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Guillain-Barré Syndrome Active Surveillance

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-Barré Syndrome Active Surveillance

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  1. Guillain-Barré SyndromeActive Surveillance October 2009-May 2010 Emily Mosites, MPH TNDOH, CEDS

  2. Tennessee Georgia Connecticut Oregon California Colorado New Mexico Maryland Minnesota New York Emerging Infections Program (EIP) GBS Surveillance

  3. Guillain-Barré Syndrome (GBS) • Auto-immune disorder • Acute onset • Ascending generalized paralysis • Often unknown cause, but is sometimes associated with recent infection

  4. 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

  5. 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

  6. 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

  7. Surveillance Activities • Neurologist/Hospital Network • Medical Records Review • Patient Interview

  8. Neurologist Network • 166 physician offices representing 425 physicians • 123 hospitals • 80 clinical pharmacies • 35 EMG laboratories

  9. Network Response Rates • 98.5% of network responded at least once since October • Average 85% response rate each month

  10. Medical Records Review • History and Physical • Neurology Consult Notes • Labs (CSF and EMG) • Discharge Summary

  11. 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

  12. Laboratory Confirmation Electromyography (EMG): Abnormal nerve conduction in limbs or Cerebrospinal Fluid (CSF) Protein: Elevated protein level without elevated white blood cell count.

  13. Patient Interview • Illness within 6 weeks before onset • Vaccination this season • Medical history Preliminary response rate: 87.5% of cases contacted

  14. 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

  15. GBS Case and non-case characteristics

  16. Confirmed and probable case antecedent events: Tennessee compared to other EIP sites

  17. 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

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

  19. Acknowledgments TN Neurologists, EMG labs, clinical pharmacists, and HIM departments TN Regional Health Offices Rendi Murphree, PhD David Kirschke, MD CDC GBS Surveillance Coordinators

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