Guillain-Barré outbreak in Pune ‘human-made epidemic’, more than 5,000 cases expected: Experts

Maharashtra’s Pune is grappling with a situation akin to an epidemic. More than 100 people have been confirmed with an unusual condition known as Guillain-Barré syndrome (GBS).

Two people have lost their lives due to this syndrome, while 17 others are on ventilators. Leading virologists and neuro-specialists in the country have indicated that this could be a sign of more such infections spreading in the future.

Virologist and former professor at the Christian Medical College in Vellore, Dr T Jacob John, who has monitored outbreaks of mysterious diseases for decades, explained that the GBS outbreak in Pune is essentially a human-made epidemic.

Reports indicate that high levels of Escherichia coli bacteria were found in water samples from local drinking sources, which clearly suggests contamination from human or animal faeces, making the water unsafe for consumption.

It is highly likely that the contaminated water led to a widespread Campylobacter infection, which ultimately triggered the GBS outbreak.

Understanding GBS

GBS is a rare autoimmune condition where the immune system attacks the body’s peripheral nervous system. It causes numbness and muscle weakness. In most cases of GBS, the bacteria Campylobacterjejuni, which resides in the intestines of humans, poultry and livestock, is the primary cause.

Dr Rajendra Kumar Pandey, a neurologist trained at Sawai Man Singh Medical College in Jaipur and a researcher on GBS, told Down to Earth (DTE) that he has treated 15-16 GBS cases this winter, and the sources of infection were varied. However, the situation in Pune is entirely different. Such an outbreak has not been witnessed before.

“The fact that over 100 people in Pune have been diagnosed with GBS clearly indicates that more than 5,000 people must have contracted the Campylobacter infection. However, it is important to note that not all cases of Campylobacter infection result in GBS,” Dr Jacob highlighted.

Now the question arises: how did such a large number of people in Pune get infected with Campylobacter jejuni, which triggered GBS?

Answering this question, Dr Jacob stated that the infection could have entered the human body through two possible routes.

“For example, people may have consumed contaminated chicken or meat from a dirty restaurant or place. However, this alone would not be sufficient to explain such a large outbreak,” he told DTE.

“For an outbreak of this scale to occur, the organism needs a transmission route. It is almost certain that water supply contaminated with human or animal faeces acted as the medium for the spread of Campylobacter jejuni. It is also clear that the initial cases of GBS were confirmed to be infected with this bacteria,” the doctor added.

Dr Pandey further said that the triggers for GBS can be many, particularly during the rainy or winter seasons, when GBS patients often come to see him. However, this case in Pune is different because all these patients have had some form of infection beforehand, such as a recent fever or immune suppression due to medications. For example, TB patients often have suppressed immunity, which can also trigger GBS.

Dr Jacob remarked that the outbreak in Pune is a direct consequence of the lack of a public health system in India because such an outbreak is highly unusual. Without proper records, it is difficult to determine when a similar outbreak occurred in India before.

Dr Sanjay Pandey, head of the neurology department at Amrita Hospital in Faridabad, told DTE that if the number of GBS cases in every hospital in Delhi were combined, the total could exceed 100. He mentioned that he attends to five-six patients every month. However, Dr Pandey agreed that these patients have autoimmune conditions and are infected from various sources.

Meanwhile, Dr Priyanka Shehravat, a neurologist trained at AIIMS and now practicing privately in Gurgaon, stated that such an outbreak is rare in India. However, they do confirm 2-3 cases of GBS every month, so it is not entirely unheard of.

Dr Shehravat further explained that after the COVID vaccine, there was a rise in immune-related diseases, although these cases were rare. During that time, GBS was triggered in some younger individuals. However, she noted that there is no such connection in the current outbreak in Pune.

The GBS outbreak in Pune highlights the delayed recognition of the issue. Doctors explain that if GBS patients are treated late, it can be life-threatening, which may explain why two people died and others ended up on ventilators. Dr Sanjay Pandey said the situation becomes even more dangerous when the patient’s lungs are involved.

Dr Shehravat said that if patients are treated within two weeks, the outcomes are much better. The treatment typically involves IVIG injections (immune globulins), which are given for five days. The cost of each injection ranges from 10,000 to 12,000 rupees. Another treatment method is plasmapheresis, which involves blood purification.

She also explained that GBS diagnosis involves not only bacterial tests but also nerve conduction studies to determine the extent of nerve damage.

As soon as the first case of Campylobacter infection was detected, the water supply should have been immediately shut down, and clean water should have been provided. However, the large number of GBS patients in Pune indicates that the local authorities failed to take such actions.

Public health woes

Dr Jacob pointed out that in western countries, even the first three cases of GBS are considered an outbreak, and their public health systems promptly investigate the affected areas. In India, however, government hospitals are often treated as the sole public health response, leading to a conflict of interest where doctors are focused on patient treatment, not on tracing the sources of infection.

The public health management system is a crucial wing of healthcare; if a doctor makes an error in their investigation, it may cost one life, but a public health system failure could result in the loss of many lives.

Dr Jacob recalled the crisis during the COVID pandemic, when the National Disaster Management Agency (NDMA) was given responsibility for controlling the spread. He asked, “Where is the NDMA now, in the case of this outbreak in Pune?” He concluded that it shows how infections are mishandled due to the lack of a scientific public health system in the country.

Dr Shehravat confirmed that contaminated food and water are the source of infection in this outbreak in Pune. She noted that earlier, diseases like cholera and measles were common because of poor drinking water and sewage systems, but improvements have been made since. Yet, if such outbreaks are still occurring, it raises concerns.

She pointed out that many people are now eating out at crowded restaurants, where cleanliness is often compromised. This lack of hygiene will contribute to the spread of such infections in the future. She stressed that, for immunity protection, our primary goal should be access to clean food and safe drinking water.

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