Pandemic Data Challenges Infection Link to Guillain-Barré Syndrome

Randy Dotinga

October 13, 2021

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Armed with pediatric data from the COVID-19 pandemic, a team of researchers is suggesting that most cases of Guillain-Barré syndrome may not be connected to infectious disease, as is sometimes assumed.

While pediatric cases of various types of infections fell by 45%-95% during the early months of the pandemic, cases of acute inflammatory demyelinating polyneuropathy (AIDP), an inflammatory neuropathy belonging to the clinical spectrum of Guillain-Barré syndrome, only fell by about 32%-37%, a rate that's similar to the 35.1% decline in overall hospital admissions over that time period, researchers found. There was also no apparent link between the appearance of COVID-19 and the number of reported AIDP cases.

"There was no clear association between respiratory or gastrointestinal infections and rates of AIDP. Further, we found that AIDP did not have the expected dramatic reduction when community-acquired infections decreased during the pandemic," Children's Hospital of Philadelphia neurologist Craig A. Press, MD, PhD, said in an interview.

Press and colleagues presented their findings in a poster at the 50th annual meeting of the Child Neurology Society.

According to Press, the cause of AIDP in most patients is unclear, although infections and vaccinations are often linked to cases. "However, the data supporting this link is often weak. Infections with Campylobacter jejuni [bacteria that causes food poisoning] are known to be associated with AIDP, while rates of AIDP in the general population and in those with influenza are similar."

For the new multicenter, cross-sectional study, researchers tracked AIDP data from the 47 pediatric hospitals that provide statistics to the Pediatric Health Information System. They focused on the period from January 2017 to September 2020, which included the first months of the COVID-19 pandemic in the United States.

"Social distancing, masks, and increased hand hygiene decrease community-acquired infectious rates in a dramatic way," Press said. "If these infections were causing AIDP, we hypothesized that the cases of AIDP would drop substantially as a result."

But this didn't appear to happen. Researchers found that the numbers of various types of infections declined from April to September 2020: Respiratory infections dipped by 73%-78%, gastrointestinal infections fell by 45%-61%, and influenza infections dipped by 88%-95%. But AIDP cases didn't fall as precipitously. In fact, their levels were about the same as they were in April 2017, a month when rates of gastrointestinal, respiratory disease, and influenza infections were at seasonally low — but not abnormal — ebbs.

"While we must be cautious interpreting the results," Press said, "this makes the link between infections as the main driver of pediatric AIDP less likely."

However, he said, "this study does not exclude the possibility that rare infections cause AIDP — the data supporting that some more rare infections like campylobacter have a connection to AIDP are more robust — or that common infections very rarely lead to AIDP. While we look for triggers causing inflammatory disorders, AIDP maybe an autoinflammatory disorder without a clear trigger."

Going forward, Press said, "we hope to look at infectious data in a more granular way to identify if specific viral or bacterial infectious may be associated with this or other inflammatory disorders. We believe that the use of data like this and the natural experiment that COVID-19 provided may help us to explore the impact of infections on disorders thought to be postinfectious."

No study funding is reported, and the authors report no relevant disclosures.

Child Neurology Society (CNS) 50th Annual Meeting. Presented September 29 to October 2, 2021.

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