Estimated incubation period for mosquito-borne disease-related Guillain-Barre syndrome

Abstract

PurposeGuillain-Barre syndrome (GBS) is a rare post-infectious peripheral polyneuropathy. Following the Zika virus epidemic in 2016, the WHO called for understanding Zika associated GBS through epidemiological studies. However, the incubation period of GBS remains little known and its characterisation is needed. MethodsArticles reporting the data of lag time between the symptom onset of Chikungunya or Zika and GBS were included for pooled analysis. Maximum likelihood estimation was adopted to estimate the incubation period distribution of GBS conditioned to that of the antecedent infection. ResultsA total of 89 Chikungunya- and Zika-related GBS cases from 23 articles were identified. The incubation period distribution of GBS is lognormal distributed with the median of 13–14 days and does not depend on the antecedent infection. ConclusionsThe incubation period of GBS follows Sartwell's model. It should be useful in confirming the association between infection and GBS in epidemiologic studies as well as to assist diagnosis and prognosis such as clinically assessing respiratory failure. It is also found that viral symptoms can occur prior to neurological symptoms, suggesting that GBS may be a parainfectious disease.