Travel Medicine and Infectious Disease 39 (2021) 101905

Contents lists available at ScienceDirect

Travel Medicine and Infectious Disease

journal homepage: www.elsevier.com/locate/tmaid

Correspondence

Role of Zika virus infection in cases and outbreaks of Guillain-Barré syndrome in Latin America:
Pooling the prevalence of studies

A R T I C L E I N F O

Keywords
Guillain-Barré syndrome
Zika
Epidemiology
Latin America

Over the last years, specially during the outbreak of 2015–2016 in
Latin America, the role of Zika virus (ZIKV) infection in the upraising
numbers of Guillain-Barré syndrome (GBS), a rapid-onset muscle
weakness disease caused by the immune-mediated damage of the pe­
ripheral nervous system, has been questioned [1]. Recently, a review
included 32 studies Latin America [2], curiously although systematically
searched for them, descriptively reporting the main findings, did not
performed a meta-analysis, showing that from 1531 cases, in 368 ZIKV
was confirmed, yielding a crude value of 24%, however with a
random-effects modelling, pooled prevalence would be different. Here­
in, we used the data reported from those 32 studies and performed a
meta-analysis of the role of ZIKV in GBS cases in Latin America, from
2014 to 2019.
We used the Open Meta-Analyst software (Providence, RI). For the
random-effects model, we found that 33.9% of patients with GBS pre­
sented confirmed ZIKV infection (95%CI 24.4–43.4%) (Fig. 1). We
performed a subgroup meta-analysis for countries (with ≥2 studies),
showing that the higher prevalence of ZIKV among GBS cases, was re­
ported in studies from Brazil, 56.5% (95%CI 0.0–97.4%), from 5 studies
(n = 178), followed by Colombia, 56.3% (95%CI 21.8–90.7%), from 6
studies (n = 198), and Puerto Rico, 41.4% (95%CI 7.6–75.1%), from 7
studies (n = 137) (Fig. 1). Other countries have lower prevalences or
only one study performed. As in 2014, 2018, and 2019 there was only
one study, from 2015 to 2017, curiously those in 2017 reported the
highest, 62.1% (95%CI 32.8–91.4%), while those in 2015–2016 were
around 27.2–27.8% (95% 14.7–40.9%) (Fig. 1). For the whole study
period, a meta-regression confirmed that 2015 was the most significant
covariate (p < 0.001).
The systematic review [2], when calculated the global prevalence of
ZIKV among GBS cases (24%) significantly underestimated the value,
that after being meta-analyzed with a random-effects model showed
~34% (95%CI 24.4–43.4%). Then, although in many cases, ZIKV and
other infectious agents were not identified, the current analysis show a
more significant proportion of association, especially during the years of
the epidemic in the Latin American countries, 2015–2017.
Certainly, the etiological study of GBS is significant for public health
purposes [2], deserving serological assessment in those patients
presenting with this peripheral neurological alteration, especially in
endemic areas [3,4], or when returning from endemic areas, of ZIKV [5],
and also from other arboviruses (e.g. dengue, chikungunya) and other
endemic infectious agents that have been historically linked to GBS [1].
Contributions
Conception and design: AJRM, Data collection: JLBA, DKBA, Data
analysis: all authors, Writing: All authors. All authors contributed to and
approved of the final version submitted.
Funding
None.
Declaration of competing interest
None.
References
[1] Rodriguez-Morales AJ, Failoc-Rojas VE, Gastrointestinal Diaz-Velez C. Respiratory
and/or arboviral infections? What is the cause of the Guillain-Barre syndrome epi­
demics in Peru? Current status - 2019. Trav Med Infect Dis 2019;30:114–6.
[2] del Carpio Orantes L, Cerda Méndez CI, Jiménez García R, Garma García AN, López
Cabrera Y, Flores Salguero LS, et al. Síndrome de Guillain Barré asociado a los brotes
de Zika, de Brasil a México. 2020. Neurología Argentina.
[3] Bonilla-Aldana DK, Bonilla-Aldana JL, Garcia-Bustos JJ, Lozada CO, Rodriguez-
Morales AJ. Geographical trends of chikungunya and Zika in the Colombian
Amazonian gateway department, Caqueta, 2015-2018 - implications for public
health and travel medicine. Trav Med Infect Dis 2020;35:101481.
[4] Zambrano LI, Fuentes-Barahona IC, Soto-Fernandez RJ, Zuniga C, da Silva JC,
Rodriguez-Morales AJ. Guillain-Barre syndrome associated with Zika virus infection
in Honduras, 2016-2017. Int J Infect Dis 2019;84:136–7.
[5] Hamer DH, Barbre KA, Chen LH, Grobusch MP, Schlagenhauf P, Goorhuis A, et al.
Travel-Associated Zika virus disease acquired in the americas through february
2016: a GeoSentinel analysis. Ann Intern Med 2017;166:99–108.
Alfonso J. Rodríguez-Morales*
Public Health and Infection Research Group, Faculty of Health Sciences,
Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia

