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Binational outbreak of Guillain–Barré syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011

  • B. R. JACKSON (a1), J. ALOMÍA ZEGARRA (a2), H. LÓPEZ-GATELL (a3), J. SEJVAR (a1), F. ARZATE (a4), S. WATERMAN (a1), A. SÁNCHEZ NÚÑEZ (a5), B. LÓPEZ (a6), J. WEISS (a7), R. QUINTERO CRUZ (a2), D. Y. LÓPEZ MURRIETA (a4), R. LUNA-GIERKE (a1) (a8), K. HEIMAN (a1) (a8), A. R. VIEIRA (a1), C. FITZGERALD (a1), P. KWAN (a1), M. ZÁRATE-BERMÚDEZ (a1), D. TALKINGTON (a1), V. R. HILL (a1) and B. MAHON (a1)...

In June 2011, a cluster of suspected cases of Guillain–Barré syndrome (GBS), which can follow Campylobacter jejuni infection, was identified in San Luis Río Colorado (SLRC), Sonora, Mexico and Yuma County, Arizona, USA. An outbreak investigation identified 26 patients (18 from Sonora, eight from Arizona) with onset of GBS 4 May–21 July 2011, exceeding the expected number of cases (n = 1–2). Twenty-one (81%) patients reported antecedent diarrhoea, and 61% of 18 patients tested were seropositive for C. jejuni IgM antibodies. In a case-control study matched on age group, sex, ethnicity, and neighbourhood of residence, all Arizona GBS patients travelled to SLRC during the exposure period vs. 45% of matched controls (matched odds ratio 8·1, 95% confidence interval 1·5–∞). Exposure information and an environmental assessment suggested that GBS cases resulted from a large outbreak of C. jejuni infection from inadequately disinfected tap water in SLRC. Binational collaboration was essential in investigating this cross-border GBS outbreak, the first in mainland North America since 1976.

Corresponding author
*Author for correspondence: Dr B. R. Jackson, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A38, Atlanta, GA 30333, USA. (Email:
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1. JJSejvar , Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology 2011; 36: 123133.

2. PFrenzen . Economic cost of Guillain-Barré syndrome in the United States. Neurology 2008; 71: 2127.

3. EScallan , Foodborne illness acquired in the United States – major pathogens. Emerging Infectious Diseases 2011; 17: 715.

4. NYuki , H-PHartung . Guillain–Barré syndrome. New England Journal of Medicine 2012; 366: 22942304.

5. INachamkin , Patterns of Guillain-Barré syndrome in children. Neurology 2007; 69: 16651671.

6.J Drenthen , Guillain–Barré syndrome subtypes related to Campylobacter infection. Journal of Neurology, Neurosurgery & Psychiatry 2011; 82: 300305.

7.BC Jacobs , Serum anti-GQ1b IgG antibodies recognize surface epitopes on Campylobacter jejuni from patients with Miller Fisher syndrome. Annals of Neurology 1995; 37: 260264.

8.E Taylor , Common source outbreaks of Campylobacter infection in the USA, 1997–2008. Epidemiology and Infection 2012; 1: 110.

9.J Calva , Cohort study of intestinal infection with Campylobacter in Mexican children. The Lancet 1988; 331: 503506.

10.J Engberg , Water-borne Campylobacter jejuni infection in a Danish town – a 6-week continuous source outbreak. Clinical Microbiology and Infection 1998; 4: 648656.

11. MLHanninen , Detection and typing of Campylobacter jejuni and Campylobacter coli and analysis of indicator organisms in three waterborne outbreaks in Finland. Applied and Environmental Microbiology 2003; 69: 13911396.

14.JE Kaplan , Simultaneous outbreaks of Guillain-Barré syndrome and Bell's palsy in Hawaii in 1981. Journal of the American Medical Association 1983; 250: 26352640.

17.KS Kohl , Assessment of public health events through International Health Regulations, United States, 2007–2011. Emerging Infectious Diseases 2012; 18: 10471053.

18. JJSejvar , Guillain-Barré syndrome and Fisher syndrome: Case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011; 29: 599612.

19. CMSmith , VRHill . Dead-end hollow-fiber ultrafiltration for recovery of diverse microbes from water. Applied and Environmental Microbiology 2009; 75: 52845289.

20. CFitzgerald , INachamkin . Campylobacter and Arcobacter . In: JVersalovic , KCCarroll , GFunke , JHJorgensen , MLLandry , DWWarnock , eds. Manual of Clinical Microbiology, 10th edn. Washington, D.C., USA: ASM Press 2011, pp. 885889.

21. TJBarrett , CMPatton , GKMorris . Differentiation of Campylobacter species using phenotypic characterization. Laboratory Medicine 1988; 19: 96102.

22. DLinton , ROwen , JStanley . Rapid identification by PCR of the genus Campylobacter and of five Campylobacter species enteropathogenic for man and animals. Research in Microbiology 1996; 147: 707718.

24. EMRibot , Rapid pulsed-field gel electrophoresis protocol for subtyping of Campylobacter jejuni . Journal of Clinical Microbiology 2001; 39: 18891894.

25. KEDingle , Multilocus sequence typing system for Campylobacter jejuni . Journal of Clinical Microbiology 2001; 39: 1423.

26.International Organization for Standardization. ISO 17995:2005. Water quality – Detection and enumeration of thermotolerant Campylobacter species. Geneva: International Organization for Standardization, 2005.

29. MTakahashi , Epidemiology of Campylobacter jejuni isolated from patients with Guillain-Barré and Fisher syndromes in Japan. Journal of Clinical Microbiology 2005; 43: 335339.

30.P Koenraad , F Rombouts , S Notermans . Epidemiological aspects of thermophilic Campylobacter in water-related environments: a review. Water Environment Research 1997; 69: 5263.

31. KJones . Campylobacters in water, sewage and the environment. Journal of Applied Microbiology 2001; 90 (Suppl. 6): 68S79S.32.

32. Environmental Protection Agency. ( Expansion of Wastewater Collection and Conveyance Systems (PIMAS III), San Luis Rio Colorado, Sonora, Mexico. Accessed 12 April 2013.

33.M Kuusi , An outbreak of gastroenteritis from a non-chlorinated community water supply. Journal of Epidemiology and Community Health 2004; 58: 273277.

34. KStanley , RCunningham , KJones . Isolation of Campylobacter jejuni from groundwater. Journal of Applied Microbiology 1998; 85: 187191.

35.FC Curriero , The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948–1994. American Journal of Public Health 2001; 91: 11941199.

36. BGWeniger , An outbreak of waterborne giardiasis associated with heavy water runoff due to warm weather and volcanic ashfall. American Journal of Public Health 1983; 73: 868872.

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Epidemiology & Infection
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