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Epidemiol Infect. 2014 May;142(5):1089-99. doi: 10.1017/S0950268813001908. Epub 2013 Aug 7.

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

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Centers for Disease Control and Prevention, Atlanta, GA, USA.
Unidad de Vigilancia Epidemiologica, Hermosillo, Sonora, Mexico.
Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
Dirección General de Epidemiología, Mexico City, Mexico.
Servicios de Salud, San Luis Río Colorado, Sonora, Mexico.
Yuma County Health Department, Yuma, AZ, USA.
Arizona Department of Health Services, Phoenix, AZ, USA.


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.

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