Sonora, Mexicali, and Baja California, Mexico and Wyoming and Arizona, United States: Unusual cluster of Guillain Barre cases - links to Campylobacter infection?

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - links to diarrheal illness suspected

http://expreso.com.mx/edicion-impresa/light/3/2011/06/29/1

Spanish to English translation

Guillain-Barr? or the dreaded polio?

Flaccid Paralysis IN THREE STATES

The 24 cases have occurred in SLRC, Mexicali, Baja California and Arizona, conduct tests to confirm the cause

Given the possibility that cases of paralysis acute flaccid, which have occurred in Sonora, Baja California and Arizona may result in Guillain-Barre syndrome or polio, the state laboratory Ministry of Health looked at 24 trials, same will also be sent to the Federal District and Atlanta, to confirm results.

Therefore, it is now held in San Luis Rio Colorado a meeting of health sector personnel Sonora, national and U.S. to discuss in more detail these cases, said Health Secretary, Bernardo Garc?a Campillo.

In Sonora the cases have occurred in San Luis Rio Colorado (SLRC) and the samples are examined at the State Laboratory of Public Health (LeSpa), which were taken from water, food and the patients themselves.

Armando Carvajal Dosamantes, director of LeSpa, afi RMO disease is delicate, so that staff will now manages more samples for testing SLRC.

In that county also will train health staff to remain vigilant for any suspicious symptoms among the population.

The common diagnosis in the 24 cases analyzed is acute flaccid paralysis, this disorder that manifest similarly in Guillain-Barre syndrome, poliomyelitis and other diseases affecting the nervous system.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - links to diarrheal illness suspected

Given the outbreak last year, I agree this is almost certainly to be excluded as polio.

http://www.expreso.com.mx/edicion-impresa/light/1/2011/06/29/1

Spanish to English translation

They will discard the presence of polio

The Ministry of Health discusses symptoms similar to Guillain-Barr?

By Pearl J. Noriega perla.noriega @ expreso.com.mx After the Secretary of Health of Sonora confi rmo eight cases of Guillain-Barr? syndrome in San Luis Rio Colorado, there are more than 24 events are analyzed to see if it comes to this disease or perhaps polio, because the symptoms are similar.

Armando Carvajal Dosamantes, director of the State Laboratory of Public Health (LeSpa) reported that human samples, food and water are analyzed in Sonora, but also in Mexico City and Atlanta as possible cases are in San Luis Rio Colorado , Mexicali and Arizona.

Therefore, today in the municipality Sonoran affected staff will be a meeting between State Health Sector, National and the United States, so a more detailed analysis of these cases and rule out the return of polio.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - links to diarrheal illness suspected

http://www.expreso.com.mx/edicionimpresa/20110629/1/3.pdf

Spanish to English translation

SUSPECTS
CASES OF PARALYSIS
Acute Flaccid
San Luis Rio Colorado 8
Mexicali 8
Arizona 8

SYMPTOMS
Weakness in lower limbs.
Tingling in the legs.
Numbness in the lower half
the body.
Inability to maintain
balance.

Acute flaccid paralysis may
be caused by various disorders
nervous system.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - links to diarrheal illness suspected

The numbers here are a bit fuzzy; if GBS is supposed to be one case per 100,000 (per year? lifetime?), then 24 cases in an area of population 2,000,000 more than would be expected (20) in just a couple weeks.

http://www.elnortedesonora.com/vernoticias.php?artid=1725

HEALTH ALERT ... Better that the state government put the batteries and raise alerts on Health about the risk of a serious epidemic of the rare disease Guillain-Barre syndrome, which according to medical protocol should be submitted one case per hundred thousand inhabitants and in San Luis Rio Colorado and are 16 cases, plus another eight that have occurred between Yuma, Arizona and Mexicali. And in that place no more than two million people. So this is alarming. Also, it was said that could also be a type of polio or a type of muscle flaccidity, which complicates the situation. Therefore, you better feel cramped win, because they can get out of hand.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - links to diarrheal illness suspected

And a possible fatality.

http://www.lacronica.com/EdicionEnLinea/Notas/Noticias/30062011/525715.aspx

Spanish to English translation

SLRC investigate possible death by flaccid paralysis
7
Share SAN LUIS RIO COLORADO 4Comments, Sonora (PH)
A resident of San Luis Rio Colorado who had been hospitalized in the city of Mexicali was suffering from Guillain Barre died this week.

