Central team focuses on source, diagnosis amid GBS cases surge

The seven-member central team deployed to assist the state government in managing cases of Guillain-Barre Syndrome (GBS) is looking at the diagnosis itself, and also tracking the source that may be triggering the syndrome, according to people familiar with the matter.

Currently, at least 100 individuals are suspected to have developed GBS in Maharashtra, largely in Pune, but the team plans to review the clinical data of all patients to cross-check the diagnosis -- there are concerns that at least some may have been mis-diagnoised -- and also look at their history over the past few weeks to establish the source.

“Focus is largely on two things: one is the case definition wherein normal diarrhoea and gastroenteritis cases will be separated from actual GBS cases by looking at the clinical data extensively; and (two), piecing together events of past two to six weeks to know the cause that led to GBS as the infection usually triggers the symptoms,” said a senior official aware of the matter, requesting anonymity.

GBS is a rare autoimmune condition in which the immune system attacks the peripheral nerves. It leads to symptoms such as numbness, tingling, and muscle weakness that can, in many cases also lead to muscular paralysis. It is sometimes triggered by bacterial infections.

According to US Center for Disease Control , a surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions.

On the sidelines of a media briefing on Tuesday, director general of the Indian Council of Medical Research (DG-ICMR), Rajiv Bahl, said that the central team had begun investigating the cases and is collecting samples extensively for laboratory testing.

“The samples are being collected that includes stool, blood, and even water samples for elaborate testing. The answers cannot be expected overnight as this is going to be an elaborate process. The infection precedes symptoms by two to six weeks, which will require the experts to piece the entire thing for such a long period to get to the source of the trigger. It is going to be largely circumstantial,” he said.

He added that normally also the link is found in around 40% of the cases. Campylobacter jejuni bacteria was found in four stool samples that were collected from 21 GBS patients in Pune, which were tested by ICMR-National Institute of Virology (NIV), Pune, while norovirus was found in some other samples. Both have been known to trigger GBS, but do not cause it. The other infections that generally precede GBS have not been identified among the patients so far.

The Union ministry of health and family welfare’s seven-member central team that has been deployed to assist the Maharashtra government comprises experts from the National Centre for Disease Control, Delhi, National Institute of Mental Health and Neuro-Sciences (NIMHANS) Bengaluru, Regional Office of Health and Family Welfare and NIV, Pune. Three experts from NIV, Pune were already supporting the local authorities, according to the health ministry’s statement.

The team is working closely with the state health department and taking stock of the on-ground situation to recommend necessary public health interventions. The central team has been tasked with monitoring the situation and coordinating with the state.

Private practitioners in Pune have been asked to notify the state of suspected GBS cases, and a general advisory has also been issued to the public to boil water, eat fresh food, and to keep cooked and raw food items separately.

Maharashtra reported its first suspected death linked to the syndrome from Solapur, while the number of suspected and confirmed cases together of the immunological nerve disorder in Pune has crossed 100.