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Zika Virus and the Guillain?Barr? Syndrome ? Case Series from Seven Countries
August 31, 2016DOI: 10.1056/NEJMc1609015
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Zika virus (ZIKV) disease had been described as a mild, self-limiting illness associated with fever, rash, joint pain, and conjunctivitis.1 However, during the outbreak in French Polynesia, 42 patients with ZIKV disease were found to have the Guillain?Barr? syndrome, which represented a marked increase from the approximately 5 cases detected annually during the previous 4 years.2 A connection with the Guillain?Barr? syndrome had previously been described in association with other flavivirus illnesses3,4 but not with ZIKV infection.
From April 1, 2015, to March 31, 2016, a total of 164,237 confirmed and suspected cases of ZIKV disease and 1474 cases of the Guillain?Barr? syndrome were reported in Bahia, Brazil; Colombia; the Dominican Republic; El Salvador; Honduras; Suriname; and Venezuela. To examine the temporal association between ZIKV disease and the Guillain?Barr? syndrome, graphical and time-series analyses were applied to these two independent data sets, which were collected through official International Health Regulations channels or from ministry of health websites (see theSupplementary Appendix, available with the full text of this letter at NEJM.org). The data obtained from country reports contained no personally identifiable information and were collected as part of routine public health surveillance; therefore, the analysis was exempt from review by an ethics board. Differences between the observed and expected numbers of cases of the Guillain?Barr? syndrome during the ZIKV transmission period, as well as differences in the incidence of the Guillain?Barr? syndrome and ZIKV disease according to age and sex, were analyzed with the use of Poisson regression models (see the Supplementary Appendix).
The analysis suggests that changes in the reported incidence of ZIKV disease during 2015 and early 2016 were closely associated with changes in the incidence of the Guillain?Barr? syndrome.
...
Zika Virus and the Guillain?Barr? Syndrome ? Case Series from Seven Countries
August 31, 2016DOI: 10.1056/NEJMc1609015
Article Metrics To the Editor:
Zika virus (ZIKV) disease had been described as a mild, self-limiting illness associated with fever, rash, joint pain, and conjunctivitis.1 However, during the outbreak in French Polynesia, 42 patients with ZIKV disease were found to have the Guillain?Barr? syndrome, which represented a marked increase from the approximately 5 cases detected annually during the previous 4 years.2 A connection with the Guillain?Barr? syndrome had previously been described in association with other flavivirus illnesses3,4 but not with ZIKV infection.
From April 1, 2015, to March 31, 2016, a total of 164,237 confirmed and suspected cases of ZIKV disease and 1474 cases of the Guillain?Barr? syndrome were reported in Bahia, Brazil; Colombia; the Dominican Republic; El Salvador; Honduras; Suriname; and Venezuela. To examine the temporal association between ZIKV disease and the Guillain?Barr? syndrome, graphical and time-series analyses were applied to these two independent data sets, which were collected through official International Health Regulations channels or from ministry of health websites (see theSupplementary Appendix, available with the full text of this letter at NEJM.org). The data obtained from country reports contained no personally identifiable information and were collected as part of routine public health surveillance; therefore, the analysis was exempt from review by an ethics board. Differences between the observed and expected numbers of cases of the Guillain?Barr? syndrome during the ZIKV transmission period, as well as differences in the incidence of the Guillain?Barr? syndrome and ZIKV disease according to age and sex, were analyzed with the use of Poisson regression models (see the Supplementary Appendix).
The analysis suggests that changes in the reported incidence of ZIKV disease during 2015 and early 2016 were closely associated with changes in the incidence of the Guillain?Barr? syndrome.
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