Table 3. Demographic characteristics, case selection and ascertainment in studies reporting more than one Guillain-Barré syndrome case with a recent Zika virus infection.
| First author | Journal, year |
Provenance (city, country) |
ZIKV outbreak | Study design | Incidence period | Study population | Ascertainment GBSa | Ascertainment ZIKV | N cases in analysis (mal:fem) |
Median age (IQR) or [range] |
|---|---|---|---|---|---|---|---|---|---|---|
| Cao-Lormeaub[4] | Lancet 2016 | Papeete, Tahiti,French- Polynesia |
Oct 2013-Apr 2014 | Prospective case-control | Oct 2013 - Mar 2014 |
All GBS inpatients in French Polynesia during ZIKV outbreak | Brighton 1–3 by neurologist or intensivist | PCR: ZIKV(S) VNT,IgM&IgG: ZIKV,DENV(S) |
42 (11:31) |
42 (36–56) |
| Simon[23] | J Neurovirol 2018 |
Noumea, New Caledonia, Melanesia | Jan-Dec 2014 |
Prospective case-control |
Jan—Dec 2014 | All GBS adult patients in New Caledonia during ZIKV outbreak | Brighton 1–2 | PCR, IgM&IgG: ZIKV, DENV(S) VNT: ZIKV(S) |
5c (3:2) |
52 (mean) [29–75] |
| Ferreira[16] | Am J Trop Med Hyg 2016 |
Recife, Brazil | Nov 2014–2015 | Case series | 15 Dec 2014–30 Jun 2015 | First six adults with acute neurological illness and ZIKV PCR+, in reference neurology hospital | Criteria NR, data compatible with Brighton 1 and 4 (2:2) | PCR: ZIKV, DENV(S) IgM&IgG: ZIKV, DENV(S) |
4 (1:3) |
33.5 [25–48] |
| Nóbrega[29] | Epidemiol Serv Saude 2018 |
Recife, Brazil | Nov 2014–2015 | Case series | 23 Dec 2014–19 Jun 2015 |
All GBS inpatients in metropolitan region identified in the Hospital Information System, with arboviral symptoms (<60d) and/or laboratory positivity | Brighton 1–4 by medical records review | ZIKV PCR tested in 1 case (S) DENV IgM tested in1 case (S) |
18 (9:9) |
44 [14–62] |
| Styczynski[27] | PLoS Negl Trop Dis 2017 |
Salvador, Brazil | Jan 2015-May 2016 | Retrospective case-control | 1 Jan 2015–31 Aug 2015 | All GBS cases (≥ 12y/o) reported to the Bahia Epidemiologic Surveillance Center | Brighton 1–3 by medical records review | IgM: ZIKV, DENV(S) VNT: ZIKV, DENV(S) |
50d (19:22) |
44 [32–54] |
| do Rosário[17] | Am J Trop Med Hyg 2016 | Salvador, Brazil | Jan 2015-May 2016 | Case series | 15 May - 30 Jul 2015 |
Adult patients admitted to ICU with ascending paresis, preceding exanthema, ZIKV IgM+ | Wakerley Criteria, 2014 | PCR: ZIKV, DENV, CHIKV(S) IgM&IgG: ZIKV, DENV, CHIKV (18 arboviruses panel in S) VNT:ZIKV, DENV, CHIKV, YFV(S) |
2 (1:1) |
46,5 [22 and 49] |
| Keesen[30] | Lancet 2017 | João Pessoa, Brazil |
2016 | Case series | 2016 | GBS cases in Paraiba province admitted to neurology reference hospital during the ZIKV epidemic in 2016 | NR | PCR: ZIKV IgM&IgG: DENV,CHIKV (type biosample NR) |
12 (8:4) |
35,5 [7–73] |
| da Silva[18] | JAMA Neurol 2017 |
Rio de Janeiro, Niteroi and São Gonçalo, Brazil |
May 2015-Nov 2016 | Cohort | 5 Dec 2015- 10 May 2016 |
All adults with <60d onset of transverse myelitis, meningo-encephalitis or GBS admitted to neuromuscular expertise center | Brighton | ZIKV PCR if -: ZIKV IgM(S,CSF) ZIKV IgM if+: DENV IgM |
28e (9:19) |
42 (22–67) |
| Azevedo[19] | Rev Soc Bras Med Trop 2018 | Rio de Janeiro, Brazil | May 2015-Nov 2016 |
Case series | Jun 2015 - Dec 2016 |
