Guillain-Barré syndrome – Panama
On 15 March 2016, the National IHR Focal Point of Panama informed PAHO/WHO of a case of Guillain-Barré syndrome (GBS) with concomitant Zika virus infection.
The case is a 13-year-old female who developed febrile illness on 19 February. On 29 February, she experienced weakness in lower extremities. On 3 March, she presented to a hospital in Panama City with areflexia. Further testing revealed Zika virus infection was detected by reverse transcription polymerase chain reaction (RT-PCR) and elevation of proteins in cerebrospinal fluid and urine – results of the tests were obtained on 12 March. The patient is responding well to treatment.
Public health response
Health authorities in Panama have implemented the following measures:
- strengthening vector control activities and eliminating mosquito breeding sites;
- disseminating information about the disease and preventive measures to the community, general practitioners and public health professional;
- preparing health services for GBS case management.
WHO risk assessment
This is the first case of GBS with confirmed Zika virus infection in Panama. Other countries in the Region of the Americas have reported cases of Zika virus infection among GBS patients. It is likely that, in the coming months, further similar cases will be recorded in countries that are currently reporting autochthonous Zika virus transmission.
All these cases provide additional evidence of an association between Zika virus infection and GBS. Nevertheless, further investigations are needed to identify the potential role of previous infections known to be associated, or potentially associated, with GBS. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.
The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection.
During outbreaks, space spraying of insecticides may be carried out following the technical orientation provided by WHO to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers, when this is technically indicated.
Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering.
Although the risk of transmission of Zika virus through sexual activity is considered to be very limited, based on precautionary principles, WHO recommends the following:
- All patients (male and female) with Zika virus infection and their sexual partners (particularly pregnant women) should receive information about the potential risks of sexual transmission of Zika virus, contraceptive measures and safer sexual practices, and should be provided with condoms when feasible. Women who have had unprotected sex and do not wish to become pregnant because of concern with infection with Zika virus should also have ready access to emergency contraceptive services and counselling.
- Sexual partners of pregnant women, living in or returning from areas where local transmission of Zika virus is known to occur, should use safer sexual practices or abstinence from sexual activity for the duration of the pregnancy.
- As most Zika virus infections are asymptomatic:
- Men and women living in areas where local transmission of Zika virus is known to occur should consider adopting safer sexual practices or abstaining from sexual activity.
- Men and women returning from areas where local transmission of Zika virus is known to occur should adopt safer sexual practices or consider abstinence for at least four weeks after return.
Independently of considerations regarding Zika virus, WHO always recommends the use of safer sexual practices, including the correct and consistent use of condoms to prevent HIV, other sexually transmitted infections and unwanted pregnancies.
WHO does not recommend routine semen testing to detect Zika virus.
WHO does not recommend any travel or trade restriction to Panama based on the current information available.