On Tuesday evening (June 21), Nationwide News Network carried a report of a speech given that day by Minister of Health Christopher Tufton, in which he gave current figures for cases of Guillain-Barre Syndrome (GBS) in Jamaica. Minister Tufton stated that 30 confirmed cases of GBS have now been identified in Jamaica (this year?) and that the majority of the current cases are Zika-related. (Nationwide’s report is available online & contains audio clips of the Minister.)
This is a significant increase in the number of cases of GBS over the figures given by Minister Tufton during his press conference 3 weeks ago, at which time he also said that none of the GBS cases identified had yet been linked to zika infection. (In an earlier blog post, I dealt with that press conference: Jamaica: Ministry of Health #Zika Virus Update – June 2, 2016.)
Minister Tufton also referred to the cost of treating GBS and the pressure being put on the public health system by the increasing number of cases of GBS.
“A confirmed case of Guillain-Barre costs or is costing in the public health system to treat 1.5 million Jamaican dollars. If we have had 30 cases confirmed to date – do the math – 1.5 million…you are talking about 45 million or so.” – Minister Tufton
I checked the Ministry of Health (MOH) website to see if anything has been posted there about these increased numbers or a copy of the Minister’s speech, but unsurprisingly there is nothing (yet). And Jamaica Information Service’s (JIS) article about the speech focuses entirely on the launch of the Agro-Grace products (which look interesting), saying nothing about the increased numbers of GBS.
So I am grateful to Nationwide for covering the story.
Nationwide News’ GBS Discussion
In their discussion about GBS that evening, Nationwide had two guests – Mr Reid Buckley and Dr Karen Webster. Mr Buckley shared his experience with GBS, which he developed in October 2014, following bouts of flu and chikungunya. He detailed being hospitalized with what was initially thought to be a stroke, but because the paralysis affected both sides of his body, the doctor treating him suspected GBS, did an MRI and, with the symptoms getting progressively worse, transferred Mr Buckley to the University Hospital, where he was admitted to the Intensive Care Unit (ICU). Mr Buckley said that the immunoglobulin needed for his treatment was not readily available in the island at the time and when tracked down at one supplier, his family was faced with the cost of J$1.6 million for 5 days of treatment.
Mr Buckley spoke about losing his ability to speak, stand, sit, swallow or eat and described the pain he experienced as severe. He said that he immediately began to feel better once the treatment started, but that it took a long time to recover, and that he needed a lot of physiotherapy during that time. He says that he is now 99% recovered, but still occasionally feels some tingling in his toe.
Dr Karen Webster, National Epidemiologist at MOH, said that there is a spectrum of GBS and Mr Buckley seems to have had a severe form of this rare condition. She said that many viral infections can have GBS as a complication; it wasn’t particularly described as being associated with chikungunya, but it has been so described for zika. She noted that with the current outbreak of zika, it is estimated that Jamaica may eventually have between 350- 400 zika-related cases of GBS.
Because of this association, from 2015 the MOH has acted to procure adequate supplies of immunoglobulin needed for treatment of GBS and to increase the numbers of functioning ventilators, which are needed when GBS affects breathing. Dr Webster said that there are adequate supplies of immunoglobulin and the aim is to have 80 treatments in stock at any one time; more would not be kept, as the immunoglobulin has a short shelf life. She said that it is expected that there would be no more than 5 cases of GBS in the peak week of the outbreak. She also said that most of the people who have had GBS this year have responded very well to the immunoglobulin treatment and have recovered quickly. In response to host Cliff Hughes’ question about cost, and whether people who couldn’t afford the expensive treatment would simply have to die, she indicated that the treatment can be accessed without cost, once GBS has been diagnosed.
Concerns have been expressed since the beginning of the year about the capacity of our health facilities to deal with any significant increase in the number of GBS cases that might result from the zika outbreak. As recently as last week, I heard such concerns being expressed again.
Weekly Epidemiology Bulletin Posted on MOH Website
When I was trying to find out if the information about the increase in GBS cases was posted on the MOH website, I noticed that the Weekly Epidemiology Bulletin produced by the Epidemiology Unit of the MOH is again being posted on the website. On June 16, most of the bulletins for 2016 were posted; none for May or June had been posted as of today. The posting of such material as this, already being produced by the MOH, makes a great deal of sense, and I hope to see more of this kind of routine proactive posting of information.
It was interesting to note that the first two bulletins for 2016 acknowledged the likely outbreak of Zika in Jamaica, with the first bulletin highlighting microcephaly and the second highlighting GBS.
I remain concerned that it is not easy to access some types of information about public health situations on a real time basis in some central online space. I know that there are problems associated with doing this, but every effort must be made to provide such information in a timely, permanent, accessible format. Access to Information Act timelines are not sufficient in a time of an active outbreak or other developing public health situation. Provision of data 30, 60 or 90 days later may have an impact on people’s ability to make fully informed decisions for themselves, their families or communities.
I again acknowledge the availability of MOH representatives to the media and their willingness to share the up-to-date information they have. Public health information is also being communicated via broadcasts and publication in the press. However, continuing efforts must be made to deal with the gaps where they exist.
More Information About GBS
- Here is a link to the US National Institute of Neurological Disorders & Stroke Information Page about GBS, which provides some basic information. Note that there is a feature that will read the article aloud, if you wish.
- The MOH has circulated to doctors this document about The Management of Guillain-Barre Syndrome, if you are interested in more detailed medical information. MOH – Zika Virus MANAGEMENT OF GUILLAIN-BARRÉ SYNDROME