GUILLAIN BARRE SYNDROME (GBS) from Vajirao & Reddy Institute

GUILLAIN BARRE SYNDROME (GBS)

• Outbreak Context: Pune has been facing a significant outbreak of Guillain-Barré Syndrome (GBS), with over 100 suspected cases
• This rare autoimmune disorder involves the immune system attacking the peripheral nervous system, leading to symptoms like muscle weakness, numbness, and in severe cases, paralysis.
• Bacterial Link: The outbreak is linked to Campylobacter jejuni, a bacterium commonly associated with contaminated food and water. Campylobacter jejuni was identified as the primary cause of the first cluster of GBS cases.
• Preliminary Symptoms: Patients often exhibited gastrointestinal symptoms, including vomiting, diarrhoea, nausea, and gastroenteritis, before the onset of the neurological symptoms associated with GBS.
• Fatality: One suspected fatality has been recorded among those affected, highlighting the severity of the outbreak.

• GBS is a rare autoimmune disease in which the immune system mistakenly attacks the peripheral nervous system, leading to tingling, muscle weakness, and numbness. If severe, it can cause paralysis in the arms and legs.
• Causes: It can be triggered by viral or bacterial infections, including Campylobacter jejuni, as well as Zika virus, cytomegalovirus, and influenza.
• Symptoms:
  • Early signs include tingling or numbness in the fingers or toes.
  • Muscle weakness often progresses to paralysis in severe cases.
  • Other symptoms can include difficulty breathing, blurred vision, and muscle pain.
• Incidence: The global incidence of GBS is approximately 1-2 cases per 100,000 people, with a slightly higher occurrence in adult males.
• Recovery: Most GBS patients recover with appropriate treatment, but recovery can be slow, and some may experience lasting effects.

• Source of Contamination: The outbreak in Pune is linked to waterborne contamination, specifically from the bacterium Campylobacter jejuni, which is typically found in uncooked food and contaminated water. This highlights an underlying issue with the safety of water supply in the affected areas.
• Health System Weakness: The outbreak emphasizes the vulnerability of urban systems and the fragility of infrastructure in preventing the spread of waterborne pathogens. Inadequate water treatment, maintenance lapses, or poor surveillance can allow such pathogens to spread, affecting large populations.
• Affected Areas: Areas along Sinhagad Road have seen a rise in GBS cases, and the situation underscores the need for stronger public health measures and water safety protocols.

• Treatment Methods:
  • Plasma exchange (also called plasmapheresis) and intravenous immunoglobulin (IVIG) therapy are the standard treatments for GBS.
  • These treatments are most effective when started early, within two weeks of symptom onset.
• Recovery: Most patients recover with appropriate treatment, but the recovery process can vary from a few weeks to several months, depending on the severity.
• Importance of Early Detection: Since GBS progression can lead to severe complications such as respiratory failure, early detection and timely intervention are essential for reducing morbidity and mortality.

• Surveillance and Water Sampling: Rapid response teams have been deployed in Pune to conduct extensive water sampling and community surveillance. This is essential for identifying contamination sources and preventing further spread.
• Central Assistance: A central team from the Union Government has also been sent to assist local health authorities in managing the situation and containing the outbreak.
• Health Awareness Campaign: There has been an emphasis on public health messaging, urging residents to avoid contaminated water and practice better hygiene to reduce the risk of infection.
• Prevention of Further Outbreaks: The outbreak demonstrates the urgent need for consistent monitoring of water quality and ensuring that appropriate measures are in place for safe drinking water and food hygiene.

• Need for New Water Treatment Plant: To address the growing demand for clean water in areas like Sinhagad Road, Vadgaon Budhruk, and surrounding villages, the Pune Municipal Corporation (PMC) has proposed the construction of a new water treatment plant.
• Project Details:
  • The proposed plant will have a 125 MLD
  • Estimated cost: Rs 207 crore.
  • The project is part of the AMRUT 2.0 scheme, aimed at urban rejuvenation and improving infrastructure.
• Approval Pending: The proposal has been pending approval from the Union Government for over a year. The local civic body is awaiting approval from the Ministry of Housing and Urban Affairs.
• Intended Impact: The new plant will provide clean water to areas like Narhe, Dhayari, Ambegaon Khurd, and others, which have seen a rise in population due to the merger of new villages into the PMC limits in 2021.

• Additional Treatment Plant for GBS-Affected Areas: The PMC has proposed building a separate water treatment plant near Khadakwasla Dam to cater to areas directly impacted by the GBS outbreak, including Nanded, Nandoshi, Kirkatwadi, and Khadakwasla.
• Land Acquisition: The PMC is working with the Irrigation Department to acquire the necessary land for this project, ensuring a quicker response to the growing water demand and contamination issues in the affected areas.
• Decommissioning of Old Infrastructure: The 54-year-old Parvati water treatment plant is being demolished due to leakage and insufficient capacity. A new plant is planned to replace it, with interim water supply from the Warje water purification plant located 10 km away.

• Urban Water Infrastructure: There is a need for consistent investment in urban water infrastructure to ensure safe drinking water and avoid contamination-related outbreaks. This includes regular monitoring and updating of water purification systems.
• Public Health Awareness: Local authorities should increase efforts in public health education to raise awareness about avoiding waterborne diseases and the importance of good hygiene in preventing outbreaks.
• Governance and Accountability: Local and state governments must be proactive in addressing infrastructure shortcomings and ensuring timely maintenance and upgrades to urban water systems.