Prevalence of Guillain-Barré syndrome among Zika virus infected cases: a systematic review and meta-analysis

Abstract

Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI=1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected.

Keywords: Arboviruses; Emergent diseases; Epidemiology; Guillain-Barré syndrome; Zika virus.

Fig. 1

Flowchart of studies selected for full-text review and inclusion on the meta-analysis.

Fig. 2

Forest plot of the prevalence of GBS associated with ZIKV infection. The plot displays pooled sample size (164,651 ZIKV-infected individuals), individual prevalence estimates by each study, pooled prevalence estimate (fixed effects model), the corresponding 95% confidence intervals, study weighting (fixed effects model) and sample size heterogeneity measures and Cochran's Q test for heterogeneity p-value.