Association of Zika virus infection with Guillain–Barré syndrome

ECDC comment

​French Polynesia experienced a large outbreak of Zika virus between October 2013 and April 2014.

During that time, there was a reported increase in the reporting of Guillain–Barré syndrome. A case–control study recently published in The Lancet [1] examined the links between Zika infection and Guillain–Barré syndrome. Of the 42 patients diagnosed with Guillain–Barré syndrome during the outbreak, 98% had anti-Zika IgM or IgG antibodies, and all 42 had neutralising antibodies against Zika, compared with 56% in the control group (patients treated at the hospital for other illnesses). In addition, 37 of the 42 patients with Guillain–Barré syndrome (88%) reported symptomatic Zika virus infection that preceded the occurrence of neurological symptoms by a median of 6 days. Most patients (95%) with Guillain–Barré syndrome had pre-existing dengue immunity, but this did not differ significantly from the control groups. Twenty-four out of 100 000 people infected with Zika virus developed Guillain–Barré in French Polynesia during the outbreak compared with a global incidence of 1–4 per 100 000 person-years.

ECDC comment

Guillain–Barré syndrome is typically seen after a viral or bacterial infection and the recent emergence of Zika virus in the Americas in 2015 has been associated with an increase of Guillain–Barré syndrome incidence in Brazil, Colombia, El Salvador, Suriname and Venezuela.
This study provides strong epidemiological evidence that Zika virus is associated with Guillain–Barré syndrome. In addition, it shows that pre-exposure to dengue does not seem to increase the risk. Pathophysiological mechanisms involved in the occurrence of Guillain–Barré syndrome following Zika virus infection will require additional investigations. Countries reporting an increase of Guillain–Barré syndrome were affected by Zika viral strains from the Asian lineage.

Reference

  1. Cao-Lormeau VM, Blake A, Mons S, Lastère S, Roche C, Vanhomwegen J, et al. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. The Lancet. Published Online: 29 February 2016. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00562-6.pdf