Q&A Interview with Dr Amit Dias
The surge in cases of Guillain-Barré Syndrome (GBS) in Pune and Maharashtra has left many alarmed, raising urgent questions about its cause, symptoms, and preventive measures. What’s behind this mysterious paralysis, and how can we protect ourselves? To shed light on the situation, we speak with Dr Amit Dias, who emphasizes, “Knowledge is the best medicine, and prevention is its strongest dose.” In this interview, he breaks down the complexities of GBS, and provides essential advice on staying vigilant and safe.
Goan Observer: Dr Dias, thank you for joining us. There is growing concern over the recent outbreak of Guillain-Barré Syndrome (GBS) in Pune and Maharashtra. Can you start by explaining what GBS is?
Dr Amit Dias: Guillain-Barré Syndrome (GBS) is a relatively rare but serious autoimmune disorder where the body’s immune system mistakenly attacks the peripheral nervous system. This leads to muscle weakness, tingling sensations, and, in severe cases, paralysis. While the exact cause is unknown, GBS is often preceded by infections, such as viral or bacterial illnesses, which trigger an abnormal immune response.
According to a current update, there are over 200 cases, of which, 42 are from the Pune Municipal Corporation (PMC), 94 from the villages in the PMC area, 32 from neighboring Pimpri Chinchwad Municipal Corporation, 33 from Pune’s rural parts and 10 from other districts. A total of 139 patients have been discharged so far, while 39 are in the Intensive Care Unit (ICU) and 18 others on ventilators. 11 have succumbed to GBS and they are not all old people.
Q: Is it a new disease?
A: No, it’s identified over a 100 years ago, but it has been described earlier. The condition is named after the French neurologists Georges Guillain and Jean Alexandre Barré, who along with André Strohl, first described the condition in 1916. They noticed soldiers experiencing muscle weakness and identified the characteristic increase in cerebrospinal fluid protein levels, which helped distinguish GBS from other neurological disorders.
Q: What are the early symptoms people should look out for?
A: As I mentioned, the early symptoms of GBS include tingling or numbness in the fingers and toes, muscle weakness that typically starts in the legs and progresses upward, severe lower back pain, difficulty walking or climbing stairs, and, in some cases, loss of bladder control. We call it the ascending paralysis. In severe cases, patients may experience difficulty breathing, facial paralysis, or complete paralysis. These symptoms require immediate medical attention, as early intervention can significantly improve outcomes.
Q: Why does GBS occur, and what could be triggering this outbreak in Pune?
A: GBS is usually triggered by an infection, such as respiratory or gastrointestinal infections. Common pathogens linked to GBS include Campylobacter jejuni, Zika virus, and Epstein-Barr virus. In rare cases, certain vaccines have also been associated with GBS. The outbreak in Pune is suspected to be linked to contaminated drinking water, with reports indicating the presence of drainage water in the water supply. However, further epidemiological and environmental investigations are needed to confirm the exact cause.
Q: Have there been similar outbreaks reported elsewhere?
A: Not frequently, but yes, there have been notable GBS outbreaks globally. For instance, in June–July 2023, Peru reported an unusual surge in GBS cases, with 130 suspected cases, of which 44 were confirmed. The regions of Peru, with Lima and La Libertad were the most impacted. Historically, Peru recorded fewer than 20 suspected cases per month nationwide. The suspect was infection with Campylobacter jejune, the same organism being implicated in the Pune outbreak.
Another significant outbreak that I know of, occurred in the United States in 1976 during a swine flu vaccination campaign, where an unexpected increase in GBS cases led to the suspension of the program. More recently, during the COVID-19 pandemic, there were concerns about a potential link between SARS-CoV-2 infection and GBS, though studies have not established a definitive causal relationship. These outbreaks highlight the importance of monitoring and investigating potential triggers.
Q: Has the World Health Organization (WHO) intervened in this outbreak?
A: Yes, the WHO is actively supporting health authorities in Pune and Maharashtra. They are collaborating with the Pune Municipal Corporation and state officials to enhance case detection, diagnosis, and treatment. The disease surveillance system is stepped up. WHO teams are also assisting in epidemiological analysis by creating spot maps to visualize case distribution and epidemic curves to monitor the outbreak’s progression.
Q: How is GBS diagnosed?
A: Diagnosing GBS involves a combination of clinical evaluation and diagnostic tests. Doctors assess the patient’s symptoms and medical history, particularly recent infections. As I mentioned, they look for ascending paralysis. The key diagnostic work up includes:
Nerve conduction studies and electromyography (EMG): To evaluate nerve function and detect abnormalities.
Lumbar puncture (spinal tap): To check for elevated protein levels in cerebrospinal fluid, a hallmark of GBS.
Imaging tests like MRI: To rule out other neurological conditions.
Q: What are the treatment options for GBS?
A: That would depend on how the person presents. While there is no cure for GBS, treatment focuses on managing symptoms and accelerating recovery and keeping the person alive. The primary treatments include:
Intravenous Immunoglobulin Therapy (IVIG): High doses of antibodies from healthy donors help neutralize the immune attack on the nerves.
Plasma Exchange (Plasmapheresis): This procedure removes harmful antibodies from the blood to slow disease progression.
Supportive care: Patients with respiratory muscle weakness may require ventilator support. Physiotherapy is crucial for regaining muscle strength and mobility.
Q: What advice would you give to someone living with GBS?
A: Recovery from GBS can be a long process, often taking months to years.
This is what the patients should consider:
Regular physiotherapy to regain their mobility and strength.
Emotional support through counseling or support groups.
Breathing exercises if respiratory muscles are affected.
Assistive devices like wheelchairs or walkers as needed.
Follow up with their doctor for regular monitoring and rehabilitation.
Q: How can people prevent Guillain-Barré Syndrome?
A: While GBS itself is not contagious, preventing infections that may trigger it is the key.
Here is what people could do:
- Drink only boiled or purified water.
- Maintain good hygiene by washing hands regularly.
- Cook food thoroughly and avoid consuming street food.
- Adopt a healthy lifestyle with a balanced diet and sufficient sleep.
- Get vaccinated appropriately, while being aware of rare risks.
Q: Finally, what message would you like to give to the public regarding this outbreak?
A: The rising number of GBS cases in Pune is of concern, but early detection and timely medical intervention can greatly improve outcomes. There is no need to panic, but it is necessary to be aware. People should stay informed, take preventive measures, and seek immediate medical help if they notice symptoms. Awareness, proactive healthcare, and collaboration between health authorities and the community are the key to managing this crisis effectively. After all, knowledge is the best medicine, and prevention is its strongest dose!
