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WHO: GBS cases in US, microcephaly in Cape Verde possibly linked to Zika
WHO officials are investigating whether two patients in the United States with confirmed Zika virus infection also developed Guillain-Barré syndrome and whether the first reported case of microcephaly in Cape Verde is linked to the country’s Zika virus outbreak that began last year.
According to WHO, nine countries have reported an increase in Guillain-Barré syndrome (GBS) cases or laboratory-confirmed Zika virus infection in GBS cases. Previously, only two countries — French Polynesia and Brazil — reported cases of microcephaly linked to Zika.
US reports two cases of GBS
On March 10, WHO was notified of two possible GBS cases in the United States. The first case is an elderly male resident of the United States who recently traveled to Central America, according to WHO. After his return, the patient developed acute febrile illness and was hospitalized in January with progressive ascending weakness of the extremities and weakened reflexes. PCR testing revealed the patient had Zika virus infection, and his symptoms began to improve after treatment. Before hospital discharge, however, he experienced a sudden subarachnoid hemorrhage due to a ruptured aneurysm and died.
The second patient is a male resident of Haiti who traveled to the U.S. in January to seek medical attention for facial weakness, difficulty swallowing and numb fingers. An examination of cerebrospinal fluid showed the patient had elevated protein and normal white blood cells. The patient tested positive for Zika virus infection and was discharged after clinical improvement with IV immunoglobulin.
“This is the first time that a country with no vector-borne transmission of Zika virus detects patients with concomitant GBS and Zika virus infection,” a WHO press release said. “These cases provide additional evidence of a possible causal relationship between Zika virus and GBS.”
WHO said it is likely that countries reporting autochthonous Zika virus transmission will have an increase in GBS cases; however, investigations are needed to better understand the pathogenesis of GBS and whether the reported increases are due to enhanced surveillance.
First microcephaly case reported in Cape Verde
In addition to the GBS cases, WHO also was notified of the first documented case of microcephaly in Cape Verde, where an ongoing Zika virus outbreak was detected in October. As of March 6, officials reported that 7,490 individuals were suspected to have Zika virus infection, including 165 pregnant women. Of the pregnant women, 44 delivered babies with no complications or abnormalities, according to WHO.
In response to the recent case, WHO has employed a team of epidemiologists, laboratory experts, maternal health specialists and communication staff to determine whether the case is linked to Zika virus infection during pregnancy, and to assess they dynamics of the outbreak. WHO officials will identify gaps and support the country’s outbreak response and investigations.