The Ministry of Health has not yet determined if the resident died from the so-called flaccid paralysis or complications of diabetes.

The man is a resident of 80 years who was hospitalized for emergency be detected with the syndrome.

Flaccid paralysis in a disease that has aroused the concern of the medical sector, due to the surge of cases in this border city.

This year there have been in this city a total of 16 cases confirmed by the Ministry of Health.

Guillain Barr? syndrome was detected in all cases in people who initially presented pictures diarrhea.

The Ministry of Health advised residents to exercise caution, improving hygiene.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - 1 fatality

As in Veracruz, there is no "test" that confirms Guillain-Barre, but whatever is causing this, they do not believe it is infectious.

http://www.ehui.com/2011/07/02/mejoran-personas-contagiadas-con-el-guillan-barre-en-slrc

Spanish to English translation

Improve people infected with the "Guillain-Barre syndrome" in SLRC

By: Denise Saenz
dsaenz@ehui.com

A total of 18 cases tested positive for the disease, "Guillain-Barr?," confirmed the mayor of San Luis Rio Colorado, Manuel Arredondo Baldenebro.

"While there have been none of them sequels to date, has not lost any lives, these patients have been recovering and continuing with his normal life," he said.

Baldenebro Arredondo explained the symptoms of this disease are loss of limb strength and clarified that usually starts in the feet, also stressed that this is a wrong response of the immune system, infection is not classified as:

"It is relating in [SLRC], with people who have presented a picture of severe diarrhea and then gives manifestations of this syndrome, but not mean it's an infection, the body reacts differently," he said.

Finally, the Mayor agreed that the municipality has [exceeded] the national average for the number of positive cases with "Guillain-Barre syndrome" and expressed concern at the situation.

[Emily]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - 1 fatality

Maybe it's best that there isn't a lot of media attention about this since the cause is unknown at this point. I wonder about Campylobacter, too. This study from 2006 indicates that it might not be that easy to diagnose.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489570/

We conclude that the role of C. jejuni in triggering GBS has been greatly underestimated.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - 1 fatality

http://www.expreso.com.mx/index.php?option=com_content&view=article&id=20374:registran-18-casos-de-guillain-barre-en-slrc&catid=1:sonora&Itemid=35

Spanish to English translation

Recorded 18 cases of Guillain-Barr? syndrome in SLRC.
Saturday, July 2, 2011 19:55
Diego Pinto E-mail. Share. HERMOSILLO, SON .- In San Luis Rio Colorado has recorded 18 confirmed cases of Guillain-Barre syndrome, the mayor of the municipality, which puts him in levels above the national average and world.


"There has been a spike in the last year across Mexico, including the United States and in San Luis we're seeing an outbreak of Guillain-Barre syndrome, we are working on prevention," said Manuel Arredondo Baldenebro.

The syndrome begins as a diarrheal box, and then develops the disease, which attacks the nervous system and can lead to death.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - 1 fatality

The article above has now been amended and now notably continues (making the Campylobacter explanation increasingly likely):

Spanish to English translation

In the border city, he said, have filed thousands of cases of diarrhea, and across the country and the world, but 18 of those have resulted in Guillain-Barre syndrome.

The recommended sanluisino municipal wash hands, cook food thoroughly, avoid eating in the street and save the optimal hygiene when toileting.

