Escalating ICU and Ventilator Burden in Pune, India’s GBS Outbreak: Need for Strengthened Public Health Preparedness

Shubhangi KanitkarKritika Soni^*

• Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India

Dear Editor, Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy often triggered by preceding infections such as Campylobacter jejuni. The pathophysiology involves autoimmune cross-reactivity where antibodies target components of peripheral nerves, leading to demyelination or axonal damage. Clinically, GBS presents with rapidly progressive, symmetrical muscle weakness, areflexia, and, in severe cases, respiratory failure requiring ventilatory support. Complications may include autonomic instability, deep vein thrombosis, nosocomial infections, and prolonged neuromuscular disability. The mainstay of treatment includes intravenous immunoglobulin (IVIG) or plasma exchange (PLEX), both aimed at halting immune-mediated nerve injury. Early recognition, meticulous supportive care, and timely immunotherapy are critical for reducing morbidity and mortality. The rise in Guillain-Barré Syndrome (GBS) cases in Pune, India, highlights the urgent need for effective public health response strategies. As of February 2, 2025, the city reported 158 GBS cases. On that date, 48 patients were in intensive care units (ICUs), down from 83 the previous day, and 21 patients were on ventilator support, reduced from 28. Additionally, 38 individuals had been discharged, and the death toll stood at five [1]. In January 2025, out of 70 suspected GBS patients in Pune district, 44 were admitted to ICUs. Among these, 14 patients required ventilator support, and 30 were on oxygen therapy [2]. WHO provided technical and on-ground support to the treating teams at Pune, India. This extended need for intensive care has placed a strain on healthcare facilities at Pune. This unusual outbreak calls for a thorough assessment of its epidemiological trends, the efficacy of response measures taken so far, and the development of strategic recommendations to improve future preparedness. Epidemiological Overview The outbreak appears to have originated in the Nandedgaon area of Pune, with surrounding regions like Kirkatwadi, Sinhagad Road, and Khadakwasla also experiencing cases. Investigations suggest that contamination of the local water supply with Campylobacter jejuni is a likely factor contributing to widespread infections. This bacterium is a known trigger for GBS, emphasizing the critical role of water quality surveillance in preventing such public health emergencies [3, 4]. Response Measures Implemented In reaction to the crisis, the Pune Municipal Corporation (PMC), in collaboration with state health authorities, has introduced several key interventions [5-7]: •Medical Assistance and Treatment: To ensure timely care, immunoglobulin injections are being provided free of cost in both public and private hospitals. This initiative aims to remove financial barriers that could prevent patients from accessing essential treatment. •Public Health Initiatives: Authorities have intensified efforts to promote hand and food hygiene while ensuring the availability of safe drinking water. These measures are crucial in addressing the underlying cause of the outbreak and curbing further spread. •Surveillance and Epidemiological Investigations: Rapid Response Teams (RRTs) have been mobilized to conduct in-depth epidemiological assessments, track outbreak patterns, and pinpoint possible triggers. This proactive approach allows for timely intervention and data-driven decision-making. •Collaboration with International Organizations: The World Health Organization (WHO) has been actively supporting local health agencies by offering technical guidance and on-the-ground assistance. Their contributions include training healthcare professionals, conducting active case surveillance, and verifying household screenings to ensure comprehensive case identification and management. Institutional ICU Responses in State To address the outbreak, the Pune Municipal Corporation (PMC), in collaboration with state and central health authorities, implemented a multi-pronged emergency response. Public health campaigns were intensified to raise awareness on proper hand and food hygiene, while targeted interventions were launched to ensure safe water supply in the affected localities. Rapid Response Teams (RRTs) were mobilized for epidemiological surveillance, source tracking, and real-time case monitoring. Additionally, the World Health Organization (WHO) provided crucial technical guidance and on-site support, including the training of healthcare personnel, implementation of active case surveillance, and