All non-congenital neurologic disorders reported to Information System for Notifiable Diseases and Arboviral Neurologic Manifestation Report | PAHO criteria | PCR: ZIKV,CHIKV(S) IgM: DENV,CHIKV(S) IgG: CHIKV(S) |
72 (NR) |
45 |
| Mehta[21] | PLoS Negl Trop Dis 2018 |
Rio de Janeiro, Brazil |
May 2015- Nov 2016 | Case series | 1 Nov 2015–1 Jun 2016 | Patients ≥12 y/o admitted to one of 11 participating hospitals, with acute neurologic disease, suspected and tested for ZIKV | Brighton by medical records review | PCR:ZIKV,DENV,CHIKV(S,CSF,U) IgM&IgG: ZIKV(S), DENV,CHIKV (S,CSF) |
7f (4:3) |
41 [19–67] |
| Sebastián[22] | J Crit Care 2017 |
7 Latin American countriesg |
2015–2016 | Case series | 1 Dec 2015- 2 Apr 2016 |
Adults with a confirmed ZIKV infection in one of 24 ICUs of the Latin America Surveillance Network | Brighton by intensivist or neurologist (results NR) | PCR: ZIKV(S) | 8 (2:6) |
38 [18–67] |
| Salinas[24] | J Neurol Sci 2017 |
Barranquilla, Colombia |
Oct 2015-Apr 2016 | Retrospective case-control |
1 Oct 2015- 2 Apr 2016 |
All GBS cases in Barranquilla reported to the national and the local surveillance systemh | Brighton 1–3 by medical records review | IgM&VNT: ZIKV, DENV(S) | 47 (25:22) |
49 [10–83] |
| Parra[32] | NEJM 2016 | Cucuta, Medellin, Cali, Barranquilla, Neiva, Colombia | Oct 2015-Apr 2016 | Prospective case-control |
Jan—Mar 2016 | All patients with GBS at six university-based hospitals | Brighton by neurologist or internist | PCR: ZIKV(S,CSF,U), DENV(S,CSF) IgM&IgG: DENV(S,CSF) |
68i (30:38) |
47 (35–57) |
| Villamil-Gomez[28] | Travel Med Infect Dis 2017 |
Sucre, Colombia |
Oct 2015-Apr 2016 | Case series | 2016 | Adults with confirmed ZIKV infection and GBS, admitted to ICU of two major clinical reference centers in Sincelejo-Sucre | NR | PCR: ZIKV; DENV NS1 IgM&IgG: DENV,CHIKV (samples NR) |
16 (4:12) |
53 (47–68) |
| Acevedo[20] | Front Microbiol 2017 |
Guayaquil, Ecuador |
Jan-Oct 2016 | Case series | 1 Feb—31 Aug 2016 | 16 adult patients with neurological symptoms and PCR+ ZIKV, DENV or CHIKV in CSF, admitted to ER or ICU of largest hospital of Guayaquil | Criteria NR, data compatible with Brighton 1, 2, 4 | PCR:ZIKV,DENV,CHIKV(CSF) | 3 (1:2) |
54 [18–62] |
| Langerak[31] | Front Neurol 2016 |
Paramaribo, Suriname | Oct 2015–2016 | Cases series | Jan—Mar 2016 | Consecutive adult patients diagnosed with GBS and preceding ZIKV infection | Criteria NR, data compatible with Brighton 1 | PCR: ZIKV(S,CSF,U); IgM&IgG: ZIKV,DENV(S) VNT: ZIKV(S), DENV NS1(S) |
3 (0:3) |
50 [40–60] |
| Dirlikov-a[33] | MMWR 2016 | Puerto Rico | Dec 2015-Dec 2016 | Case series | 1 Jan—31 Jul 2016 | GBS cases admitted at 13 hospitals, identified by the GBS Passive Surveillance System-Puerto Rico Department of Health | Brighton by medical records review | PCR: ZIKV,DENV,CHIKV(S,CSF) IgM: ZIKV,DENV,CHIKV(S,CSF) |
34 (20:14) |
55 [21–88] |
| Dirlikov-b[25] | JAMA Neurology 2018 | Puerto Rico | Dec 2015-Dec 2016 | Case series | Jan—Dec 2016 | All GBS cases admitted at all the 57 general hospitals of Puerto Rico and identified by the GBS Passive Surveillance System. | Brighton1-3 by medical records review | PCR: ZIKV,DENV,CHIKV (S,CSF,U,Sa) IgM: ZIKV,DENV,CHIKV(S,CSF) |
107j (47:60) |
54 [4–88] |
| Rozé[26] | Clin Infect Dis 2017 | Martinique, French Caribbean |
