Zika virus risks creating outbreak of Guillian-Barré
The spread of the Zika virus has resulted in a rise in cases of Guillain-Barré syndrome (GBS), which can cause progressive paralysis. With a Zika outbreak set to affect the US, and the possibility - based on a French Guyana outbreak - of up to 30,000 cases of Zika-associated GBS, the World Health Organization has issued guidelines to US hospitals. It suggests additional training for staff to spot the early signs of GBS including limb weakness, increased monitoring of diagnosed patients in case of complications such as deep vein thrombosis, occupational therapy upon recovery, and a campaign to "demystify" GBS in the eyes of the media.

An epidemic of GBS associated with Zika virus would stress hospital and intensive care resources nationally. Each hospital located in an area at risk for transmission of Zika should evaluate its ability to provide optimal monitoring and supportive care for patients with GBS. This may require enhanced education of nurses in the neurological examination, increased staffing of respiratory therapists, plans for emergency expansion of available intensive care beds, and assessment of available local and regional expertise. A recent disaster preparedness study estimated that US hospitals could absorb 26 200 to 56 300 mechanical ventilators in addition to those already in use, but only with exhaustive planning prior to the pandemic.

CHALLENGE 3: ACUTE TREATMENT

Intravenous immunoglobulin (IVIg) and plasmapheresis represent the 2 evidence-based acute treatments for GBS. Guidelines developed by the American Academy of Neurology suggest that these 2 therapies have equivalent efficacy, and receiving both does not confer additional benefit.