He stressed that, despite having 18 cases, there have been no deaths from the syndrome, manifested by loss of strength in the feet.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 24 unexplained paralytic illnesses - 1 fatality

I believe this brings the total number of cases to at least 32.

http://sdpnoticias.com/nota/113549/Confirman_18_casos_del_sindrome_de_Guillain_Barre_en_SLRC

Spanish to English translation

Notimex
Confirmed 18 cases of Guillain-Barr? SLRC
Notimex

2011-07-04 17:34:00

San Luis Rio Colorado, Son., 4 Jul. (Notimex) .- In this town of Sonora increased to 18 the number of confirmed cases of Guillain-Barre syndrome, according to the Health Sector, said the local mayor, Manuel Arredondo Baldenebro .

The doctor also Instituto Mexicano del Seguro Social (IMSS) detailed prevention campaign that continues to prevent more patients to register with the disease.

Last June, the Ministry of Public Health (SSP) State reported 16 cases of this syndrome in this county, but in July there are two other confirmed cases.

According to the binational meetings to follow up this issue in the neighboring county of Yuma, Arizona, eight other cases were found and six more in Mexicali, Baja California.

Baldenebro Arredondo noted that the incidence in this town of Sonora, is placed in above-average levels nationally and globally.

He said all cases of Guillain-Barr? began with a box diarrhea in patients, followed by the nervous condition which generates generalized muscular weakness.

The mayor said the authorities' work is aimed to abate gastrointestinal diseases, the incidence of fires in the region by high summer temperatures

[sharon sanders]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 32 unexplained paralytic illnesses - 1 fatality

Also please see this thread:

Veracruz, Tobasco and Nayarit- Flaccid Paralysis in the region of Orizaba, 42 sick, 2 dead - November & December 2010

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 32 unexplained paralytic illnesses - 1 fatality

And this is two more new cases.

http://sdpnoticias.com/nota/116090/Confirman_20_casos_del_Sindrome_de_Guillain_Barre_en_SLRC

Spanish to English translation

Notimex
Confirmed 20 cases of Guillain-Barr? SLRC
Notimex

2011-07-07 10:23:00

San Luis Rio Colorado, Son., 7 Jul. (Notimex) .- The Ministry of Public Health (SSP) State has confirmed 20 cases of Guillain-Barre syndrome (nerve disease) in this border, considered a rare rate above the national average.

The state agency, in its latest report said that during last June showed that 16 patients with poorly and four so far in July.

He said those affected by this disease of the nervous system are in good health and most received treatment in their homes.

According to the report, the incidence of this syndrome is above the national average and is atypical.

According to the SSP state, all patients affected by Guillain-Barre syndrome in this border began with a diarrheal [picture], after which the symptoms continued.

This disease occurs when the body's immune system attacks his nervous system itself, resulting in muscle weakness and flaccidity.

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 34 unexplained paralytic illnesses - 1 fatality

Oh, now this is going to get some attention...

It is not clear if the assumption in the comments below is right; I suspect one of the articles might have mentioned that by now.

http://www.promedmail.org/pls/apex/f?p=2400:1001:5840597757315575::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,89247

Archive Number 20110708.2072
Published Date 08-JUL-2011
Subject PRO/EDR> Guillain-Barre syndrome - Mexico (SO), USA (AZ) post-diarrhea

GUILLAIN-BARRE SYNDROME - MEXICO (SONORA), USA (ARIZONA) POST-DIARRHEA

************************************************** *********************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1] Mexico (Sonora)
[2] USA (Arizona)
[3] USA (Arizona): correction

******
[1] Mexico (Sonora)
Date: Wed 22 Jun 2011
Source: SDP noticias, Notimex report [in Spanish, trans. & summ.,
edited]
<http://sdpnoticias.com/nota/103036/Registran_16_casos_del_sindrome_de_Guillain_Barre_ en_SLRC>


On 22 Jun 2011, the state Public Health Secretariat (SSP) confirmed
another case of Guillain-Barre syndrome in the border city of San Luis
Rio Colorado, Sonora, Mexico, bringing the total to 16 patients seen
during recent weeks. The director of the SSP General Hospital in the
city, Sergio Kelly Berraza, said that the new patient was taken to a
hospital in Mexicali, Baja California.

