Ninety-day national health emergency in Peru after 182 GBS cases reported since June 2023
A surge in cases of Guillain-Barre Syndrome (GBS) in Peru has brought forward concerns over the links between the novel coronavirus (COVID-19) and the rare neurological disorder.
The syndrome was among the prolonged neurological issues, known as long COVID complications, reported around the world following the onset of the COVID-19 pandemic. Scientists have also been looking into the role of COVID-19 vaccines behind GBS cases.
Peru has declared a 90-day national health emergency as 182 cases have been reported nationwide through June 2023, along with four deaths, reported news agency MercoPress.
The country saw a large outbreak of GBS in 2019 as well. A study published in the biomedical library National Library of Medicine identified 683 suspected or confirmed GBS cases in the country from May 20-July 27, 2019.
Read more: COVID-19: J&J vaccine can heighten risk of rare neurological condition
GBS is a serious autoimmune disorder that attacks the peripheral nervous system and leads to weakness, tingling and numbness initially in the limbs. These can then expand to the rest of the body and eventually cause paralysis, which can last 6-12 months or longer.
The syndrome can affect the nerves that control muscle movement as well as those that transmit pain, temperature and touch sensations. This can result in muscle weakness and loss of sensation in the legs and / or arms. While it is more common in adults and in males, people of all ages can be affected.
Treatment consists of cleaning or immunising the blood. One of the treatments is plasmapheresis, a procedure that removes the plasma from the blood and replaces it with other fluids. The treatment can cost up to $15,000. Peru’s state hospitals are providing free treatment for GBS cases.
The syndrome usually occurs following a bacterial or viral infection or, on rarer occasions, following vaccinations. People who develop GBS do so several days or weeks after they have been sick with diarrhoea or a respiratory illness, according to the United States Centers for Disease Control and Prevention.
Patients with Epstein-Barr, Zika, human immunodeficiency virus (HIV), Herpes and Campylobacter jejuni have displayed GBS symptoms in the past. After the onset of the COVID-19 pandemic, several cases of GBS following infections with SARS-CoV-2 were reported around the world.
There are concerns regarding cases following administration of COVID-19 vaccine as well — about 100 suspected cases of GBS were identified among the 12.8 million people who have received the Johnson & Johnson vaccine. There were reports of the syndrome following vaccination with AstraZeneca COVID-19 vaccines as well, both of which used an adenovirus platform.
A subcommittee set up by the World Health Organization concluded that rare cases of GBS have been reported following vaccinations with adenovirus vector COVID-19 vaccines, but such was not the case for mRNA COVID-19 vaccines.
After the onset of COVID-19, from February 28 through March 21, 2020, five patients in northern Italy developed GBS, said a letter published in The New England Journal of Medicine.
The case of a 57-year-old man who developed acute motor-sensory axonal neuropathy, a variant of GBS, about 12 days after he was infected with COVID-19, was detailed in the journal Frontiers in Neurology.
In India, around 24 cases of COVID-19 patients with GBS were found since August 2020, stated a November 2020 report by the newspaper Indian Express.
Though GBS mostly affects adults, cases of children with COVID-19 and GBS have also been reported. A nine-year-old boy displayed GBS symptoms like unbalanced gait, back pain and lower limb weakness following infection by SARS-CoV-2, according to a March 2022 report published in the journal The BMJ.
Read more: The Zika virus is here to stay in India, Kanpur just latest victim
GBS illnesses following vaccines are not unheard of. There have been reports of people getting ill from GBS days or weeks after being vaccinated with Shingrix, the shingles vaccine and after getting the flu shot, according to the journal Yale Medicine.
In 1976, there was a small increased risk of GBS after swine flu vaccination, which was formulated specifically for a potential pandemic strain of flu virus.
The first case of GBS following receiving both doses of the two-dose Pfizer COVID-19 vaccine series was reported in a 42-year-old woman. She had received the second shot a week before the onset of the syndrome.
A June 26, 2023 study published in journal Cureus looked into five cases that developed the GBS post-COVID-19 AstraZeneca vaccine, along with its pathophysiology, management and outcome.
J&J or Janssen vaccines had a higher incidence of GBS cases, a cohort study that looked into over 487 million COVID-19 vaccine doses found.
The study was published in the journal JAMA Network and found GBS reporting rates was 9-12 times higher in these than Pfizer-BioNTech and Moderna vaccines, which may represent background incidence.
However, these studies stated the advantages of receiving COVID-19 vaccines outweigh the potential side effects, which are usually benign.
“Although the incidences of GBS, TM [spinal illness transverse myelitis], or GBS/TM overlap syndrome are rare, physicians should still be aware of these complications and treat them appropriately when they present in patients following COVID-19 vaccinations,” the study published in JAMA Network said.
Read more: Zika virus explained: Should India be worried?
The incidence rate of GBS after SARS-CoV-2 infection or vaccination was low, another review article from May 2023 published in the Wiley Online Library pointed out.
However, the high prevalence of COVID-19 and severe complications of GBS, for example, autonomic dysfunction and respiratory failure, highlighted the importance of post-COVID-19 GBS, it further said.
In Peru, from January 3, 2020 to July 5, 2023, there have been 4,512,091 confirmed cases of COVID-19 with 221,043 deaths reported to WHO. As of June 1, 2023, a total of 89,593,907 vaccine doses have been administered.
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GBS is a serious autoimmune disorder that attacks the peripheral nervous system and leads to weakness, tingling and numbness initially in the limbs. Photo: iStock .png)
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