Monday, July 10, 2023

Peru: MOH Declares Health Emergency Over Increase In Guillain-Barré Syndrome

Photo Credit - MINSA


Two days ago Peru's Ministry of Health declared a 90-day Health Emergency due to a sharp rise in the number of Guillain-Barre syndrome (GBS) reported across the country. Readers with long memories may recall we saw a similar declaration in June of 2019, which was eventually linked to a Campylobacter outbreak.

While many people erroneously assume vaccines are the primary cause of GBS, it is most often associated with bacterial or viral infections. The CDC describes the disorder:
What is Guillain-Barré syndrome (GBS)?
Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that usually last for a few weeks. Most people recover fully from GBS, but some people have long-term nerve damage. In very rare cases, people have died of GBS, usually from difficulty breathing. In the United States, an estimated 3,000 to 6,000 people develop GBS each year.
What causes GBS?
The exact cause of GBS is unknown, but about two-thirds of people who develop GBS experience symptoms several days or weeks after they have been sick with diarrhea or a respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS. People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination. 
Clusters of GBS are rare, but we have seen them reported (see 2011's The Sonora/Arizona GBS Cluster). In that particular case, the outbreak was linked to inadequately disinfected tap water (see Binational outbreak of Guillain-Barré syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011.)

The (translated) press release from Peru's MOH follows.  I'll have more after the break. 

Government declares health emergency due to unusual increase in cases of Guillain Barré syndrome

Press release

- Head of Minsa reported that the measure seeks to protect the health and life of the population - More than S/ 12 million is allocated for the purchase of immunoglobulin and other supplies

July 8, 2023 - 3:45 p.m.

Due to the unusual increase in cases of Guillain Barré syndrome (GBS), the Government, through Supreme Decree No. 019-2023-SA, declared a national health emergency for a period of 90 calendar days, reported the minister of Health, César Vásquez, during his visit to the National Institute of Neurological Sciences (INCN) where he visited two patients hospitalized for this disease.

“So far we have controlled the disease. Guillain Barré appears every year and there has been a significant increase in recent weeks that forces us to take actions as a State to protect the health and life of the population, "said the head of the Ministry of Health (Minsa ) .

The minister explained that this declaration, approved yesterday by the Council of Ministers, will allow the purchase, through the National Center for the Supply of Strategic Health Resources (Cenares), immunoglobulin for the treatment of GBS patients for up to the next two years.

The decree contemplates the action plan that includes financing for the acquisition of goods and services for an amount greater than S/ 12 million. The minister recalled that plasmapheresis and immunoglobulin treatments are available in hospitals and institutes located in the regions of Piura, Cajamarca, La Libertad, Puno, Huánuco, Callao, Loreto, Áncash and Lima.

“The regions are supplied with medicines, and for those that need we have started a redistribution while buying. As Minsa we are assuming the leadership that corresponds to us. We are sitting down with the regional authorities to see their budget execution, because the patients must have their proper treatment”, affirmed the minister.

To date, a total of 182 GBS cases have been reported. Of these, 31 patients are hospitalized and 147 have been discharged. Unfortunately, 4 deaths occurred in January, March and May.


This morning, the Minister of Health went to the National Institute of Neurological Sciences (INCN), in order to verify the care provided to two patients with SGC, as well as to the other hospitalized in this establishment.

The minister was received by the director of the INCN, Jorge Medina Rubio, with whom he toured all areas, such as hospitalization, outpatient, emergency, pharmacy, Intermediate Care Unit (NICU), as well as the Museum of Neuropathology.

The authority spoke with the relatives of the patients and guaranteed them timely and quality care. Likewise, it collected the demands of health workers related to medicine, equipment and human resources.

In addition to the 2019 outbreak previously mentioned, Peru saw an outbreak in 2018 which was tentatively linked to an enterovirus outbreak (see Outbreak of Guillain-Barre syndrome in Peru)and earlier outbreaks have been loosely tied to Zika infections.

A 2022 review (see below) published in the Journal of the Faculty of Human Medicine offers a long list of potential viral causes of GBS (including Zika, EV-D68, Influenza A & B, Dengue, SARS-COV-2, etc.), and is well worth reading in its entirety. 

Viral etiology of the Guillain-Barré syndrome: Looking for the idiopathic answer

Jorge Arturo Vega Fernández1 , Biologist - Microbiologist
Danny Omar Suclupe Campos1 , Biologist - Microbiologist
Mayra Massely Coico Vega1 , Biologist - Microbiologist
Franklin Rómulo Aguilar Gamboa2 , Biologist - Microbiologist

1Department of Microbiology, Faculty of Biological Sciences, Pedro Ruiz Gallo University. Lambayeque, Peru.
2Immunology-Virology Laboratory, Lambayeque Regional Hospital. Lambayeque, Peru.

Guillain-Barré Syndrome (GBS) is a rare disorder of the nervous system, where the patient's immune system attacks the peripheral nerve cells in the arms and legs, causing muscle weakness, loss of sensation and sometimes total paralysis. The origin of this disorder has been associated with immune responses triggered by post-infection with Campylobacter spp.

However, when there is no obvious cause of the disease, it is usually not investigated due to the greater interest in the treatment. Therefore, most cases are reported as idiopathic origin.

Between January and March 2016 worldwide, GBS outbreaks were reported in 8 countries, linked to the emergence of the Zika virus. In Peru, GBS outbreaks have been reported more frequently since the end of 2018 and, although no association with Zika has been confirmed, the increase in cases, the geographical extension where they occurred and the clinical characteristics of affected patients, have common patterns that lead to suspect an infectious origin mainly of viral type.

Therefore, it is important to know the current scientific evidence about the role that some viruses play in this syndrome, allowing us to expand our epidemiological picture with new tools to deal with this disease.

         (Continue . . . )

While we await further word on the size, scope, and etiology of Peru's latest Guillain-Barré outbreak, a few past blogs on GBS may be of interest.

Nature: Long-term Neurologic Outcomes of COVID-19