Guillain-Barré Syndrome (GBS) is a rare autoimmune disorder causing weakness, numbness, or paralysis. While most recover, severe cases need ICU care. In Maharashtra, particularly Pune, the outbreak, which began on 9 January, has exceeded 200 cases
Published Feb 12, 2025 | 7:00 AM ⚊ Updated Feb 12, 2025 | 7:00 AM
Synopsis: Maharashtra is grappling with a surge in Guillain-Barré Syndrome (GBS) cases, with Pune as the epicenter. As of 11 February, there are 192 suspected cases, 167 confirmed, and seven deaths. 48 patients are in intensive care, 21 on ventilators. The outbreak, linked to contaminated water sources, began in early January, and GBS is causing nerve damage, leading to weakness and paralysis.
Maharashtra is battling an alarming outbreak of Guillain-Barré Syndrome (GBS), a rare autoimmune disorder, with Pune emerging as the epicenter.
As of Tuesday, 11 February the state health authorities reported 192 suspected cases, 167 confirmed infections, and seven fatalities, while 48 patients remain in intensive care—21 relying on ventilators. The outbreak has been traced to contaminated water sources.
GBS is a rare autoimmune disorder where the body attacks its peripheral nerves, leading to weakness, numbness, or paralysis. Most patients recover, but severe cases require ICU care.
In Maharashtra, particularly in Pune and its surrounding areas, an outbreak started on 9 January. Initially, patients started coming to various hospitals in Pune and nearby regions, and within a month, the number of cases crossed 200.
The two common types of infections that can trigger GBS are respiratory infections and gastrointestinal infections.
These symptoms usually last three to four days, and the infection itself resolves. However, for GBS to develop, the person’s immune system must be strong enough to fight the infection first.
“Interestingly, people with very weak immune systems, such as those with uncontrolled diabetes or on immunosuppressive drugs, may not develop GBS because their immune response isn’t robust enough to trigger the condition,” said Hyderabad based Neurologist Dr Sudhir Kumar to South First. “This is why GBS is seen more commonly in healthy individuals. In Pune’s outbreak, nearly 80 percent of affected individuals were under 50 years old, with the majority being young, otherwise healthy people. However, GBS can occur at any age, including in children and the elderly.”
“However, it is important to understand that GBS itself is not an infection. Many people mistakenly believe that GBS spreads like an infection, but that is not the case,” he said.
What happens is that a person gets infected with a pathogen, and the body mounts an immune response to fight it. This immune response is usually protective, but in a small number of people, it turns abnormal and starts attacking their own nervous system. This is what leads to GBS.
“So essentially, GBS is a post-infectious immune-mediated neurological disorder. The antibodies, which are meant to fight infections, mistakenly identify the nervous system as foreign and start attacking it. In GBS, the peripheral nervous system is affected. There is typically a gap of one to two weeks between the initial infection and the onset of neurological symptoms,” said Dr Kumar.
Health investigators have identified Campylobacter jejuni, a foodborne bacterium, as the primary trigger. Known to cause gastrointestinal infections that may escalate into GBS, the pathogen has been detected in water from several reverse osmosis (RO) plants in Pune.
These facilities, designed to purify water, were found distributing tainted supplies. Tests revealed high levels of Escherichia coli (E. coli), signaling fecal contamination, alongside C. jejuni.
In Pune outbreak, it was due to a gastrointestinal infection caused by Campylobacter jejuni. Most affected individuals had a history of diarrhea, blood in stools, and abdominal cramps about a week before they started developing neurological symptoms. Stool samples were tested, and as per the Pune municipal authorities, out of 70 samples tested, 26 showed the presence of Campylobacter jejuni, confirming the link.
“This bacterium spreads through ingestion—either through food or water contaminated with fecal matter from an infected person. Common sources include undercooked meat, but in this outbreak, the primary mode of transmission was contaminated water,” said Dr Kumar.
The suspected cause was sewage contamination of a drinking water source. Municipal authorities acknowledged that water from this well was distributed without proper chlorination. Water sample testing later revealed that 30-40 percent of the collected samples lacked any chlorine. Thus, it is likely that people consuming this contaminated water became infected.
Despite advanced RO filtration systems, Campylobacter jejuni managed to survive and spread through water supply through several sophisticated adaptations. The bacteria formed protective biofilms on pipe surfaces, creating a shield against disinfectants. It found unexpected allies in water-dwelling amoebae, which provided shelter from harsh conditions.
Also, C. jejuni’s ability to survive in cold temperatures allowed it to persist for weeks in storage tanks at 4°C. Some strains even developed resistance to oxygen-rich environments, typically lethal to these bacteria. This combination of survival mechanisms enabled the pathogen to bypass water treatment systems and reach consumers, leading to the severe GBS outbreak.
“It is not inherently lethal. Most people who contract it experience only a short-term gastrointestinal illness with diarrhea and recover without complications. However, in about 1 out of 1000 cases, the immune response triggered by the infection leads to GBS,” said Dr Kumar.
He said that in Pune, approximately 200 people developed GBS, meaning thousands more were likely infected but did not progress to GBS. Since most cases of mild diarrhea do not result in hospital visits, we do not have an exact number of total infections. But based on past outbreaks, we estimate that for every one person who develops GBS, around 1000 were infected with Campylobacter jejuni.
Dr Kumar pointed out that GBS does not spread like a viral infection. It is not contagious. The infection that triggers GBS, in this case Campylobacter jejuni, spreads through contaminated water or food. GBS is not contagious. It is an autoimmune response triggered by an infection. The infection that caused the outbreak in Pune spread through contaminated water, but once the water supply issue is addressed, the outbreak will end. GBS cases may continue to appear sporadically, but there is no risk of an epidemic spreading beyond the affected area.
“Since the source of contamination in Pune was a specific water supply, the outbreak remains geographically confined. “Additionally, by the time a person develops GBS, they have already cleared the infection, meaning they are no longer contagious. The immune response that causes GBS happens after the infection is gone. So, there is no risk of person-to-person transmission,” said Dr Kumar.
These reports are misleading. GBS cases occur regularly across India. For example, in Hyderabad alone, neurologists see around 40-50 GBS cases every month. So, when the media reports a ‘first case’ in a particular city, it is often because they are unaware that GBS has always been present. It is not a new disease.”
“During the COVID-19 pandemic, we saw a slight increase in GBS cases because viral infections, including influenza and COVID-19, can also trigger it. However, the current outbreak in Pune is specific to Campylobacter jejuni and confined to a particular region,” he said.
Treatment for GBS includes intravenous immunoglobulin (IVIG) and plasma exchange. These are expensive treatments but effective. With proper medical care, around 95 percent of patients recover, though they may require physiotherapy for 3-6 months to regain full strength.”
“In Pune, out of approximately 200 cases, only about 10 deaths have been reported. This aligns with the expected mortality rate of around 5 percent. Most fatalities occur in patients who develop autonomic dysfunction, where the body’s ability to regulate blood pressure and heart rate becomes compromised. If patients receive timely ventilator support and treatment, their chances of survival and recovery are high,” said Dr Kumar.
(Edited by Ananya Rao)
