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A Surge of Guillain-Barré Syndrome Cases in Pune: Understanding the Outbreak

In recent weeks, the city of Pune in western India has seen a troubling rise in cases of Guillain-Barré Syndrome (GBS), a rare disorder characterized by the immune system’s attack on nerve cells. This surge has affected around 160 individuals since January, with the cases leading to admissions to intensive care units, and has been linked to a potential outbreak of the campylobacter jejuni pathogen.

The series of events began last month when a mother noticed her six-year-old son’s unusual difficulty in writing, an early sign of the disorder. Initially concerned about standard childhood frustrations over homework, she could not foresee that this would be the onset of GBS. Tragically, within days, the child was hospitalized, losing the ability to move and requiring ventilator support. Fortunately, he is now on a path to recovery.

As of now, the situation has also escalated to five suspected fatalities among the reported cases, raising alarms in a city that is both an educational and IT hub, surrounded by bustling industrial towns. Among the hospitalized patients, nearly 48 remain in intensive care, with 21 on ventilators, underscoring the severity of the outbreak.

Symptoms and Pathways

Symptoms of GBS typically initiate with tingling or numbness in the extremities, evolving into muscle weakness and mobility difficulties over a span of two to four weeks. The mortality rate associated with GBS can vary, ranging between three to 13%, depending on individual health care access and severity of the cases.

The current outbreak in Pune is believed to be connected to campylobacter jejuni, a leading cause of foodborne illnesses globally and a significant contributor to GBS cases. This pathogen was identified as a culprit in GBS outbreaks as early as the 1990s in rural areas of China, where contaminated water from poultry farms facilitated its spread.

Prevalence of GBS in India

Instances of GBS are not rare in India. A study conducted from 2014 to 2019 at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore revealed that a substantial percentage of GBS patients had prior infections, with one-third testing positive for campylobacter. Co-infections were common, further complicating the health landscape.

Internationally, similar outbreaks have been reported. In Peru, over 200 suspected cases of GBS were documented within the first half of 2023, leading the government to enact emergency health measures as two-thirds of the cases were linked to campylobacter.

Understanding the Risk Factors

In countries with robust hygiene practices, GBS cases often stem more from respiratory infections rather than from foodborne pathogens. Various other factors, such as viral infections—like Zika— and even certain vaccines, have also been linked to GBS cases in different regions around the world. Experts note that the presence of campylobacter is a significant factor, as it contaminates poultry and can be contracted through undercooked meat.

According to Professor Hugh Willison from the University of Glasgow, the specific strain of campylobacter involved in the Pune outbreak shares a unique molecular configuration that allows it to mimic human nerve cells. This molecular mimicry can trigger the immune system to mistakenly attack the body’s own nervous system, resulting in GBS. It is estimated that about one in 100 strains of campylobacter carry this risk, making the overall likelihood of developing GBS approximately one in 10,000.

The consequences of GBS can lead to severe neurological damage, described as an “acute neurological tsunami” by Willison. Recovery is challenging, and while treatments like plasma exchange and intravenous immunoglobulin (IVIG) can help mitigate the condition’s severity, they are not cures. Moreover, diagnostic challenges arise, particularly in rural settings where healthcare professionals may be less familiar with the disease’s symptoms.

Public Health Measures in Response

The World Health Organization (WHO) has responded by sending teams to Pune to work with local health authorities in managing the outbreak. They are involved in tracing and monitoring cases, in addition to emphasizing the need for proper hygiene practices. Investigations have led to the surveying of over 60,000 households and sampling of water sources. Health advisories are urging residents to consume boiled water and avoid stale or inadequately cooked food.

Experts remain concerned about the potential for large-scale contamination of water supplies or widespread consumption of infected poultry. Given the present uncertainty, officials advise the community to remain calm while underscoring the importance of health and safety measures to reduce the risk of further infections. The situation in Pune serves as a poignant reminder of the complex interactions between pathogens and public health that can lead to devastating human consequences.

Source
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