Declining Guillain-Barré Syndrome After Campylobacteriosis Control

Declining Guillain-Barré Syndrome
After Campylobacteriosis Control, New Zealand, 1988-2010

Abstract and Introduction

Abstract

Infection with Campylobacter
spp. commonly precedes Guillain-Barré syndrome (GBS). We therefore hypothesized
that GBS incidence may have followed a marked rise and then decline in
campylobacteriosis rates in New Zealand. We reviewed records for 1988–2010:
hospitalization records for GBS case-patients and campylobacteriosis
case-patients plus notifications of campylobacteriosis. We identified 2,056
first hospitalizations for GBS, an average rate of 2.32
hospitalizations/100,000 population/year. Annual rates of hospitalization for
GBS were significantly correlated with rates of notifications of
campylobacteriosis. For patients hospitalized for campylobacteriosis, risk of
being hospitalized for GBS during the next month was greatly increased. Three
years after successful interventions to lower Campylobacter spp.
contamination of fresh poultry meat, notifications of campylobacteriosis had
declined by 52% and hospitalizations for GBS by 13%. Therefore, regulatory
measures to prevent foodborne campylobacteriosis probably have an additional
health and economic benefit of preventing GBS.

Introduction

Guillain-Barré syndrome (GBS) is an
autoimmune condition that affects the peripheral nervous system. Patients
typically describe ascending weakness and sensory disturbance that evolve over
several days; during this acute phase, approximately one third of patients
require ventilatory support. The condition is generally self-limiting, but for
3%–10% of patients, it is fatal.^[1]

An estimated 40%–70% of patients
with GBS had an infection before GBS onset; for 6%–39% of these patients, the
infection affected the gastrointestinal system.^[2] Campylobacteriosis is the most commonly identified
antecedent infection; several studies have shown that in industrialized
countries (Europe, North and South America, Japan, and Australia), Campylobacter
spp. infection preceded GBS for 20%–50% of patients.^[4]

During 1980–2006 in New Zealand,
incidence of campylobacteriosis steadily increased. The notification rate in
2006 (379 cases/100,000 population) remains the highest national rate reported
in the literature.^[6] In 2006, in response to this high incidence, New Zealand
introduced an array of voluntary and regulatory interventions to reduce
contamination of poultry with Campylobacter spp.^[7] By 2008, the rate of campylobacteriosis notifications had
dropped to 157 cases/100,000 population, a decrease of 59% over 2 years;^[7] this decline has persisted.^[8] Given the known association between Campylobacter spp.
infection and GBS and the marked recent changes in reported rates of
campylobacteriosis in New Zealand, we examined GBS hospitalization data for
evidence of responsiveness to trends in campylobacteriosis incidence.