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 The World Health Organization last month predicted that Zika would
spread to all countries in the Americas except for Canada and Chile.
"Right now we're focusing on Puerto Rico, where we've just started
seeing cases of Zika as well as cases of Guillain-Barre syndrome,"
Dr. James Sejvar, a neuroepidemiologist at the CDC, told Reuters in
an interview.
"In order to get ahead of the curve, we're going to try to rapidly
establish active surveillance for Guillain-Barre in Puerto Rico in
the hopes that we're catching the outbreak early."
On Feb. 5, the government of Puerto Rico declared a state of
emergency as confirmed Zika cases climbed to 22.
In addition to thousands of cases of birth defects in Brazil thought
to be linked to Zika, health officials have noted a significant
increase in Guillain-Barre, a rare syndrome in which the body's
immune system attacks part of the nervous system. It usually occurs
a few days after exposure to a virus, bacteria or parasite.
 Guillain-Barre causes gradual weakness in the legs, arms and upper
body, and in some cases, total paralysis.
The World Health Organization declared the Zika outbreak an
international health emergency on Feb. 1, largely based on evidence
linking Zika to pregnancy and the birth defect known as
microcephaly, marked by a small head size and underdeveloped brains.
But the WHO is also studying increased cases of Guillain-Barre.
Sejvar recently did a retrospective study of Guillain-Barre in
Brazil, looking at cases that occurred six months earlier.
In that study, researchers enrolled 41 patients who developed
Guillain-Barre Syndrome, and 85 people of similar ages who did not
develop the disorder.
They found "an unexplained higher incidence in relatively younger
individuals," Sejvar said, striking individuals in their 40s,
although older individuals were the largest group to develop the
disorder.
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Most studies of Guillain-Barre have suggested that by six months,
over half of patients would have recovered. But in the Brazil study,
nearly 85 percent of the patients with Guillain-Barre still had
motor deficits or weakness.
More studies will be needed to say whether these trends can be
generalized to other regions, he said.
The study in Puerto Rico will be prospective, a more rigorous
investigation that gathers information at the beginning of an
illness and compares outcomes to similar individuals who did not
develop Guillain-Barre.
The hope is to "quickly identify" cases of Guillain-Barre and enroll
them in the study, Sejvar said.
That helps in terms of collecting blood samples and spinal fluid
while patients are acutely ill. It also gives researchers a better
idea of the clinical characteristics in cases of Guillain-Barre that
follow a Zika infection.
Sejvar said it is possible that Puerto Rico will not have a large
outbreak of Zika, but based on what has happened in Colombia and El
Salvador, where the virus has begun spreading and cases of
Guillain-Barre have emerged, he said there is a potential that
Puerto Rico could have a large outbreak.
If that does occur, he said, the study "would add more strength to
this idea that Zika is somehow related to the development of
Guillain-Barre."
(Reporting by Julie Steenhuysen; Editing by Bernard Orr)
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