Detecting Guillain-Barré syndrome caused by Zika virus using systems developed for polio surveillance

Perspectives Zika virus disease is caused by a ri-bonucleic acid (RNA) virus, which is transmitted to humans by mosquitoes of the Aedes aegypti species. Around 80% of infections are asymptomatic. 1 Symptomatic infections are characterized by mild fever lasting from four to seven days, associated with maculopapular rash, arthralgia, conjunctivitis, muscle pain and headache. Until recently, Zika virus disease has never been associated with deaths, intrauterine infections, or congenital anomalies. In 2013 and 2014, during an outbreak in French Polynesia, the disease was linked with Guillain-Barré syndrome. 2 Zika infection can be established by detection of Zika virus RNA or specific viral antigens in human clinical samples. It is suspected that over 40 countries had autochthonous Zika virus transmission in 2015 and early 2016. 3,4 In some countries, there is a temporal association of Zika virus infections with severe clinical manifestations, particularly Guillain-Barré syndrome and congenital neurological malformations. 3,4 In De-cember 2015, officials from the Brazilian Ministry of Health reported 76 patients diagnosed with neurological syndromes, of whom 42 (55%) were confirmed as having Guillain-Barré syndrome. 4 Similarly , between December 2015 and Janu-ary 2016, Salvadorian health officials reported 46 patients with Guillain-Barré syndrome, more than 50% of whom had febrile illness lasting between seven to 15 days before onset of the syndrome. 4 A case-control study conducted in 2013 and 2014 in French Polynesia has shown evidence of Zika virus infections causing Guillain-Barré syndrome. 2 The French Polynesia study found, in most of the patients, neurological symptoms following Zika virus infections lasted a median of six days. 2 With increasing evidence of linkages between Guillain-Barré syndrome and Zika virus infection, 2–4 it is imperative to enhance Guillain-Barré syndrome surveillance. This can be done using existing surveillance systems like the one for acute flaccid paralysis (AFP) used by polio eradication programmes. 5 Scientists warn that in view of outbreaks that occurred in Africa, southeast Asia, the Pacific Islands, and the Americas, the disease now has pandemic potential. 6 In February 2016, the World Health Organization (WHO) declared that the reported clusters of microcephaly and other neurological disorders from the WHO Region of the Americas constituted a Public Health Emergency of International Concern and recommended to enhance surveillance for Zika virus infection. 7 The Aedes species of mosquitoes that transmits the Zika virus and other infections like dengue, chikungunya and yellow fever exists worldwide, posing a high risk for global transmission. …