Hop­kins re­search ties Zika to Guil­lain-Barre

Virus thought to cause neu­ro­log­i­cal prob­lems in adults

Baltimore Sun - - FRONT PAGE - By An­drea K. McDaniels

Re­searchers at Johns Hop­kins Medicine work­ing with sci­en­tists in Colom­bia have dis­cov­ered what they be­lieve is the strong­est ev­i­dence yet that the Zika virus causes neu­ro­log­i­cal prob­lems in adults.

Much of the re­search on the mosquito­borne Zika has fo­cused on preg­nant women, be­cause the virus can cause mi­cro­cephaly in fe­tuses, caus­ing ba­bies to be born with brain dam­age and ab­nor- mally small heads.

The new re­search shows that the health ef­fects might be more wide­spread.

Hop­kins re­searcher Dr. Car­los A. Par­doVil­lamizar said the re­search, pub­lished Wed­nes­day in the New Eng­land Jour­nal of Medicine, bol­sters con­cerns that Zika can lead to the neu­ro­log­i­cal dis­or­der Guil­lainBarre in adults. Un­til now, the virus was thought to be linked to the dis­or­der only in rare cases.

Guil­lain-Barre is a ner­vous sys­tem Dr. Car­los A. Pardo-Vil­lamizar of Johns Hop­kins Medicine, in his lab­o­ra­tory, is the lead re­searcher of a study on the Zika virus as a cause of brain dam­age in adults.

“This is ev­i­dence there is a very strong link be­tween Zika and Guil­lainBarre.”

dis­or­der in which a per­son’s im­mune sys­tem at­tacks the nerves, in the worst cases even­tu­ally par­a­lyz­ing the whole body.

The ex­act cause of the dis­or­der is not known, but re­search has found its symp­toms of­ten erupt af­ter a vi­ral or bac­te­ria in­fec­tion. It af­fects one or two out of 100,000 peo­ple who first suf­fer from in­fec­tions.

Most peo­ple re­cover from the dis­or­der, but some side ef­fects — such as weak­ness or numb­ness — may per­sist. Re­search has shown that Guil­lain-Barre can lead to vi­sion prob­lems in some peo­ple.

The Hop­kins find­ings come a week af­ter Congress al­lo­cated $1.1 bil­lion for re­search and aid to fight the spread of Zika as sci­en­tists across the world dis­cover more about its ef­fects on peo­ple’s health.

Dr. Tom Frieden, di­rec­tor of the U.S. Cen­ters for Dis­ease Con­trol and Preven­tion, has said health of­fi­cials are be­com­ing more con­cerned about the dis­ease the more they learn about it.

Re­searchers are be­gin­ning to be­lieve that even ba­bies born with­out mi­cro­cephaly may suf­fer prob­lems af­ter birth.

The CDC re­ports that there have been 3,625 cases of Zika in the main­land United States, and an­other 22,000 in U.S. ter­ri­to­ries such as hard-hit Puerto Rico. There have been 808 con­firmed cases in preg­nant women in the con­ti­nen­tal United States. Twenty-one ba­bies have been born with birth de­fects and five preg­nan­cies have been lost.

In Mary­land, there have been 101 cases, in­clud­ing 43 in Bal­ti­more and the five sur­round­ing coun­ties and 51 in the Mary- land sub­urbs of Wash­ing­ton.

Pardo, an as­so­ci­ate pro­fes­sor of neu­rol­ogy and pathol­ogy at the Johns Hop­kins School of Medicine, said doc­tors in Colom­bia con­tacted him dur­ing the early stages of the Zika out­break there in the fall of 2015 with con­cerns about pa­tients suf­fer­ing from neu­ro­log­i­cal com­pli­ca­tions.

The re­searchers in Colom­bia took cere­brospinal fluid, blood and urine sam­ples from 68 peo­ple with Guil­lain-Barre symp­toms at six hospi­tals.

Of those, 42 were sent to one main lab­o­ra­tory in Colom­bia, where virus and im­munol­ogy stud­ies were con­ducted to see if any had Zika. The sci­en­tists de­ter­mined urine to be most re­li­able in mak­ing a di­ag­no­sis be­cause the virus lasted longer in urine than in other bod­ily flu­ids.

