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Guillain-Barré Syndrome Active Surveillance. October 2009-May 2010 Emily Mosites, MPH TNDOH, CEDS. Tennessee Georgia Connecticut Oregon California. Colorado New Mexico Maryland Minnesota New York. Emerging Infections Program (EIP) GBS Surveillance. Guillain-Barré Syndrome (GBS).

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guillain barr syndrome active surveillance

Guillain-Barré SyndromeActive Surveillance

October 2009-May 2010

Emily Mosites, MPH

TNDOH, CEDS

emerging infections program eip gbs surveillance
Tennessee

Georgia

Connecticut

Oregon

California

Colorado

New Mexico

Maryland

Minnesota

New York

Emerging Infections Program (EIP) GBS Surveillance
guillain barr syndrome gbs
Guillain-Barré Syndrome (GBS)
  • Auto-immune disorder
  • Acute onset
  • Ascending generalized paralysis
  • Often unknown cause, but is sometimes associated with recent infection
symptoms
Symptoms
  • Prickling sensation in fingers and toes
  • Weakness in legs that can ascend to upper body
  • Unsteady gait or inability to walk
  • Can involve respiratory system
  • Most patients hospitalized
epidemiology
Epidemiology
  • Estimated background rate: 1-2 cases per 100,000 persons per year
  • Expected in Tennessee: Just over 1 case per week.

GBS Cases Reported in Previous Years

Observed Rate= 0.16 per 100,000 persons per year

surveillance objectives
Surveillance Objectives

Per CDC GBS Surveillance Protocol

  • Rapidly detect potential cases of GBS
  • Produce regular reports on cases of GBS including risk factor information
  • Determine whether vaccination with the H1N1 vaccine is associated with increased risk of GBS
surveillance activities
Surveillance Activities
  • Neurologist/Hospital Network
  • Medical Records Review
  • Patient Interview
neurologist network
Neurologist Network
  • 166 physician offices representing 425 physicians
  • 123 hospitals
  • 80 clinical pharmacies
  • 35 EMG laboratories
network response rates
Network Response Rates
  • 98.5% of network responded at least once since October
  • Average 85% response rate each month
medical records review
Medical Records Review
  • History and Physical
  • Neurology Consult Notes
  • Labs (CSF and EMG)
  • Discharge Summary
case definition
Case Definition

Brighton Clinical Criteria:

Acute onset of bilateral and relatively symmetric flaccid weakness/paralysis of the limbs

and

Decreased or absent deep tendon reflexes

and

Monophasic illness pattern with weakness nadir reached between 12 hours and 28 days

and

Absence of an alternative diagnosis

laboratory confirmation
Laboratory Confirmation

Electromyography (EMG):

Abnormal nerve conduction in limbs

or

Cerebrospinal Fluid (CSF) Protein:

Elevated protein level without elevated white blood cell count.

patient interview
Patient Interview
  • Illness within 6 weeks before onset
  • Vaccination this season
  • Medical history

Preliminary response rate: 87.5% of cases contacted

tennessee data
Tennessee Data

98 cases referred

12 out of jurisdiction (MS, GA, KY, etc)

21 GBS note in medical history

10 under evaluation

23 did not meet Brighton Criteria

29 CONFIRMED, 3 PROBABLE CASES

~ 1.3 cases per week

confirmed and probable case antecedent events tennessee compared to other eip sites19
Confirmed and probable case antecedent events: Tennessee compared to other EIP sites

Tennessee H1N1 Vaccination Coverage Estimate

(thru Jan, 2010):

Under 18: 34.5%

18 and over: 19.5%

Interim Report, CDC, MMWR, April 2, 2010 / 59(12);363-368

conclusions
Conclusions
  • Network responsiveness high
  • Observed matches expected rate of GBS cases per week
  • No increasing trend or major fluctuations in reported cases
acknowledgments
Acknowledgments

TN Neurologists, EMG labs, clinical

pharmacists, and HIM departments

TN Regional Health Offices

Rendi Murphree, PhD

David Kirschke, MD

CDC GBS Surveillance Coordinators