With 111 confirmed cases and three reported deaths in less than three weeks due to Guillain-Barre syndrome, the neurology and critical care community must proactively enhance early detection, optimise treatment strategies, and ensure resource allocation to minimize morbidity and mortality. Dr Lomesh Bhirud, Neurologist and Neuro-Interventionalist, Ruby Hall Clinic shares with IndiaMedToday the on-ground scenario in the wake of the Guillain-Barre’ syndrome(GBS) outbreak that has gripped the city of Pune. He shares real-time updates on the response mechanisms and immediate interventions that are being enforced to mitigate the outbreak

GBS has caught our nation unaware, with 158 cases and 3 deaths in less than three weeks. In the wake of mounting cases in the upcoming weeks, how prepared are we to steer through and mitigate an outbreak of this scale?

This upsurge in GBS has placed a huge demand on health systems. With 111 confirmed cases and three reported deaths in less than three weeks, the neurology and critical care community must proactively enhance early detection, optimise treatment strategies, and ensure resource allocation to minimise morbidity and mortality. The current surge underscores the necessity for coordination across tertiary and secondary care centres. Most critical care units will be able to manage GBS cases, while the burden on ICUs will increase because approximately 30 per cent of cases might require ventilatory support. Hence, strengthening the capacity of the ICU, providing plasmapheresis units, and enhancing coordination between the multidisciplinary team of neurologists, intensivists, and rehabilitation specialists are also priorities. Additionally, integrating real-time data sharing between healthcare institutions will allow for early intervention and resource reallocation where needed.

Early detection plays a crucial role in a progressive neurological disorder like GBS. How is early detection being prioritised to ensure timely intervention?

GBS presents with heterogeneous manifestations, and delays in diagnosis can contribute to worsened patient outcomes. Efforts are being made to standardise diagnostic algorithms across healthcare facilities to minimise variability in clinical assessment. Training on emergency physicians, general practitioners, and intensivists has been strengthened for early recognition of characteristic presentation in progressive weakness, areflexia, and autonomic dysfunction. From a diagnostic point of view, nerve conduction studies (NCS) and cerebrospinal fluid (CSF) analysis are brought forward. Access to electrodiagnostic facilities and availability of trained personnel should be ensured for early identification at semi-urban and rural centres and timely referral to specialised centres. 

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Training on emergency physicians, general practitioners, and intensivists has been strengthened for early recognition of characteristic presentation in progressive weakness, areflexia, and autonomic dysfunction.

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Is our diagnostic infrastructure and capabilities well equipped to navigate the spurt in cases?

While large hospitals have adequate infrastructure for diagnosing GBS, there is a glaring gap in the accessibility of such facilities at smaller healthcare levels. The wide availability of kits for lumbar puncture, nerve conduction testing, and trained neurophysiologists would be critical for improving the precision of diagnosis. In addition, the increased turnaround times in CSF analysis on account of the overburdened pathology labs need to be addressed through the optimisation of processes and decentralization of testing facilities.

What surveillance systems and public health interventions are being enforced by the health ministry?

This epidemiological pattern of this GBS surge calls for an organized surveillance system. Health authorities are tracking post-infectious triggers, like antecedent viral or bacterial infections, that could be triggering the surge. Sentinel surveillance systems need to be enhanced to capture and analyse data on patients for a better understanding of geographical and demographic risk factors. Public health interventions include risk stratification of hospitalised patients, monitoring for complications such as respiratory insufficiency and autonomic instability, and ensuring standardised treatment protocols across healthcare centres. Hospitals are also being encouraged to establish dedicated GBS task forces to streamline case management.

What measures are being taken to address the panic-stricken public given that GBS comes across as a life-threatening disease?

Misinformation about GBS can result in undue panic, leading to delayed hospital presentations or inappropriate utilisation of healthcare facilities. Hospitals and municipal health authorities should communicate selectively with primary care physicians and specialists to ensure the dissemination of correct clinical information. Helplines are an integral component of crisis response frameworks, providing guidance to healthcare professionals and referring physicians to specialised centres that could manage GBS cases.

Immunoglobulin injections for GBS are currently priced at Rs 20,000 by private hospitals. How are the ministry officials ensuring affordability and accessibility to economically weaker sections of society in such times of crisis? 

With the cost of intravascular immunoglobulins (IVIG) priced at Rs 20,000 per vial in private hospitals, there is a serious cost barrier. Meetings with pharmaceutical companies and government procurement agencies are being considered to explore bulk purchasing models and sub-bulk purchasing for public hospitals. Based on the potential duration of therapy, reimbursement policies and expanded insurance coverage must be reviewed for this treatment to be accessible.

What measures are being taken to ensure accessibility and affordability in rural areas and outskirts of Pune?

Answer: Limited access to tertiary care in rural areas continues to be a major concern. The health ministry is working on equitable distribution of IVIG supplies to district hospitals while advocating for enhanced referral pathways to tertiary care centres. Mobile diagnostic units and telemedicine services are being explored to bridge the gap between urban and rural healthcare facilities.

What proactive steps can be taken on-ground by the health ministry to monitor and control the situation?

On-ground monitoring of cases of GBS, ICU bed occupancy, and stock levels of immunoglobulin are being done in real-time. Neurologists and intensivists are being looped into coordinated task forces so that treatment guidelines can remain consistently implemented. The hospitals are also advised to establish standardised rehabilitation protocols, given the long-term functional impairment associated with GBS.