They found that 17 pa­tients tested pos­i­tive for Zika and an­other 18 had Zika an­ti­bod­ies in their blood or spinal fluid, in­di­cat­ing the per­son might have been ex­posed to the virus. Just about all of the pa­tients showed two or more Zika symp­toms, in­clud­ing fever, headache and rash.

There was ev­i­dence that Guil­lain-Barre de­vel­oped faster from a Zika in­fec­tion than from other in­fec­tions such as in­fluenza or her­pes, Pardo said. Nearly half of pa­tients com­plained of neu­ro­log­i­cal symp­toms within four days of Zika symp­toms.

Re­searchers made the link be­tween Zika and Guil­lain-Barre in 2013 af­ter an out­break in French Poly­ne­sia. About 32,000 peo­ple were in­fected by the Zika out­break, and 42 pa­tients were con­firmed to have Guil­lainBarre, a 20-fold in­crease over the pre­vi­ous four years. Thir­tytwo other pa­tients showed other neu­ro­log­i­cal dis­or­ders, such as fa­cial paral­y­sis or encephalitis.

In a pa­per pub­lished in the jour­nal Lancet that year, the re­searchers said they found ev­i­dence of Zika an­ti­bod­ies in the 42 cases. An­ti­body tests are lim­ited be­cause they can’t de­ter­mine fully if Guil­lain-Barre was caused by the Zika virus or an­other ail­ment, such at the mos­quito-borne dengue virus. The CDC also re­leased a re­port in Septem­ber that de­scribed 56 sus­pected cases of Guil­lain-Barre in Puerto Rico in the first six months of this year. Of those, 34 were de­ter­mined to have Zika and treated. The num­ber of pa­tients with both dis­or­ders was 2.5 per­cent greater than those with Guil­lain-Barre and no signs of Zika.

Dr. Matthew B. Laurens is di­rec­tor of the in­ter­na­tional clin­i­cal tri­als unit within the Di­vi­sion of Malaria Re­search at the In­sti­tute for Global Health at the Univer­sity of Mary­land School of Medicine.

He said the Hop­kins re­search is the most com­pre­hen­sive to date on the link be­tween Guil­lain-Barre and Zika.

“We know vi­ral ill­nesses can cause Guil­lain-Barre, but this is ev­i­dence there is a very strong link be­tween Zika and Guil­lainBarre,” Laurens said. “It is doc­u­ment­ing the bur­den of dis­ease of Guil­lain-Barre in this pop­u­la­tion that is ex­pe­ri­enc­ing a Zika out­break.”

Laurens said the find­ings could help coun­tries pre­pare for the dis­or­der. Many small hospi­tals in poorer coun­tries likely don’t have the med­i­ca­tion to treat it: in­tra­venous im­munoglob­u­lin, which is avail­able in de­vel­oped coun­tries. Poorer coun­tries might now keep some in stock.

Laurens said re­searchers need to know all the side ef­fects of Zika be­fore test­ing a vac­cine on healthy peo­ple. They would not test it on a healthy per­son if it could cause Guil­lain-Barre.

The Hop­kins re­searchers have not yet stud­ied how the Zika virus leads to Guil­lain-Barre. That’s some­thing they now plan to look at, us­ing sam­ples col­lected by the Colom­bian sci­en­tists. The sci­en­tists will use mini-brains, mi­cro­scopic spheres made up of the main com­po­nents of the brain, to study the con­nec­tion be­tween the two dis­eases.

“We will look at what hap­pens to the cells when ex­posed to the virus,” said Dr. Paula Bar­reras, a Johns Hop­kins fel­low work­ing on the re­search.

Pardo said col­lab­o­ra­tion with the Colom­bia doc­tors en­abled them to turn around re­search re­sults quickly. Hop­kins pro­vided the Colom­bians with a kit filled with test tubes to col­lect the sam­ples. They also cre­ated a data­base in which the Colom­bians could en­ter in­for­ma­tion about each in­fected pa­tient.

Lack of re­sources in poorer coun­tries of­ten makes such re­search cost-pro­hib­i­tive, Pardo said.

KENNETH K. LAM/BAL­TI­MORE SUN

SAL­VA­TORE DI NOLFI/EPA

The U.N. Se­cu­rity Coun­cil will vote Thurs­day on An­to­nio Guter­res be­fore sug­gest­ing him to the Gen­eral As­sem­bly.

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