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Guillain-Barré syndrome and antecedent cytomegalovirus infection, USA 2009–2015

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Abstract

Objective

To describe incidence and clinical characteristics of cases of Guillain-Barré syndrome (GBS) in the USA during 2009–2015, and characteristics of GBS cases with antecedent cytomegalovirus (CMV) infection among persons with employer-sponsored insurance.

Methods

We analyzed medical claims from IBM Watson MarketScan® databases. GBS patients were defined as enrollees with an inpatient claim with GBS as the principal diagnosis code, based on ICD-9 or ICD-10, and ≥ 1 claim for lumbar puncture or EMG/nerve conduction study. We assessed intensive care unit (ICU) hospitalization, intubation, dysautonomia, and death. We also assessed selected infectious illness within 60 days prior to the first GBS-coded inpatient claim.

Results

We identified 3486 GBS patients; annual incidence was 1.0–1.2/100,000 persons during 2009–2015. GBS incidence was higher in males (1.2/100,000) than in females (0.9/100,000) (p = 0.006) and increased with age, from 0.4/100,000 in persons 0–17 years old to 2.1/100,000 in persons ≥ 65 years old (p < 0.001). Half of GBS patients were hospitalized in the ICU, 8% were intubated, 2% developed dysautonomia, and 1% died. Half had a claim for antecedent illness, but only 125 (3.5%) had a claim for specific infectious pathogens. The mean age among 18 GBS patients with antecedent CMV infection was 39 years versus 47 years among those without antecedent  CMV infection (p = 0.038).

Conclusions

Incidence of GBS using a large national claims database was comparable to that reported in the literature, but cases appeared to be less severe. Half of GBS patients reported prior infectious illness, but only a minority had a specific pathogen identified.

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Acknowledgments

We thank Mary Ann Hall for her editorial assistance and thoughtful review of the paper.

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Authors and Affiliations

  1. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30333, USA

    Jessica Leung & Tatiana M. Lanzieri

  2. Division of High-Consequence Pathogens and Pathology, Prion and Public Health Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

    James J. Sejvar & Jesus Soares

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  1. Jessica Leung
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Correspondence to Jessica Leung.

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This analysis only included deidentified data; it was therefore deemed by the Centers for Disease Control and Prevention (CDC) not to be human subject research and it did not require CDC’s Institutional Review Board approval.

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The authors declare that they have no conflict of interest.

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This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Leung, J., Sejvar, J.J., Soares, J. et al. Guillain-Barré syndrome and antecedent cytomegalovirus infection, USA 2009–2015. Neurol Sci 41, 885–891 (2020). https://doi.org/10.1007/s10072-019-04156-z

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