Jan-Oct 2016 | Case series | Jan—Oct 2016 | All GBS inpatients at only specialized center in the country | Brighton 1–2 by neurologist |
PCR:ZIKV,DENV,CHIKV (S,CSF,U) IgM&IgG: ZIKV,DENV,CHIKV(S) VNT ZIKV (if ZIKV PCR-&IgM-or ZIKV&DENV IgM+) |
30k (8:15) |
61 (56–71) |
| del Carpio-Orantes[14] | Neurología 2018 | Veracruz, Mexico |
2016 | Case series | 2016–2017 | All GBS cases documented by Instituto Mexicano del Seguro Social with GBS and tested for arboviruses | Brighton 1–3 by medical records review |
PCR: ZIKV,DENV,CHIKV(S) IgM&IgG: ZIKV(S) IgM: DENV/CHIKV(S) |
18 | 47 [19–70] |
| Umapathi[15] | J Peripher Nerv Syst 2018 |
Singapore, Singapore | Aug-Nov 2016 | Prospective case-control | May—Dec 2016 | All GBS cases from all public and private hospitals in Singapore before and during ZIKV outbreak | ICD10 G61.0 records in electronic databases | PCR: ZIKV,DENV(S,U) VNT, IgM&IgG: ZIKV,DENV(S) |
12m (7:5) |
55,5 [25–81] |
| Total | 587 |
Age as median and IQR (interquartile range) or [range] unless indicated otherwise. mal = male | fem = female | NA = not applicable | Brighton = Brighton Collaboration Criteria levels[10] | EMG = electromyography/nerve conduction studies | y/o = years old | ICU = Intensive Care Unit | ZIKV = Zika virus | CHIKV = Chikungunya virus | DENV = Dengue virus | PCR = polymerase chain reaction | VNT = virus neutralization test | DENV NS1 = DENV NS1 antigen | NR = Not Reported | S = serum | CSF = cerebrospinal fluid | U = urine | Sa = saliva ER = emergency room | ICD10 = 10th revision of the International Statistical Classification of Diseases and Related Health Problems).
aPatients not fulfilling the Brighton Criteria were included: da Silva (n = 3), Mehta (n = 1), Parra (n = 6).
bAdditional data retrieved from previous publication by Watrin et al, 2016[48].
cClinical data available for 5 cases with laboratory evidence of ZIKV infection (IgM & IgG positive).
dAge, infectious symptoms and laboratory data available for 41 cases included in case-control study, neurologic signs and symptoms available for all 50 reported cases.
eOne post-vaccine case was excluded from data extraction, data on CSF examination were available for all 29 cases, age and clinical data were available for 27 ZIKV positive cases.
fA total of 13 GBS cases with suspected/probable/confirmed ZIKV were reported but data were available for only 7 cases with positive arbovirus tests.
gColombia, Venezuela, Salvador, Guatemala, Puerto Rico, Ecuador, Perú and Chile.
h Colombia National Surveillance System (Sivigila) and Secretaria de Salud de Barranquilla.
iFive cases from Barranquilla may overlap with cases reported by Salinas et al.
jfA total of 123 GBS cases with suspected/probable/confirmed ZIKV were reported but clinical and laboratory data were available for 107 cases tested for ZIKV.
kLaboratory data available for all cases and clinical data for 23 cases with laboratory evidence of ZIKV.
lClinical data of 8 cases additionally retrieved from previous publication by del Carpio-Orantes et al, 2017.[49]
mA total of 14 cases were reported, data were extracted from 11 cases collected during the ZIKV outbreak plus one case with laboratory evidence of recent ZIKV infection before the outbreak.