Leonelo E Bautista1. 1. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, 610 Walnut Street, WARF 703, Madison, WI 53726-2397, United States. Electronic address: lebautista@wisc.edu.
Abstract
OBJECTIVE: Findings from studies of the association between Zika virus (ZIKV) infection and Guillain-Barré syndrome (GBS) are inconsistent. I conducted a systematic review and meta-analysis to clarify the nature of this association. METHODS: I searched PubMed, Scopus, Cochrane, CINAHL, Web of Science, Scielo, and DOAJ for case report, ecological, and analytic studies with "Zika" and "Guillain-Barré syndrome" as keywords, published up to July 1stth 2018. I evaluated if ZIKV infection status influenced the diagnosis of GBS (detection bias) in case-report and analytic studies; assessed if changes in weekly number of cases of ZIKV infection during outbreaks were followed by changes in number of GBS cases 1-8 weeks later; gauged the likelihood of selection, confounding, information, sparse data, and time-dependent bias (i.e. when ZIKV infection was ascertained after GBS onset) in analytic studies; and calculated the average ZIKV-GBS odds ratio (OR) in studies without time-dependent bias. RESULTS: In case reports, ZIKV infection prevalence in GBS cases was 2.4 to 25 times higher than expected. Changes in the number of ZIKV-infection cases during outbreaks were not consequentially followed by changes in the number of GBS cases (OR: 1.01; 95% CI: 0.99-1.03). Major biases were likely in all but one analytic study, which showed a non-significant ZIKV-GBS association. The average ZIKV-GBS OR in studies without time-dependent bias was 1.57 (95% CI: 0.86-2.86). INTERPRETATION: These findings indicate the available evidence is insufficient to claim ZIKV infection causes GBS. Therefore, stakeholders may want to reconsider current ZIKV-GBS public health and patient care recommendations.
OBJECTIVE: Findings from studies of the association between Zika virus (ZIKV) infection and Guillain-Barré syndrome (GBS) are inconsistent. I conducted a systematic review and meta-analysis to clarify the nature of this association. METHODS: I searched PubMed, Scopus, Cochrane, CINAHL, Web of Science, Scielo, and DOAJ for case report, ecological, and analytic studies with "Zika" and "Guillain-Barré syndrome" as keywords, published up to July 1stth 2018. I evaluated if ZIKV infection status influenced the diagnosis of GBS (detection bias) in case-report and analytic studies; assessed if changes in weekly number of cases of ZIKV infection during outbreaks were followed by changes in number of GBS cases 1-8 weeks later; gauged the likelihood of selection, confounding, information, sparse data, and time-dependent bias (i.e. when ZIKV infection was ascertained after GBS onset) in analytic studies; and calculated the average ZIKV-GBS odds ratio (OR) in studies without time-dependent bias. RESULTS: In case reports, ZIKV infection prevalence in GBS cases was 2.4 to 25 times higher than expected. Changes in the number of ZIKV-infection cases during outbreaks were not consequentially followed by changes in the number of GBS cases (OR: 1.01; 95% CI: 0.99-1.03). Major biases were likely in all but one analytic study, which showed a non-significant ZIKV-GBS association. The average ZIKV-GBS OR in studies without time-dependent bias was 1.57 (95% CI: 0.86-2.86). INTERPRETATION: These findings indicate the available evidence is insufficient to claim ZIKV infection causes GBS. Therefore, stakeholders may want to reconsider current ZIKV-GBS public health and patient care recommendations.
Authors: Victor Emmanuel Viana Geddes; Otávio José Bernardes Brustolini; Liliane Tavares de Faria Cavalcante; Filipe Romero Rebello Moreira; Fernando Luz de Castro; Ana Paula de Campos Guimarães; Alexandra Lehmkuhl Gerber; Camila Menezes Figueiredo; Luan Pereira Diniz; Eurico de Arruda Neto; Amilcar Tanuri; Renan Pedra Souza; Iranaia Assunção-Miranda; Soniza Vieira Alves-Leon; Luciana Ferreira Romão; Jorge Paes Barreto Marcondes de Souza; Ana Tereza Ribeiro de Vasconcelos; Renato Santana de Aguiar Journal: Front Cell Infect Microbiol Date: 2021-03-15 Impact factor: 5.293
Authors: Jacob T Beaver; Lisa K Mills; Dominika Swieboda; Nadia Lelutiu; Edward S Esser; Olivia Q Antao; Eugenia Scountzou; Dahnide T Williams; Nikolaos Papaioannou; Elizabeth Q Littauer; Ioanna Skountzou Journal: Hum Vaccin Immunother Date: 2020-08-06 Impact factor: 4.526