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Diagnosis of neurological disorders and the Zika virus epidemic in Colombia 2014 –2016

2016; Elsevier BV; Volume: 51; Linguagem: Inglês

10.1016/j.ijid.2016.09.010

1878-3511

Jorge Enrique Machado‐Alba, Manuel Enrique Machado‐Duque, Andrés Gaviria‐Mendoza, Viviana A Orozco-Giraldo,

Long-Term Effects of COVID-19

•Diagnoses of neurological disorders were obtained from a database of 6.5 million inhabitants.•The number of cases of Guillain–Barré syndrome increased four-fold in March 2016.•During the same period, there was no increase in the number of other neurological disorders. Zika virus infection in Colombia was first notified in August 2015, and the first cases of native transmission occurred in October of that year.1Petersen L.R. Jamieson D.J. Powers A.M. Honein M.A. Zika virus.N Engl J Med. 2016; 374: 1552-1563Crossref PubMed Scopus (885) Google Scholar, 2Vorou R. Zika virus, vectors, reservoirs, amplifying hosts, and their potential to spread worldwide: what we know and what we should investigate urgently.Int J Infect Dis. 2016; 48: 85-90Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar, 3Instituto Nacional de Salud, Colombia. Boletín Epidemiológico Semanal—Zika Semana epidemiológica número 15 de 2016. Bogotá: Instituto Nacional de Salud; 2016. Available at: http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2016%20Boletin%20epidemiologico%20semana%2015.pdf. (accessed April 25, 2016).Google Scholar The infection has been associated with several complications including certain neurological disorders, such as an increased incidence of Guillain–Barré syndrome (estimated odds ratio >34), microcephaly, and polyneuropathy. The health care systems of affected countries and the World Health Organization have increased efforts towards research, prevention, and control because of the multiple negative implications of this infection in the population.4Broutet N. Krauer F. Riesen M. Khalakdina A. Almiron M. Aldighieri S. et al.Zika virus as a cause of neurologic disorders.N Engl J Med. 2016; 374: 1506-1509Crossref PubMed Scopus (194) Google Scholar, 5Beckham D. Pastula D. Massey A. Tyler K. Zika virus as an emerging global pathogen: neurological complications of Zika virus.JAMA Neurol. 2016; 73: 875-887Crossref PubMed Scopus (47) Google Scholar Colombia has experienced the second highest number of cases of Zika virus infection in South America.2Vorou R. Zika virus, vectors, reservoirs, amplifying hosts, and their potential to spread worldwide: what we know and what we should investigate urgently.Int J Infect Dis. 2016; 48: 85-90Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar Following the publication of a review article reporting the increased risk of neurological disorders caused by Zika virus infection,5Beckham D. Pastula D. Massey A. Tyler K. Zika virus as an emerging global pathogen: neurological complications of Zika virus.JAMA Neurol. 2016; 73: 875-887Crossref PubMed Scopus (47) Google Scholar all records of these diagnoses reported as the primary diagnosis in a population database of about 6.5 million people, corresponding to 14.1% of the population of Colombia, were investigated. This resulted in a descriptive study of all patients of any age affiliated with the Colombian health care system who were treated at a medical consultation and received a prescription for neurological or psychiatric medication between January 2015 and March 2016. Data were obtained from the database of the largest drug dispenser in the country, Audifarma S.A., and validated. A total of 81 neurological disorders included in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) were identified during the observation period (diagnoses of myelopathy, neuropathy, paralysis, and demyelinating disorders were included). The number of new monthly cases of Guillain–Barré syndrome remained stable during the first 7 months of 2015, but from August 2015, when Zika virus infection first appeared in Colombia, the number of reported cases started to increase, reaching a four-fold increase in March 2016, the time of the greatest number of reported cases in the country (Figure 1). During the same period of time, the number of new diagnoses of other neurological disorders showed no increase (Figure 1). From the beginning of the epidemic phase (week 40, 2015) to epidemiological week 15 of 2016, there were 3292 confirmed cases and 68 660 suspected cases of infection in Colombia.3Instituto Nacional de Salud, Colombia. Boletín Epidemiológico Semanal—Zika Semana epidemiológica número 15 de 2016. Bogotá: Instituto Nacional de Salud; 2016. Available at: http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2016%20Boletin%20epidemiologico%20semana%2015.pdf. (accessed April 25, 2016).Google Scholar These results suggest the possibility that Zika virus infection is associated with Guillain–Barré syndrome (besides microcephaly), but not with other neurological disorders. Prompt confirmation of the infection and increased measures aimed at searching for and identifying Guillain–Barré syndrome should be promoted in order to start treatment early and avoid the appearance of complications.5Beckham D. Pastula D. Massey A. Tyler K. Zika virus as an emerging global pathogen: neurological complications of Zika virus.JAMA Neurol. 2016; 73: 875-887Crossref PubMed Scopus (47) Google Scholar, 6Yuki N. Hartung H.P. Guillain-Barré syndrome.N Engl J Med. 2012; 366: 2294-2304Crossref PubMed Scopus (818) Google Scholar, 7Sarmiento-Ospina A. Vásquez-Serna H. Jimenez-Canizales C.E. Villamil-Gómez W.E. Rodriguez-Morales A.J. Zika virus associated deaths in Colombia.Lancet Infect Dis. 2016; 16: 523-524Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar Funding: This research did not receive funding. Conflict of interest: All authors declare that they have no conflict of interest.