"In total we have recorded 16 cases, including one hospitalized in
Mexicali, 4 recovering at home, and the rest fully recovered," said
Kelly Barraza. He explained that due to the presence of the disorder,
the health sector began a campaign to prevent diarrheal diseases among
the local population and reduced their incidence.

"Although cases of diarrhea have declined and with it the risk of
Guillain-Barre syndrome (GBS), health authorities will not let our
guard down," he said. He added that all patients in recent weeks who
showed symptoms of the syndrome, first had diarrhea.

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

******
[2] USA (Arizona)
Date: Wed 22 Jun 2011
Source: Yuma SUn (Arizona) [edited]
<http://www.yumasun.com/news/syndrome-70907-health-san.html>


A diarrhea outbreak south of the border in San Luis Rio Colorado,
Sonora, Mexico, is being followed closely by officials at the Yuma
County Health Department, who are watching for a possible health
impact to Yuma area residents.

Over the weekend [18-19 Jun 2011], health officials in that border
city confirmed an increase in gastrointestinal illnesses with diarrhea
symptoms, which they are studying for a possible connection to
Guillain-Barre syndrome [GBS].

Benito Lopez, an epidemiologist at the county health department,
reported that the agency, in coordination with a statewide effort, is
studying recent cases of gastrointestinal illnesses in the Yuma area.
"We have no results yet, but we are very aware of the registered cases
and we are trying to determine what caused them. We are in constant
communication with the health sector in San Luis."

In San Luis Rio Colorado, Gustavo Lopez, the Sonora assistant
secretary of health, recommended not eating food from street vendors
and only eating where it is clear that food is hygienically and safely
prepared with water available for washing hands.

Yuma Regional Medical Center said the hospital is not aware of a
diarrhea outbreak or any cases of Guillain-Barre syndrome in the Yuma
area.

[byline: Cesar Neyoy]

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

******
[3] USA (Arizona): correction
Date: 23 Jun 2011
Source: Yuma Sun [edited]
<http://www.yumasun.com/news/story-70943-thursday-barr&#37;C3%A9.html>


A story in the Yuma Sun had some inaccurate information about Yuma
Regional Medical Center [YRMC].

According to Kaitlan Schick, corporate communications specialist with
YRMC, the hospital has seen some patients with symptoms of
Guillain-Barre syndrome, coming from both San Luis, Arizona, and San
Luis Rio Colorado, Sonora. However, the Yuma County Health Department
is tracking the actual number of cases in the county.

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[San Luis Rio Colorado in Sonora, Mexico and San Luis in the US state
of Arizona can be seen on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/11ds>. - Sr.Tech.Ed.MJ

ProMED-mail thanks Ronan Kelly of Flu Trackers for these reports.
This moderator apologizes to the readers for the delay in posting. The
2010 report cited in the "see alsos" was from the Veracruz state,
which is substantially separated from Sonora, which borders the USA.

Although not stated in the reports, _Campylobacter jejuni_ is the
likely cause of the diarrheal illnesses in this cluster of GBS. Since
the 1995 paper by Rees, et al (1), _C. jejuni_ was found to be
associated with GBS as recent campylobacteriosis was found in 26 per
cent of patients with GBS as compared to 1 per cent of matched
controls. Of note, the GBS cases associated with _C. jejuni_ were
significantly associated with the poorer outcome of slow recovery and
residual disability. Although no specific serotype of _C. jejuni_ was
linked to GBS in the study above, a subsequent paper (2) found that
serotype O:19 strains were overrepresented in USA and Germany cases of
GBS and these strains were likely to be serum-resistant.

