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18 AUG 2011
In a recently published letter to the Editor of the online journal Emerging Infectious Diseases hosted by the Centers for Disease Control and Prevention Atlanta, a team of researchers from icddr,b, University Medical Centre Rotterdam in the Netherlands, Dhaka Medical College and Hospital, and World Health Organization Bangladesh have highlighted the incidence of Guillain-Barré syndrome (GBS) in children in Bangladesh.
Guillain-Barré Syndrome is an acute polyradiculoneuropathy, a disorder affecting the nervous system, and is associated with high mortality and permanent disability. In Bangladesh, GBS is frequently preceded by an enteric infection caused by Campylobacter jejuni, one of the most common bacterial causes of human gastroenteritis in the world. Food poisoning caused by Campylobacter can severely weaken the patient, but is rarely life-threatening. It has been linked with subsequent development of GBS, which usually develops two to three weeks after the initial diarrhoeal illness.
Since the eradication of polio in Bangladesh, GBS is now the most frequent cause of acute flaccid paralysis (AFP), a clinical manifestation characterised by weakness or paralysis of arms and legs. Some patients also suffer respiratory muscle paralysis, for which they require artificial ventilation. AFP was previously commonly associated with poliomyelitis, a viral disease that can affect nerves and can lead to partial or full paralysis.
The non-polio incidence rate of AFP in Bangladesh is 3.25 cases per 100,000 children below 15 years of age. The country has achieved remarkable success in its drive to eliminate poliomyelitis, with not a single case having been reported since 2000.
Researchers’ study of GBS in Bangladesh
Researchers at icddr,b and their collaborators hypothesised that most AFP cases in Bangladesh can be diagnosed as GBS. The objective of their study was to estimate the crude incidence rate of GBS among children below 15 years of age in Bangladesh by using data from a national/WHO surveillance of AFP.
The crude incidence rates of GBS in children from Bangladesh varied from 1.5 to 2.5 per 100,000 per year. For yet unknown reasons, the incidence rate appears to be higher in the three southern divisions (2.5 per 100.000 per year) as compared to the three northern divisions of Bangladesh (1.5 per 100.000 per year).
The researchers also recently published the results of a prospective matched case-control study in Dhaka Medical College Hospital, Bangabandhu Sheikh Mujib University and Dhaka Central Hospital. They reported that 57% of the GBS cases were associated with a recent Campylobacter infection. The disease was frequently observed in children, usually severe, and leading to permanent paralysis and disabilities. The mortality was 14%.
GBS working group in Bangladesh
The GBS research group at icddr,b/ Dhaka Medical College Hospital started in 2005 and was partially funded by the Government of Bangladesh under the ‘Improved Health for the Poor’ project. The group is now a leading working group among developing countries.
The team is expanding its research focus into the immunobiology and genetics of GBS. New diagnostic tools are being evaluated to better predict the outcome of the disease and target new and specific medical interventions to those who will benefit most from it.
At a one-day symposium to be held on 10 November 2011, current knowledge, knowledge gaps and future research will be shared with an audience of neurologists, intensive care and infectious disease specialists, other health professionals and policy makers.
For details please contact Dr Hubert P Endtz, Director, Centre for Food and Water borne diseases, icddr,b.
