The National Center for Epidemiology, Prevention, and Disease Control of Peru (the equivalent of our Centers for Disease Control and Prevention) issued an epidemiological alert on June 26, 2023, due to an unusual increase in Guillain-Barré Syndrome cases. Preliminary clinical cases indicate as many as 130 illnesses reported between June 10 and July 15, 2023, with 94 cases showing progression to severe symptoms of paralysis and long-term side effects.
Guillain-Barré Syndrome is a serious complication of Campylobacter infection, or campylobacteriosis. This type of infection is caused by exposure to the pathogenic bacteria, Campylobacter often associated with meat, milk, fruits, and vegetables.
Humans become exposed to Campylobacter by consuming contaminated foods or drinks. These food products can become contaminated in many different ways.
Certain livestock such as chicken, turkey, cows, and others can be infected with Campylobacter bacteria without showing any outward signs of illness. This bacteria lives in the intestines, liver, and other organs of the animals and can be transferred to the meat products inadvertently during slaughter.
This bacterium is extremely common in chicken. One National Antimicrobial Resistance Monitoring System (NARMS) study in 2015 found Campylobacter on 24% of the raw chicken purchased from retailers.
Cooking chicken to an appropriate internal temperature of 165°F is effective at killing Campylobacter present in potentially contaminated chicken.
Milk can become contaminated with Campylobacter when a lactating cow has a Campylobacter infection. This can happen when the infection is in the udder or when milk is contaminated with manure.
The pasteurization process is effective at killing Campylobacter present in potentially contaminated milk.
Fruits and vegetables can become contaminated through contact with soil or water containing feces from Campylobacter infected animals such as cows, birds, or other animals. Lakes and streams that are used for irrigation can become contaminated with infected feces, transferring the bacteria to the food products.
Washing or scrubbing fruits and vegetables or disinfecting untreated drinking water helps but cooking to at least 165 °F is the best solution.
Someone with Guillain-Barré Syndrome will often begin with symptoms of Campylobacter infection. Guillain-Barré Syndrome symptoms begin to progress when the bacteria leave the digestive system and spread to the bloodstream and other parts of the body.
Bloody diarrhea is a common symptom of Campylobacter infection. Nausea and vomiting may accompany the diarrheal symptoms in addition to fever and stomach cramps.
Symptoms usually begin around two to five days after exposure to Campylobacter bacteria and generally lasts about a week. Some people experience more severe complications. About 5 to 20% of those with Campylobacter infection develop a long-term health condition known as irritable bowel syndrome. About 1 to 5% will develop arthritis. Around 1 in every 1,000 reported infections leads to a severe complication known as Guillain-Barré Syndrome.
Most people recover from Campylobacter infection without medical intervention. Rest and hydration are key to recovery. However, more severe cases may need antibiotic treatment.
Guillain-Barré Syndrome happens when a person’s own immune system attacks their body’s nerves. This results in muscle weakness and potential paralysis. Early symptoms include weakness and tingling, often beginning in the legs and then moving to the arms and upper body. This weakness can become so severe that people can become paralyzed.
These symptoms can progress in as little as a few hours to as many as several weeks, though most people often recover around 2 to 3 weeks after the start of symptoms. While most fully recover from the illness, some experience permanent nerve damage or even die from Guillain-Barré Syndrome.
Common treatment of Guillain-Barré Syndrome involves specialized infusions.
One type is called a plasma exchange. This is a procedure where the liquid part of the blood (plasma) is removed and replaced with healthy plasma.
Another type is called high-dose immunoglobulin therapy. This is an infusion of antibodies designed to help fight the illness.
The unusual rise in cases prompted the Presidency of the Republic of Peru to declare a “National Health Emergency” in early July 2023 to increase and enhance the implementation of public health responses.
As of the last update on July 25, 2023, the cause of the unexpected outbreak is unknown and remains under investigation.
A significant rise in cases between weeks 23 (June 10, 2023) and 28 (July 15, 2023) prompted action. Most of the cases are reported in 7 of the country’s 24 departments, including Lima and Callao (75 cases), La Libertad (39 cases), Piura (21 cases), Lambayeque (20 cases), Cajamarca (17 cases), Junín (12 cases), and Cusco (10 cases). Of the 130 cases suspected, 100 have been confirmed compatible with Guillain-Barré Syndrome, including 4 deaths.
So far, the outbreak has hit adult males over 30 years old the hardest as 158 suspected Campylobacter illnesses were adults over 30 and more than half of the reported cases were males.
This is not Peru’s first Guillain-Barré Syndrome outbreak. Another unprecedented outbreak of Guillain-Barré Syndrome happened in 2019 where there were ultimately about 700 reported cases of the complication.
This five-week period (23 to 28) shows a dramatic rise in monthly case count when compared to the past few years. Take a look at the figure below.
Figure 1. Guillain Barré Syndrome case trends in Peru 2021, 2022 and 2023 (Epidemiological week 28)
Source: National Center for Epidemiology, Prevention and Disease Control (CDC) Peru-Peru. The situation of Guillain Barré syndrome -Peru, 2023 (Epidemiological Week 28)
The red line represents cases by week for the 2021 year. The line is fairly low with an average of about four cases per week. The green line represents that same data for the 2022 year. This too averages about four cases a week. The blue line represents the 2023 year. The beginning of the year averages looks on par with previous years; however, this changes at week 23. This extreme spike shows a dramatic rise in cases.
In response to this ongoing outbreak, The Ministry of Health agency of National Center for Epidemiology, Prevention, and Disease Control of Peru issued an epidemiological alert on June 26, 2023, and continues monitoring the situation.
The Health Emergency decree allows for the implementation of an action plan and allows for certain resources to be allocated to respond to this emergency. An unusual rise in cases taxes hospitals. Additionally, treatment protocols require specific medications not typically available in these numbers.
The action plan includes financing for the increased surveillance, prevention, and response actions as well as increased messages to health professionals and the general public with information to help prevent the spread of illness. It also entails the acquisition of a large supply of human immunoglobulins used for treatment of patients with Guillain-Barré Syndrome.
The World Health Organization (WHO) is also supporting health authorities of Peru in managing this crisis.
The WHO has issued the following advice for Peru Member States
The WHO has not issued any travel and/or trade restrictions in response to this event at this time.
Campylobacter and Guillain-Barré Syndrome can be scary illnesses. If you have questions, related to your Campylobacter or Guillain-Barré Syndrome illness, contact the experienced team at The Lange Law Firm, PLLC for a free consultation. Call (833)330-3663 or email here to get answers about your illness.
By: Heather Van Tassell
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