GBS in parts of Maharashtra: Likely reasons for disease's outbreak

Infected water source likely the reason for rare neurological condition, say doctors

(This report has been updated)    Maharashtra has reported two suspected deaths and 130 suspected cases of a rare neurological condition Guillain-Barré Syndrome (GBS), while other parts of the country seem to be relatively insulated. That is barring West Bengal where doctors suspect GBS to be the underlying cause of illness in some children.

 

Why is it that Maharashtra, particularly Pune, is witnessing an ‘outbreak’?

 

GBS cases

 

Infected water is the likely reason why Pune and some other places in Maharashtra are witnessing suspected cases, according to experts.

 

Seasonal peaks in the incidence of GBS cases has been well documented in India with a surge in cases around autumn, said Dr Nikhil Jadhav, consultant – neurology at Fortis Hospital in Mulund, Mumbai. “The only thing unusual about the current outbreak in Pune is the geographic clustering of cases which might be due to exposure of a large population to a common infected water source,” he said.

 

Jadhav felt that clinical examination by an expert is the key to early diagnosis. Patients who receive treatment within five to seven days of symptom onset generally have good long-term outcomes.

 

Another reason could be that the pathogen causing the current outbreak might be a mutated variant, and has not been previously encountered by the local population.

 

Dr Ashish Gosar, a neurologist at Saifee Hospital in Mumbai, said that GBS cases could increase if a new viral strain has mutated and spread to Maharashtra.

 

"Every time a person is exposed to this virus, the immune response that the body mounts is very strong. This virus likely has some antigenic mimicry with the body, which is why we are seeing more cases of GBS in this geographical area," said Dr. Gosar.

 

What is GBS

 

GBS is a rare but serious inflammatory condition that affects the nerves. It typically follows a gastrointestinal or respiratory infection where the body’s immune system produces antibodies to fight the infection. The antibodies may then mistakenly attack the body’s own nerves, leading to progressive weakness, often starting in the limbs and potentially involving respiratory muscles.

 

Dr Manish Chhabria, a senior consultant in neurology at Sir H N Reliance Foundation Hospital, said GBS is usually triggered by bacterial infections, such as Campylobacter jejuni, which can spread through contaminated water. Respiratory infections have also been known to cause GBS.

 

"Although we are seeing rising cases in Maharashtra, it is important to note that GBS can occur anywhere. It usually presents itself a few days or weeks after a primary infection has subsided," said Chhabria. 

As such experts highlighted that reasons behind the Pune outbreak can  involve multiple factors. 

 

“Cases of Guillain-Barré Syndrome (GBS) in Pune have been rising, particularly following outbreaks of dengue. GBS is an autoimmune disorder where the body’s immune system mistakenly attacks peripheral nerves, often triggered by infections such as viral or bacterial illnesses. There is a noticeable pattern where these viral infections, especially dengue, seem to trigger immune responses that can lead to GBS. While Pune’s unpredictable monsoons increase mosquito populations and the risk of such infections, the rise in GBS cases is a broader concern across many regions. Hence, it is crucial to strengthen vector control efforts and improve early diagnosis to manage the condition before it becomes severe," said Dr Pankaj Verma, senior consultant, internal medicine, Narayana Hospital, Gurugram. 

In West Bengal, several children have been diagnosed with GBS. One case involved a 17-year-old student from North 24 Parganas who died from septic shock and myocarditis, with doctors suspecting GBS as an underlying cause. Two other children, aged seven and eight, are on ventilators in Kolkata. One of them is showing slight improvement after weeks of intensive care.

 

Preventive measures for GBS infection include boiling water before drinking, avoiding stale or uncovered food, and practicing basic hygiene such as washing hands regularly.

 

Public health officials have urged people to remain vigilant and consult a health care provider if they experience symptoms such as muscle weakness, especially following a recent infection.

 

 

 

At a glance

 

● 130 suspected patients and 2 suspected deaths of GBS have been found until now. Of these 72 are diagnosed as confirmed GBS cases.

 

● 25 patients are from Pune MC, 74 from newly added villages in PMC area, 13 from Pimpri Chinchwad MC, 9 from Pune Rural and 9 are from other districts.

 

● 20 out of these are currently on ventilators.   

Measures implemented until now in Maharashtra

 

 o A state-level rapid response team visited to the affected area immediately

 

o Pune MC and rural district authorities have been instructed to increase surveillance activities.

 

o 121 stool samples were sent to NIV Pune.

 

o A total of 200 blood samples have been sent to NIV.

 

  o 144 Water samples from different parts of the city have been sent for chemical and biological analysis to the Public Health Laboratory, samples from 8 water sources found contaminated.

 

o An appeal has been made to the private medical practitioners to notify any GBS patient to the respective public health authorities.

 

o In house-to-house surveillance activities, total 52283 houses covered. 

Guidance for citizens

 

o Care should be taken to keep the water quality good. For example, drinking boiled water  o Food should be fresh and clean

 

o Do not eat stale food and partially cooked food (Chicken or mutton)