WHO reported in July 2023 that the National Centre for Epidemiology, Prevention, and Disease Control (CDC) of Peru has issued an epidemiological alert due to an “unusual increase” in Guillain-Barré Syndrome (GBS) cases. Apart from an outbreak in 2019, historica data indicate that the average monthly number of cases is lower than 20 nationwide. However, between 10th June and 15th July 2023, 130 suspected cases have been reported. Of these, 44 have been confirmed.
National health emergency
The Presidency of the Republic of Peru declared a national health emergency in early July 2023 due to the unusual increase, responding with enhanced implementation of public health responses. The potential cause of this incidence “remains under investigation”. From epidemiological week 1 to week 28, in July, a total of 231 suspected cases were reported, of which 56% were reported in a 5-week period from 10th June to 15th July.
The highest number of cases from the start of the year have been recorded in 7 of the country’s 24 departments: Lima and Callao, La Libertad, Piura, Lambayeque, Cajamarca, Junín, and Cusco. The age group most affected appears to be adults aged 30 years or older (158 cases), and children below the age of 17 accounted for 19% of cases. More than half of reported cases have been males.
The declaration of a national health emergency provides:
- The implementation of an action plan that includes financing for the provision of strategic resources in health, including the acquisition of 7000 human immunoglobulins as part of the treatment of patients with GBS, promoting recovery, and preventing complications associated with the disorder.
- Intensification of surveillance, prevention, and response actions to possible cases.
- Communication of risk to health professionals and issuance of key messages to the population to adopt preventative measures.
- Advice, information, and guidance on GBS to health professionals and the general population.
GBS
GBS is a rare neurological disorder of “variable clinical severity”, including “fatal outcomes”. It is the most common form of acute flaccid paralysis globally, characterised by motor weakness, areflexia, sensory abnormalities, and elevated protein levels in cerebrospinal fluid. Commonly, an upper respiratory or gastrointestinal illness precedes GBS.
The 130 cases reported during the 5-week period in question included preliminary clinical manifestations of gastrointestinal infection, respiratory infection, and fever. Furthermore, 72.3% of these cases presented with an upward progression of paralysis as neurological manifestation.
As there is currently no known cure for GBS, patients who present with the illness need supportive treatment, sometimes in intensive care. Many available treatments can help manage symptoms and support the recovery process. However, some cases can produce almost total paralysis.
In 2019, Peru experienced an “unprecedented” outbreak of GBS with almost 700 reported cases. From clinical-epidemiological characteristics and a study of the identified agents, it was concluded that this outbreak was associated with the Campylobacter jejuni sequence type (ST) 2993 genotype.
Advice to Member States
WHO’s advice to Member States is to “maintain the ongoing monitoring of the incidence and trends of neurological disorders” like GBS, to “identify variations against their expected baseline values and implement protocols for improved patient management”.
GBS is a “rare condition” that can affect people of all ages. The cause is “not fully understood”. Further investigation is required to identify the possible causes associated with this increase, and there have been no reported surges in neighbouring countries. WHO has not issued recommendations that would impose travel and/or trade restrictions on Peru as a response.
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