PLoS Neglected Tropical Diseases (Aug 2017)

Increased rates of Guillain-Barré syndrome associated with Zika virus outbreak in the Salvador metropolitan area, Brazil.

  • Ashley R Styczynski,
  • Juliane M A S Malta,
  • Elisabeth R Krow-Lucal,
  • Jadher Percio,
  • Martha E Nóbrega,
  • Alexander Vargas,
  • Tatiana M Lanzieri,
  • Priscila L Leite,
  • J Erin Staples,
  • Marc X Fischer,
  • Ann M Powers,
  • Gwong-Jen J Chang,
  • P L Burns,
  • Erin M Borland,
  • Jeremy P Ledermann,
  • Eric C Mossel,
  • Lawrence B Schonberger,
  • Ermias B Belay,
  • Jorge L Salinas,
  • Roberto D Badaro,
  • James J Sejvar,
  • Giovanini E Coelho

DOI
https://doi.org/10.1371/journal.pntd.0005869
Journal volume & issue
Vol. 11, no. 8
p. e0005869

Abstract

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In mid-2015, Salvador, Brazil, reported an outbreak of Guillain-Barré syndrome (GBS), coinciding with the introduction and spread of Zika virus (ZIKV). We found that GBS incidence during April-July 2015 among those ≥12 years of age was 5.6 cases/100,000 population/year and increased markedly with increasing age to 14.7 among those ≥60 years of age. We conducted interviews with 41 case-patients and 85 neighborhood controls and found no differences in demographics or exposures prior to GBS-symptom onset. A higher proportion of case-patients (83%) compared to controls (21%) reported an antecedent illness (OR 18.1, CI 6.9-47.5), most commonly characterized by rash, headache, fever, and myalgias, within a median of 8 days prior to GBS onset. Our investigation confirmed an outbreak of GBS, particularly in older adults, that was strongly associated with Zika-like illness and geo-temporally associated with ZIKV transmission, suggesting that ZIKV may result in severe neurologic complications.