Zika Virus Alert: WHO Warns Of Neurological Complications, Including Guillain-Barre Syndrome

At least 151 Zika virus disease cases were reported in three states in India including Gujarat, Karnataka, and Maharashtra in 2024.

New Delhi:

 Amid a global concern involving Guillain-Barre Syndrome (GBS), the World Health Organisation (WHO) cautioned that some Zika Virus-infected adults and children may develop neurological complications including GBS, neuropathy, and myelitis.
The findings by the WHO assume special significance for India following the fact that between January 1 and December 31, 2024, a cumulative total of 151 Zika virus disease (ZVD) cases were reported from three states in India, with Gujarat being the top state with a maximum number of cases.

ZVD Situation In India
Between January 1 and December 31, 2024, a cumulative total of 151 Zika virus disease cases were reported from Gujarat, Karnataka, and Maharashtra. However, Maharashtra reported the maximum number of 140 ZVD cases through the Integrated Disease Surveillance Programme (IDSP). Among the 140 cases, the majority (125 cases) were reported from Pune, 11 from Ahmednagar, and one case from each of Kolhapur, Sangli, and Solapur districts and the Mumbai suburban area.
Seven Zika cases were reported from the Bengaluru urban district and three from the Shivamogga district of Karnataka. Gandhinagar in Gujarat reported one Zika case in 2024.
“However, as of December 31, 2024, no cases of microcephaly and/or Guillain-Barre syndrome (GBS) associated with this (ZVD) outbreak have been reported in India,” the global health watchdog said.

Highest ZVD Cases Since 2021
The number of ZVD cases reported in 2024 in Maharashtra is the highest since 2021 compared with respectively one, three and 18 Zika Virus (ZIKV) disease cases reported in 2021, 2022 and 2023. The number of cases reported in Karnataka state in 2024 is also the highest number reported since the first case reported in 2022.
The State Integrated Disease Surveillance Programme(IDSP) Unit does not routinely disaggregate the number of ZVD cases (pregnancy status); therefore, the number of ZIKV infections among pregnant women is unknown.
The WHO, however, said that as of December 31, no cases of microcephaly and/or GBS associated with this outbreak have been reported.

What Is Zika Virus?
Zika virus is a mosquito-borne virus first identified in Uganda in 1947 in a Rhesus macaque monkey, and evidence of infection and disease in humans was reported in other African countries in the 1950s. It is transmitted to humans by the bite of an infected Aedes mosquito. This virus is also transmitted from mother to foetus during pregnancy, as well as through sexual contact, transfusion of blood and blood products, and possibly through organ transplantation.

The ZIKV is transmitted to humans by the bite of an infected Aedes mosquito. Zika virus is also transmitted from mother to foetus during pregnancy, as well as through sexual contact, transfusion of blood and blood products, and possibly through organ transplantation. There is no specific treatment available for Zika virus infection or disease.

Concerns Involving Zika Virus
Zika virus can cause large epidemics, particularly when introduced in immunologically naive populations, resulting in a substantial demand on the public health system, including surveillance, case management, and differential laboratory diagnostic testing, especially in the case of co-circulation of other mosquito-borne diseases like dengue and chikungunya. In most cases, infection with ZIKV is asymptomatic or mildly symptomatic and of short duration. However, infection during pregnancy is associated with a risk of microcephaly and other congenital malformations in infants (congenital Zika syndrome (CZS)) as well as preterm birth and miscarriage.
“Some ZIKV-infected adults and children may develop neurological complications including GBS, neuropathy and myelitis. There is no specific treatment available for Zika virus infection or disease,” the WHO said.
The actual incidence of ZVD could be higher due to the asymptomatic or mild clinical presentation in most of the ZIKV infections, combined with varied levels of awareness among clinicians. Aedes mosquito density in India varies by season and location, with the highest densities occurring during the monsoon and post-monsoon seasons.

Guillain-Barré Syndrome
Guillain-Barré Syndrome (GBS) is an autoimmune disease in which the body’s immune system mistakenly attacks the peripheral nerves, leading to muscle weakness, paralysis, and, in severe cases, respiratory failure. “The exact cause is unclear, but it is often triggered by infections such as Campylobacter jejuni (suspected to cause the recent outbreak in Pune), Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Influenza, and also SARS-CoV-2 (COVID-19). Other triggers include vaccinations (rarely), recent surgery, trauma, and autoimmune diseases,” said Dr Tamorish Kole, renowned health expert and Chair of the Clinical Practice Committee at the International Federation for Emergency Medicine.
He said that GBS usually manifests as rapidly worsening muscle weakness, which can lead to autonomic dysfunction, respiratory distress, and paralysis.
“Prompt diagnosis using clinical evaluation, cerebrospinal fluid analysis, and nerve conduction studies is essential for effective management. Treatment primarily involves intravenous immunoglobulin (IVIG) or plasmapheresis, supplemented by supportive care to prevent complications. While most patients recover, some may experience persistent weakness or fatigue,” said Dr Kole.

Precautions To Avoid GBS
According to Dr Kole, individuals should take precautions to avoid infections to prevent Guillain-Barré Syndrome, as these are the most common triggers.

“This includes practising good hygiene, such as frequent handwashing, consuming clean food and water to prevent bacterial infections like Campylobacter jejuni, and getting vaccinated against flu and other viruses when recommended,” Dr Kole.

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