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Guillain-Barré syndrome in times of pandemics
  1. Sonja E Leonhard1,
  2. David R Cornblath2,
  3. Hubert P Endtz3,4,
  4. James J Sejvar5,
  5. Bart C Jacobs6
  1. 1Neurology, Erasmus MC, Rotterdam, The Netherlands
  2. 2Neurology, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Medical Microbiology & Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
  4. 4Fondation Mérieux, Lyon, France
  5. 5National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  6. 6Neurology and Immunology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Bart C Jacobs, Neurology and Immunology, Erasmus MC, Rotterdam 3015 GD, The Netherlands; b.jacobs{at}erasmusmc.nl

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The SARS-CoV-2 pandemic is the last in line of several epidemics of infectious diseases that have been linked to the Guillain-Barré syndrome (GBS). As threats of epidemics of emerging infectious diseases persist, this is the time to learn from the past and to advance our response to future outbreaks in terms of research and management of GBS.

In the past decade, the world confronted several pandemics of emerging infectious diseases including Zika virus and most recently Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). One of the neurological complications reported in relation to these infectious diseases is the Guillain-Barré syndrome (GBS), a rapidly progressive immune-mediated polyradiculoneuropathy that can cause paresis in all limbs, cranial and respiratory muscles.1–3 Approximately 20% require admission at an intensive care unit (ICU), and 2%–12% die, depending on the care available.4

In the past, research responses investigating a possible link between GBS and outbreaks of infectious diseases or vaccines have been delayed. This is problematic as healthcare institutions need to be able to prepare for increased incidences in patients with GBS, and public health personnel need to identify any possible mitigating factors. History now seems to repeat itself when case reports of SARS-CoV-2-related GBS are mounting, and disquiet over a possible association increases. As threats of epidemics of emerging infectious diseases persist, this is the time to learn from the past and to advance our response to future outbreaks in terms of research and management of GBS.

Challenges and prospects in research preparedness

The first aims when studying a possible link between an infectious agent and GBS are to determine if a true association exists and to determine the impact in terms of frequency and severity. During an outbreak, observational cohorts are set up rapidly by clinicians, some of whom may lack experience in diagnosing and managing GBS due to the need to quickly mobilise personnel. These studies are often done at a single centre and not harmonised with GBS research from other centres, which can result in missing out of important clinical information.

How can one ensure a high-quality study within the limited time frame afforded by an infectious disease epidemic? Many hurdles must be overcome before recruitment …

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