic...

COVID-19 and Guillain-Barre Syndrome: a systematic review of case reports

“…Despite searching six databases, we found few case reports. As it was the case with Zika virus 8 , 17 , more cases may appear later in the pandemic. As the COVID-19 pandemic progresses, clinicians should be aware that GBS and other variants are possible and relevant complications.…”

Epidemics and outbreaks of peripheral nervous system disorders: I. infectious and immune-mediated causes

“…During the 6-month period of the French Polynesia arboviral epidemic (2013-2014), 28,000 cases of ZIKV infection were observed (10% of the total population): among them, 42 cases of GBS were reported (with a pattern more suggestive of AMAN/AMSAN), versus < 2 annual usual cases in this area [55]. In Latin America and the Caribbean, GBS incidence was estimated to have increased 2.6 times during the ZIKV outbreak [56]. It was hypothesized that ZIKV-GBS may be due to dysregulation of the activity of the RNA editing enzymes [57].…”

“…ZIKV infection was sporadically observed in some African and Asian countries until its epidemic capacity was revealed in the southwestern Pacific Ocean (2007), South Pacific (2013-2014), then South America, Latin America and the Caribbean (2015-2016) (Fig. 3) [56]. Before 2013 ZIKV was not known to provoke neurological complications, but many cases of GBS were then linked to ZIKV, with three strains of ZIKV (two from Africa, then one from Asia that spread in the South Pacific and America) supporting an expansion of its lineage with several recombination events [55].…”

Castanospermine reduces Zika virus infection-associated seizure by inhibiting both the viral load and inflammation in mouse models

“…Following ZIKV infection, neurological abnormalities were reported in mouse models ( Figueiredo et al, 2019 ) as well as in clinical conditions ( Capasso et al, 2019 ; Moura da Silva et al, 2016 ). In our initial studies, we observed seizure in ZIKV infected mice while handling it, but not in CST treated ones.…”