Guillain-Barré syndrome as a cause of acute flaccid paralysis in Iraqi children: a result of 15 years of nation-wide study

Abstract

Background: Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis (AFP) in the post-poliomyelitis eradication era. This is the first study done to identify the epidemiology, clinical features, and outcome of GBS in Iraqi children over 15 years.

Methods: The surveillance database about AFP cases < 15 years reported during January 1997-December 2011 was used.

Results: GBS represented 52.5% of AFP cases, with an incidence of 1.33 case/100,000 population < 15 years/year. There was a higher incidence in the Southern provinces, age group 1-4 years, males, and outside the capital city of province, with no significant seasonal variations (p = .22). Survival probability after the 1 year of onset for those with respiratory muscle involvement was .76 (95% CI: .60-.86), versus .97 (95% Cl: .96-.98) for those who did not develop it (p < .001); and .97 (95% CI: .96-.98) for those living inside the capital city, versus .94 (.93-.95) for those living outside (p = .001). Cumulative incidence of residual paralysis for patients living inside the capital city was .21 (95% CI: .18-.24), versus .27 (95% CI: .25-.29) for those living outside (p < .001).

Conclusions: The incidence, age and gender distribution, and seasonality of GBS among Iraqi children is similar to those reported from other previous studies. It is the most important cause of AFP, especially in those between the age of 1 to 4 years living in rural areas.

Figure 1

Incidence of Guillain-Barré syndrome per province, Iraq, 1997–2011.

Figure 2

Number of cases with Guillain-Barré syndrome per age group, Iraq, 1997–2011.

Figure 3

Number of cases with Guillain-Barré syndrome per month, Iraq, 1997–2011.

Figure 4

Cumulative survival of cases with Guillain-Barré syndrome based on history of respiratory muscle paralysis, Iraq, 1997–2011.

Figure 5

Cumulative survival of cases with Guillain-Barré syndrome based on their household location within the province, Iraq, 1997–2011.

Figure 6

Cumulative incidence of residual paralysis among cases with Guillain-Barré syndrome, Iraq, 1997–2011.

Figure 7

Cumulative incidence of residual weakness among cases with Guillain-Barré syndrome based on their household location within the province, Iraq, 1997–2011.