Public health surveillance and incidence of adulthood Guillain-Barré syndrome in Spain, 1998–1999: the view from a sentinel network of neurologists

Abstract

Temporal variation in Guillain-Barré syndrome (GBS) warrants monitoring in certain situations. This study sought to describe a public-health-based GBS surveillance service in Spain and conduct pilot surveillance in the period 1998-1999. Neurologists from 11 hospitals countrywide, serving a population of 3.9 million, reported all patients, ages 20 years or over, admitted to hospital with suspected GBS. Cases that did not belong to the designated hospital catchment area or failed to fulfill diagnostic criteria after follow- up were excluded. Reported monthly incidence was compared against predicted incidence obtained from retrospective data (1985-1997) using a reported method based on 97.5% percentile values. Alarm thresholds for 2000 onwards were obtained by applying the same method to the updated 1985-1999 series. During the 2-year period, 98 GBS cases were reported, yielding an overall age-adjusted incidence of 1.26 per 100 000 population, with a breakdown by sex of 1.83 for males and 0.76 for females. Monthly incidence remained below or was similar to the corresponding threshold limit value. Seasonality with highest incidence in winter was more pronounced in the elderly. Preceding events, mainly respiratory infections, were identified in 71% of patients. Pilot two-year GBS surveillance in Spain resulted neither in alarm nor in preventive measures. Adult GBS incidence in Spain might be monitored by a surveillance system set up at short notice when a possible threat is perceived. A monthly incidence of over 3 per 100 000 person-years in the population aged 20 years or older would exceed threshold values.

Population Incidence of Guillain-Barré Syndrome: A Systematic Review and Meta-Analysis

“…The number of age groups for which rates were reported ranged from 3 to 9 (median, 7). Five articles presented both case counts and denominators [17,18,20,22,25] ; 5 articles presented case counts and rates [8,24,27,29,31] ; 1 study provided only rates and we obtained case counts from the authors [21] ; 1 study published only the rates in a line graph and we obtained publicly available census data to generate case counts and denominators [23] , and 1 study published only the rates in a histogram and we obtained case counts and denominators from the authors [26] .…”

The Epidemiology of Guillain-Barré Syndrome Worldwide

“…Most patients diagnosed with GBS will be hospitalised due to the nature of the disease [8,26,32,33,[35][36][37]64] : 3 studies reported small numbers of outpatient or community patients identified in their studies compared with numbers of hospitalised GBS cases [12,32,38] . Ten studies noted the inclusion of mild cases in their studies [16,24,29,33,38,45,46,50,57,59] and the design of other studies implied the inclusion of mild cases: 2 studies using general practitioner records [22,23] , a surveillance study [54] , a door-to-door survey [58] and the record linkage system used by the Mayo Clinic [66] .…”

“…Of those studies that used mainly hospital records, 2 noted that all patients were given intravenous immunoglobulin or plasma exchange therapy [20,67] , and this implies that only serious cases were included, whereas others reported proportions of patients receiving these therapies of between 24 and 49% for intravenous immunoglobulin and 34-51% receiving plasma exchange [26,27,30,47,61] . Ten studies reported missing mild cases [12,32,36,64,69,70] or reported finding it difficult to detect mild cases if they had not been admitted to hospital [17,25,37,62] .…”

“…In the majority of studies that included incidence rates broken down by age, increases in rates were observed in most studies of people aged 50 years or more [11, 17, 22, 26, 31-33, 35-39, 46-49] , with some showing a decrease in the highest age group of 6 80 years [22,26,31,[35][36][37][38][47][48][49] .…”

Short-term outcome of Guillain-Barré syndrome: Tertiary centre experience

“…U periodu pika bolesti oko polovina pacijenata je vezana za invalidska kolica ili postelju dok se letalni ishod, i pored savremene terapije koja nam stoji na raspolaganju, registruje kod 1-18% pacijenata (8). Smatra se da se težina bolesti razlikuje kod različitih subtipova GBS, ali da zavisi i od podneblja na kom se bolest javlja (9). Akutna motorna aksonalna neuropatija spada u najtežu formu bolesti u Evropi i Sjevernoj Americi, za razliku od Dalekog istoka, gdje bolesnici sa AMAN imaju bolju prognozu (10).…”