https://doi.org/10.1016/j.tmaid.2020.101905
Received 6 September 2020; Accepted 26 October 2020
Available online 1 November 2020
1477-8939/© 2020 Elsevier Ltd. All rights reserved.

Downloaded for Ida Bagus Gede Anom Sattwika Anom (anomsattwika@gmail.com) at University of Warmadewa from ClinicalKey.com by Elsevier on March 19, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
Correspondence Travel Medicine and Infectious Disease 39 (2021) 101905

Fig. 1. Random-effects model for the pooled prevalence of ZIKV infection among GBS patients. All the studies (upper panel), and subgroup analyses by countries
(middle panel), and by years (lower panel).

Downloaded for Ida Bagus Gede Anom Sattwika Anom (anomsattwika@gmail.com) at University of Warmadewa from ClinicalKey.com by Elsevier on March 19, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
Correspondence Travel Medicine and Infectious Disease 39 (2021) 101905

Grupo de Investigación Biomedicine, Faculty of Medicine, Fundación Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco,
Universitaria Autónoma de Las Americas, Pereira, Risaralda, Colombia Peru
Clinical Epidemiology and Biostatistics, Universidad Científica Del Sur,
Samuel Pecho-Silva
Lima, Peru
Clinical Epidemiology and Biostatistics, Universidad Científica Del Sur,
School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ),
Lima, Peru
Cochabamba, Bolivia
Pneumology Service, Hospital Nacional Edgardo Rebagliati Martins, Lima,
D. Katterine Bonilla-Aldana Peru
Public Health and Infection Research Group, Faculty of Health Sciences,
Juan Pablo Escalera-Antezana
Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ),
Semillero de Zoonosis, Grupo de Investigación BIOECOS, Fundación
Cochabamba, Bolivia
Universitaria Autónoma de Las Américas, Sede Pereira, Pereira, Risaralda,
National Responsible for Telehealth Program, Ministry of Health, La Paz,
Colombia
Bolivia
Jorge Luis Bonilla-Aldana
Grupo de Investigación en Ciencias Animales Macagual, Universidad de La *
Corresponding author. Clinical Epidemiology and Biostatistics,
Amazonia, Florencia, Caquetá, 180002, Colombia Universidad Científica Del Sur, Lima, Peru.;
Kovy Arteaga-Livias E-mail addresses: arodriguezm@utp.edu.co, ajrodriguezmmd@gmail.
Clinical Epidemiology and Biostatistics, Universidad Científica Del Sur, com (A.J. Rodríguez-Morales).
Lima, Peru

Downloaded for Ida Bagus Gede Anom Sattwika Anom (anomsattwika@gmail.com) at University of Warmadewa from ClinicalKey.com by Elsevier on March 19, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.