CBC
It was in early January that Awanti Naik's symptoms first crept up on her, starting with double vision and quickly followed by a debilitating headache and a strange feeling in her face. "There was heaviness in my jaw and eyes, and my throat was completely blocked," she said. "I was very much worried." She and her husband rushed to hospital where she spent 12 days in intensive care, attached to an IV for food since she couldn't speak or swallow. Naik, a public school teacher, said she tried to communicate with the doctors to find out if she would ever recover from her facial paralysis. "I thought, 'I don't want to live like this. I don't want to live with double vision,'" Naik, 40, told CBC News from her home in Pune, a city in India's western Maharashtra state, where she is slowly recovering.She was diagnosed with Guillain-Barré syndrome, or GBS, a rare autoimmune disorder in which the body's immune system attacks its nerves, causing muscle weakness and varying degrees of paralysis. 32 still in intensive careNaik's is one of 212 confirmed cases of GBS in Pune as of Thursday, all part of an outbreak that continues to see new patients diagnosed in a city that has rapidly grown as it's become an education and information technology hub.As of Thursday afternoon, 11 people there had died, two in the previous 48 hours, according to Pune city officials. More than a dozen patients are on ventilators, with 32 still in intensive care.This Jan. 12, 2013, photo shows an employee working at a poultry farm in Koregaon Mul village, some 30 kilometres from the western Indian city of Pune, where there is currently an outbreak of Guillain-Barré syndrome. Though GBS cases are often linked to undercooked chicken, Indian officials believe that water contamination is the main source of this outbreak. (Punit Paranjpe/AFP via Getty Images)Once the nature of the outbreak was identified, local authorities worked quickly to free up beds at government hospitals and cover costs, said Dr. Ameet Dravid, an infectious disease specialist at the privately run Poona Hospital. But the initial days of the outbreak in early January, when many patients arrived at ERs with severe diarrhea and creeping paralysis, were filled with confusion. "From one GBS case a month per hospital, we were going to six a week" in each of the three hospitals within a confined area of Pune, said Dravid, who treated and monitored several of the patients."That was the first suspicion that something was wrong." Authorities analyzed bodily fluids from patients and traced the outbreak to a pathogen called campylobacter jejuni, which is a common cause of foodborne illness and is considered the main type of bacteria to cause GBS around the world. But the disorder is rare because only a specific strain of campylobacter jejuni, which has an outer layer that mimics the structure of nerve cells, actually leads to the autoimmune disease developing. The outer layer around this particular strain of the pathogen fools the body's immune system into killing its nerve cells alongside the bacteria, causing paralysis in the patient. Challenges in treatmentThe World Health Organization has sent teams to Pune to help local health workers trace and monitor cases in the affected area to make sure "every suspected case is identified, diagnosed and treated," it said in a release. GBS is notoriously difficult to diagnose, especially for doctors in remote parts of India, because it requires specialized testing kits. "If this had happened in a rural area, it would have been very tough to diagnose these GBS cases," Dravid told CBC News from his private clinic, adding he was thankful that the patients were admitted to hospitals where there were qualified neurologists available to help identify the cause of the paralysis. Dr. Ameet Dravid, an infectious disease specialist at the privately run Poona Hospital. (Salimah Shivji/CBC)After extensive tests on more than 6,000 water samples, officials traced the likely source of the pathogen, which made so many sick with severe diarrhea, to contaminated wells and multiple other sources of water. They believe the bacterial contamination got into the water supply in the area where the outbreak is concentrated, but do not know how it occurred.'We need to wake up'Health officials in Pune, along with Maharashtra state authorities, have repeatedly told residents not to panic, adding that measures to control the contamination are in place though those measures are unclear.There were also concerns at first that traces of the pathogen were found in raw chicken, but officials said multiple samples turned up negative. Experts believe if poultry was carrying the pathogen, it could have been after it was washed with water containing the bacteria. "This is a public health failure," said Dravid. "We need to wake up."WATCH | Dozens still in hospital after GBS outbreak: The extent of the outbreak points to a larger problem across a rapidly developing India, but one that is particularly acute in Pune, one of the country's fastest growing cities with many moving to the area for job opportunities in the IT sector: Water purification facilities and other public health measures have not kept up with the pace of urbanization, the doctor said. "There is now growing clamour that public health needs to be given more importance," Dravid said, particularly as Pune also saw a record-high number of dengue cases last year, during a very wet monsoon season. The mosquito-borne viral disease is also a significant public health concern, as it can cause prolonged health issues and its annual mortality rate is rising. Last year was the worst on record for worldwide dengue cases. As for GBS, the recovery rate is quite high — usually about 95 per cent, though degrees of recovery vary. But the complication is that there is no cure and treatment is expensive.After the initial immune attack prompts muscle weakness and creeping paralysis, GBS patients generally require time and significant physiotherapy to repair nerve damage. A substantial number of Dravid's patients still have weakness in their limbs or symptoms like tingling and numbness, and others are using wheelchairs to avoid falling. "That is the real cost of this war, which we have fought in the last month." Long-term effectsNaik and her family are feeling the costs associated with her illness — she is still plagued with double vision and unable to teach.She has temporarily lost her income as she tries to recover; her mother has moved into her house to help with daily tasks while she's on sick leave. "[Our] finances were in crisis because the treatment is very, very expensive," Naik said, with her medical insurance not covering the full cost and hospital staff demanding the remaining payment before administering her medicine. The state government began covering the cost of treatment for patients in government hospitals, not private ones, in late January. She said she tries to keep a positive outlook for her 16-year-old daughter. But mostly, there's anxiety over her vision and the state of the water she and her family have access to. "I'm very scared to even drink water or eat any fruits or vegetables. I don't know, is it safe?"