coordination of household-level screenings to enhance early detection and containment efforts. Recommendations for Future Preparedness The GBS outbreak in Pune provides crucial lessons for strengthening responses to similar public health threats [3-7]: •Enhancing Disease Surveillance: Establishing strong surveillance systems at the community level is vital for the early detection of health anomalies. Routine monitoring of water sources and food safety measures can help identify potential risks before they escalate into full-blown outbreaks. •Public Awareness and Education: Spreading awareness about proper hygiene practices—such as thorough handwashing and safe food consumption—can significantly lower infection risks linked to GBS. Educational campaigns should be culturally relevant and disseminated through multiple media channels for maximum reach. •Infrastructure Improvements: Investing in reliable water supply systems and adequate sanitation infrastructure is crucial for preventing waterborne infections. Routine inspections and maintenance of water sources can help minimize contamination incidents. •Healthcare Training and Capacity Building: Equipping medical personnel with the knowledge to recognize early signs of GBS and other neurological disorders is key to ensuring swift diagnosis and treatment. Ongoing training sessions and workshops can keep healthcare workers updated on the latest clinical management guidelines. •Developing Emergency Response Frameworks: Establishing well-defined emergency response protocols, including clear outbreak investigation procedures, resource distribution strategies, and inter-agency coordination plans, can significantly improve response efficiency in future public health crises. •In light of the challenges observed during the GBS outbreak in Pune, we propose a set of forward-looking, context-specific recommendations to enhance public health preparedness. First, mobile neuro-response teams should be established at the district level to ensure rapid deployment during neurological outbreak clusters, enabling early triage, diagnosis, and care coordination. Second, the development of real-time ICU monitoring dashboards & AI assisted triage linked to district health command centers can streamline resource allocation, track bed occupancy, and anticipate ventilator demand during surges. Finally, targeted neurocritical care training modules should be instituted for general duty doctors and emergency staff, equipping them with essential skills for early recognition and initial stabilization of GBS and other neuro-emergencies in resource-constrained settings. These interventions—grounded in field realities and scalable across regions—can significantly bolster preparedness for future neuro-infectious public health threats. Conclusions The GBS outbreak in Pune underscores the necessity of a comprehensive approach to public health preparedness. By drawing lessons from this event and implementing the suggested measures, health systems can be better positioned to prevent, detect, and respond effectively to similar outbreaks in the future. References 1. Pune adds nine cases of Guillain Barre Syndrome, Tally at 158. Available from: https://timesofindia.indiatimes.com/city/pune/pune-adds-nine-cases-of-guillain-barr-syndrome-tally-at-158-who-teams-on-ground-to-help/articleshow/117867279.cms 2. 30 suspected GBC cases on oxygen. Available from: https://www.hindustantimes.com/cities/pune-news/30-suspected-gbs-cases-on-oxygen-14-on-ventilator-support-in-pune-101737745335978.html 3. World Health Organization. WHO assists response to Guillain-Barré Syndrome in Pune. Available from: https://www.who.int/india/news/feature-stories/detail/who-assists-response-to-guillain-barr–syndrome-in-pune 4. Vax-Before-Travel. Pune’s Guillain-Barré Syndrome Cases Cause Traveler Concerns. Available from: https://www.vax-before-travel.com/punes-guillain-barre-syndrome-cases-cause-traveler-concerns-2025-02-01 5. Bloomberg. Paralyzing Disorder GBS Spreads in India’s Pune in Rare Outbreak. Available from: https://www.bloomberg.com/news/articles/2025-02-10/paralyzing-disorder-gbs-spreads-in-india-s-pune-in-rare-outbreak 6. The Indian Express. Guillain Barre Syndrome cases rise to 207: Over half of cases are in Sinhagad Road area. Available from: https://indianexpress.com/article/cities/pune/guillain-barre-syndrome-cases-rise-to-207-pune-health-dept-data-hints-at-c-jejuni-bacteria-as-major-trigger-for-outbreak-9836812/ 7. Hindustan Times. Central govt issues guidelines for GBS management in Maharashtra. Available from: https://www.hindustantimes.com/cities/pune-news/central-govt-issues-guidelines-for-gbs-management-in-maharashtra-101738868542007.html