Subsequently, it has been found that the pathophysiology of the
association was an example of antigenic mimicry (3). That is, the
lipooligosaccharide of certain _C. jejuni_ strains cross reacted with
human GM1 ganglioside and, in rabbits, anti-GM1 antibody was elicited
following _C. jejuni_ lipooligosaccharide and limb weakness developed.
More recently, Bax, et al (4) reported that differences in sialic acid
linkage of the bacterial saccharide produced different modulations of
the immune response which can explain why some organisms may be linked
to GBS and others not.

References
----------
1. Rees JH, Soudain SE, Gregson NA, Hughes RAC. _Campylobacter
jejuni_ infection and Guillain-Barre syndrome. N Engl J Med 1995;
333(21): 1374-9. Available at
<http://www.nejm.org/doi/full/10.1056/NEJM199511233332102#t=article>.
2. Allos BN, Lippy FT, Carlsen A, Washburn RG, Blaser MJ.
_Campylobacter jejuni_ strains from patients with Guillian-Barre
syndrome. Emerg Infect Dis 1998; 4(2): 263-8. Available at
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640125/>.
3. Yuki N, Susuki K, Koga M, et al. Carbohydrate mimicry between
human ganglioside GM1 and _Campylobacter jejuni_ lipooligosaccharide
causes Guillain-Barre syndrome. Proc Natl Acad Sci USA 2004; 101(31):
11404-9. Available at
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC509213/>.
4. Bax M, Kuijf ML, Heikema AP, et al: _Campylobacter jejuni_
lipooligosaccharides modulate dendritic cell-mediated T cell
polarization in a sialic acid linkage-dependent manner. Infect Immun
2011; 79(7): 2681-9. Abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/21502591> - Mod.LL]

[alert]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 34 unexplained paralytic illnesses - 1 fatality

I have been running the numbers from the ProMED post on Campylobacter and GBS, and my analysis as follows seems to show that explanation is insufficient to explain this outbreak:

Consider a random population of two million people (the population of the outbreak area given in this thread) that is not experiencing any unusual outbreak. Since GBS in that population is one case per 100,000 (again from both this thread and the Veracruz thread), there should be about 20 GBS cases in that population, and 1,999,980 individuals without GBS. As 26&#37; of GBS cases have had recent Campylobacter infection (according to the ProMED post), 5.2 of the 20 GBS cases would be the result of such infections. As 1% of the general population has recent Campylobacter infections (again from the ProMED post), about 20,000 individuals would have been infected. (Despite the large number, this is not anomalous; some articles I have read estimate the total number of Campylobacter infections in the US at several million per year.) So 20,000 infections would cause about 5 GBS cases in a normal population, for a rate of one GBS case per 4,000 Campylobacter infections. I know of no explanation why the rate of GBS among Campylobacter infections should be affected by whether there is an outbreak of the bug; in what follows we are only considering infected individuals anyway.

In this outbreak, we seem to have about 1,000 cases of diarrhea, with about 32-34 GBS cases, for a rate of about one "GBS" case per 30 infections, about 130 times the rate expected. If one assumes there are many more Campylobacter infections than the 1,000 reported, the 32-34 GBS cases would require about 130,000 infections, an attack rate of about 6.5% of the entire population of the area. If this is the same outbreak as in Veracruz, such a scenario would be unlikely, as the Veracruz outbreak contained four AFP cases in a single apartment building, where there couldn't possibly be 160,000 people.

All this suggests that either something is atypical about the Campylobacter strain in these outbreaks, something is atypical about the population involved, or some other agent is involved.

[Emily]

Re: Sonora and Mexicali, Mexico and Arizona, United States: Cluster of 34 unexplained paralytic illnesses - 1 fatality

The Easter 2010 earthquake caused a big disruption in the water supply to the region. I was wondering about public health implications from that.

http://geo-mexico.com/?p=2484