title: Guillain-Barré Syndrome During Ongoing Zika Virus Transmission - Puerto Rico, January 1-July 31, 2016.
abstract: Guillain-Barré syndrome (GBS) is a postinfectious autoimmune disorder characterized by bilateral flaccid limb weakness attributable to peripheral nerve damage (1). Increased GBS incidence has been reported in countries with local transmission of Zika virus, a flavivirus transmitted primarily by certain Aedes species mosquitoes (2). In Puerto Rico, three arthropod-borne viruses (arboviruses) are currently circulating: Zika, dengue, and chikungunya. The first locally acquired Zika virus infection in Puerto Rico was reported in December 2015 (3). In February 2016, the Puerto Rico Department of Health (PRDH), with assistance from CDC, implemented the GBS Passive Surveillance System (GBPSS) to identify new cases of suspected GBS (4). Fifty-six suspected cases of GBS with onset of neurologic signs during January 1-July 31, 2016, were identified. Thirty-four (61%) patients had evidence of Zika virus or flavivirus infection; the median age of these patients was 55 years (range = 21-88 years), and 20 (59%) patients were female. These 34 patients were residents of seven of eight PRDH public health regions. All 34 patients were hospitalized and treated with intravenous immunoglobulin G (IVIg), the standard treatment for GBS; 21 (62%) required intensive care unit admission, including 12 (35%) who required endotracheal intubation and mechanical ventilation. One patient died of septic shock after treatment for GBS. Additionally, 26 cases of neurologic conditions other than GBS were reported through GBPSS, including seven (27%) in patients with evidence of Zika virus or flavivirus infection. Residents of and travelers to Puerto Rico and countries with active Zika virus transmission should follow recommendations for prevention of Zika virus infections.* Persons with signs or symptoms consistent with GBS should promptly seek medical attention. Health care providers in areas with ongoing local transmission seeing patients with neurologic illnesses should consider GBS and report suspected cases to public health authorities.
authors: Emilio
authors: E
authors: Dirlikov
authors: Chelsea G
authors: CG
authors: Major
authors: Marrielle
authors: M
authors: Mayshack
authors: Nicole
authors: N
authors: Medina
authors: Desiree
authors: D
authors: Matos
authors: Kyle R
authors: KR
authors: Ryff
authors: Jomil
authors: J
authors: Torres-Aponte
authors: Rebecca
authors: R
authors: Alkis
authors: Jorge
authors: J
authors: Munoz-Jordan
authors: Candimar
authors: C
authors: Colon-Sanchez
authors: Jorge L
authors: JL
authors: Salinas
authors: Daniel M
authors: DM
authors: Pastula
authors: Myriam
authors: M
authors: Garcia
authors: Marangely Olivero
authors: MO
authors: Segarra
authors: Graciela
authors: G
authors: Malave
authors: Dana L
authors: DL
authors: Thomas
authors: Gloria M
authors: GM
authors: Rodríguez-Vega
authors: Carlos A
authors: CA
authors: Luciano
authors: James
authors: J
authors: Sejvar
authors: Tyler M
authors: TM
authors: Sharp
authors: Brenda
authors: B
authors: Rivera-Garcia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011647:Puerto Rico / Q000453:epidemiology; D055815:Young Adult; D000071244:Zika Virus / Q000302:isolation & purification; D000071243:Zika Virus Infection / Q000453:epidemiology / Q000635:transmission*