Incidence of Guillain-Barré Syndrome (GBS) in Latin America and the Caribbean Before and During the 2015-2016 Zika Virus Epidemic: A Systematic Review and Meta-Analysis
31 Pages Posted: 28 Jan 2019More...
Background: A severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015-2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS.
Methods: For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and time-frame, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS.
Findings: Of the 6586 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0·40 in Brazil to 2·12/100 000 in Chile. The pooled annual IR in the Caribbean was 1·64 (95% CI 1·29-2·12, I2<0·01, p=0·44). During the ZIKV epidemic, GBS IRs ranged from 0·62 in Mexico to 9·35/100 000 in Martinique. GBS increased 2·9 times during ZIKV and 1·9 times during chikungunya outbreaks over background rates.
Interpretation: Background IRs of GBS tend to be higher in Caribbean than Latin America countries and appear to peak during arboviral disease outbreaks.
Funding Statement: This study was partially funded through ZikaPLAN (AWS), by European Union's Horizon 2020 research and innovation program under Grant Agreement No. 734584.
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: The study is registered with PROSPERO, number CRD42018086659.
Keywords: Guillain-Barré Syndrome, Epidemiology, Systematic Review, Meta-analysis, Zika virus, Latin America and the Caribbean, Arbovirus, Epidemic
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