MUMBAI: As 18 out of 140 patients with the debilitating neurological disorder, Guillain-Barre Syndrome (GBS), are on ventilator support in Pune, there is some cold comfort in knowing that this isn’t the worst GBS outbreak in the world-yet. It could, however, be considered one of the largest GBS outbreaks as medical literature classified 30 to 50 cases as an outbreak until 2019 when Peru registered the worst flare-up.
The South American country had 1,120 cases in 2019, with 683 cases reported in two months. The country’s annual caseload stood at 59 in 2017 and rose to 262 in 2018 before peaking in 2019. Unlike India where the present outbreak seems confined to only Pune, Peru registered cases from across the country and had little information available about deaths. The Peruvian story didn’t end there; the country witnessed an outbreak again in 2023 when 130 suspected cases were reported between June 10 and July 15.
The problem with GBS, as a Professor of Medicine in a medical college in Mumbai said, is that it is an autoimmune condition that technically doesn’t seem like an epidemic-causing condition. “GBS has been seen as an independent disorder that is sporadically seen across the country, but we now need to change our mindset and accept that it can emerge as an outbreak and study it epidemiologically to look for links between the various patients,” he said.
Dr Gajanan Velhal, Head of Community Medicine at B K L Walawalkar Rural Medical College, in Ratnagiri, concurred, “We need to study the common factors between the patients to understand why GBS has emerged as an outbreak.” The only common link between Peru and Pune is the microbe-Campylobacter jejuni. Smaller studies from across the world have shown that Campylobacter jejuni infection is linked with higher disability and mortality rates. GBS has been so rare-India has a reported annual incidence of 1.75 to 2 per lakh population-that there are few in-depth studies.
The first-ever detailed analysis of the prevalence and disability burden of GBS was conducted in 2021 and appeared in the ‘Journal of Neuroinflammation’. Using data between 1990 and 2019 from the Global Burden of Diseases Study 2019, the analysis showed that Japan, Brunei Darussalam, Singapore, the Republic of Korea, the US, and Mexico had much higher than expected burdens, whereas countries and territories such as China, Fiji, Taiwan, and Guam had much lower than expected burdens.
The highest prevalence rate of GBS was found in Japan, probably due to the high frequency of infections and presumably also due to genetic and environmental predispositions. It said higher exposure to potential causes, such as the microbe, Haemophilus influenzae, Cytomegalovirus, Zika virus, and respiratory or gastrointestinal infections, could be another reason for the increase.