A question of hygiene: On the Guillain-Barré Syndrome outbreak in Pune.

The GBS outbreak in Pune reveals the fragility of its urban systems.

 At the heart of the current Guillain-Barré Syndrome (GBS) outbreak in Pune, where over 100 cases of suspected GBS have been recorded, is a bacterial infection. A health investigation has revealed Campylobacter jejuni, a bacteria found in contaminated food and water, to be behind the first cluster of cases. In almost all the patients, recent case history has shown episodes of gastroenteritis, vomiting, diarrhoea and nausea before the onset of the characteristic peripheral numbing of GBS, leading to paralysis. One case of death due to suspected GBS has also been recorded — of a patient who had visited Pune. This outbreak reveals the fragility of the scaffolding that urban systems in India are built on, with pathogens managing to breach all safety nets that humans have built for themselves, to emerge through and cause havoc. Any slip up in maintenance or in surveillance, clearly leads to discomfort, ill health and debility for a large number of people. GBS is a rare, autoimmune neurological disorder, in which a person’s immune system launches an attack on the peripheral nervous system, leading to tingling, weakening of muscles, numbing and paralysis in the arms and legs, not unlike in the acute flaccid paralysis of polio. It can be caused by viral or bacterial pre-infections, as per the World Health Organization (WHO). Globally, it is estimated that GBS has an incidence of 1-2 per 1,00,000 population, and is more predominant among adult males. While India-specific large epidemiological studies on GBS are lacking, as testing for GBS in a resource-poor setting is difficult, according to a WHO report (1993), it was estimated that 138 cases of GBS were seen annually in seven major teaching hospitals, with approximately 75% of cases occurring in adults. While studies across the world have shown numbers to rise in seasons of weather change, it is possible that this is India’s largest outbreak in recorded history.

Patients are treated with plasma exchange or intravenous immunoglobulin therapy, and most recover. However, these treatments are most effective if started within two weeks of the first symptoms, making early detection and initiation of treatment absolutely crucial. Rapid response teams in Pune are in place, collecting water samples and mounting surveillance on the community, and a central team has also been rushed to affected areas. It is key to ensure that all measures are in place to pick up patients, and initiate treatment as soon as possible. It is the duty of the local and State governance to provide clean drinking water to all residents and ensure that adequate social messaging is provided periodically on avoiding contaminated, unhygienic food.