title: Investigation of a Guillain-Barré syndrome cluster in the Republic of Fiji.
abstract: BACKGROUND
  In 2014, we investigated a cluster of Guillain-Barre syndrome (GBS) in Fiji that occurred during a dengue epidemic. We designed a case-control study to determine the etiology.
  
  
  METHODS
  Cases were patients meeting Brighton Collaboration criteria for GBS with onset from February 2014 to May 2014. Controls were persons without symptoms of GBS who were matched by age group and location. We collected information on demographics and potential exposures. Serum samples were tested for evidence of recent arboviral or Leptospira spp. infections.
  
  
  RESULTS
  Nine cases of GBS were identified for an incidence of five cases per 100,000 population/year. Median age of cases was 27years (range: 0.8-52); five (56%) were male. Six (67%) reported an acute illness prior to GBS onset. Among the 9 cases and 28 controls enrolled, odds ratios for reported exposures or antibodies against various arboviruses or Leptospira spp. were not statistically significant.
  
  
  CONCLUSIONS
  No clear etiologies were identified for this unusual GBS cluster. There was a temporal association between the GBS cluster and a dengue epidemic, but we were unable to substantiate an epidemiologic or laboratory association. Further study is needed to explore potential associations between arboviral infections and GBS.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States; Department of Neurology, University of Colorado Denver, Aurora, CO, United States.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Pastula
authors.affiliation: Fiji Ministry of Health and Medical Services, Suva, Fiji.
authors.forename: Aalisha Sahu
authors.initials: AS
authors.lastname: Khan
authors.affiliation: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Sharp
authors.affiliation: Western Pacific Region, World Health Organization, Suva, Fiji.
authors.forename: Viema L
authors.initials: VL
authors.lastname: Biaukula
authors.affiliation: Fiji Ministry of Health and Medical Services, Suva, Fiji.
authors.forename: Taina K
authors.initials: TK
authors.lastname: Naivalu
authors.affiliation: Fiji Ministry of Health and Medical Services, Suva, Fiji.
authors.forename: Eric
authors.initials: E
authors.lastname: Rafai
authors.affiliation: Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.lastname: Ermias Belay
authors.affiliation: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.
authors.forename: J Erin
authors.initials: JE
authors.lastname: Staples
authors.affiliation: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.
authors.forename: Olga I
authors.initials: OI
authors.lastname: Kosoy
authors.affiliation: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.
authors.forename: Janeen J
authors.initials: JJ
authors.lastname: Laven
authors.affiliation: Colonial War Memorial Hospital, Suva, Fiji.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Bennett
authors.affiliation: Colonial War Memorial Hospital, Suva, Fiji.
authors.forename: Adam W J
authors.initials: AWJ
authors.lastname: Jenney
authors.affiliation: Colonial War Memorial Hospital, Suva, Fiji.
authors.forename: Ravi Narayan
authors.initials: RN
authors.lastname: Naidu
authors.affiliation: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lanciotti
authors.affiliation: Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Renee L
authors.initials: RL
authors.lastname: Galloway
authors.affiliation: Western Pacific Region, World Health Organization, Suva, Fiji.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Nilles
authors.affiliation: Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States. Electronic address: zea3@cdc.gov.
authors.forename: James J
authors.initials: JJ
authors.lastname: Sejvar
authors.affiliation: Fiji Ministry of Health and Medical Services, Suva, Fiji.
authors.forename: Mike
authors.initials: M
authors.lastname: Kama
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D005260:Female; D005367:Fiji / Q000453:epidemiology; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D055815:Young Adult
keywords: Case-control study; Dengue virus; Epidemiology; Fiji; Guillain-Barré syndrome; Zika virus