'We've Complained About Water Quality But...': Locals Amid GBS Outbreak in Pune

Contaminated water is at the heart of this unusual outbreak of GBS, a potentially fatal neuropathic condition.

What has baffled experts is that GBS is a rare neurological condition, typically affecting just 1 in 100,000 people globally each year.

(Photo: Aroop Mishra/The Quint)

Avinash Lagade’s four-year-old nephew is discharged from the ICU on the same day The Quint speaks with him.

“He has completely lost sensation in his lower body. He was in the ICU for six days, but thankfully he’s improving.”

While Avinash's nephew is recovering slowly due to timely treatment, at least 13 others in his town of Nanded in Maharashtra remain on ventilator support – and two have died.

According to Maharashtra state health officials, as of 3 February, suspected cases of Guillain-Barré Syndrome (GBS) in the state have reached 158, and the suspected death toll is five, with most cases concentrated in and around Pune.

What has baffled experts is that GBS is a rare neurological condition, typically affecting just 1 in 100,000 people globally each year.

"In a matter of weeks, we have seen a significant rise in cases, raising serious concerns."

Piyush Chaudhari, an infectious disease specialist at Jehangir Hospital in Pune

At the heart of this unusual outbreak of this potentially fatal neuropathic condition may be a basic – and avoidable – issue: contaminated drinking water and poor sanitation.

The Outbreak

Speaking to The Quint, Dr Chaudhari explains, "GBS (Guillain-Barré Syndrome) is not an infection; it is a neurological condition caused by a dysregulated immune response that may follow an infection."

He explains,

"In GBS, the immune system, due to the similarity between the molecular structures of our body’s proteins (mainly in neural tissue) and the antigen of the infecting agent, mistakenly attacks our nerve tissue in the same way it would attack the bacteria or virus."

"As the nerves are affected, it leads to neuropathy, causing weakness in the areas controlled by those nerves. Symptoms usually appear two or three weeks after an infection," he adds.

In the past, it's been linked to several bacterial and viral infections, with several cases emerging post-COVID.

Dr Anshu Rohatgi, Senior Consultant Neurologist, Sir Ganga Ram Hospital in Delhi, tells The Quint that some spike in GBS cases happen throughout the year. "COVID and the COVID vaccine have been known to trigger GBS, and we did see many cases of GBS post COVID as well. However, this isn't unique to COVID. Other vaccines and infections can also trigger it. We have also seen Zika virus being linked to GBS in the past."

Basically, when the body is attacked by a pathogen, the antibody response can sometimes get overloaded and misdirected, attacking the nervous system.

However, there is no known comorbidity that predisposes people to GBS.

Dr Chaudhari says, "The question of why some individuals develop a dysregulated immune response leading to GBS remains unclear. The most concerning aspect of GBS is that since it’s not directly caused by the infection itself, there is no way to predict which individual’s immune system will react abnormally. "

Avinash says that others in his family also developed stomach issues, but their condition gradually improved. In the case of his four-year-old nephew, it started with diarrhoea and vomiting but within two days he lost sensation in his arms and legs.

"At first when we tried standing him up, he would cry saying he was in pain. His whole body became weak," he recounts.

"Then he wasn't able to stand at all and kept falling over. He wasn't able to move his legs or toes. This is when we rushed him to the hospital."

Avinash Lagade

Because the outbreak had already been reported by then, Avinash's nephew was given timely treatment.

Dr Chaudhari explains that one common cause for outbreaks has been Campylobacter jejuni, a bacterial gastrointestinal infection, which is typically transmitted through contaminated food and water. This is also the suspected bacteria behind the outbreak in Maharashtra.

Apathy Towards Sanitation

Although health officials have not confirmed it, the prime suspect in the case of the Pune outbreak is contaminated water from a baoli that is the only water source for five towns in Pune district, including Kirkatwadi, Nanded, Kolhewadi, Khadakwasla, and parts of Dhayari.

Speaking to The Quint, Pune Health Officials said samples are being collected, and that investigation is underway.

However, the water quality supplied to these villages, which also happen to be among the first where clusters of cases initially exploded, remains under scrutiny.

Avinash who lives within a 200-meter radius of the baoli says that there is no filtration plant to treat the water that is supplied to all the homes. "We have been complaining about the water quality for 4-5 weeks," he adds.

Rahul Ghule, another local resident who also has a family member down with GBS, says, "The water filtration for our town used to be managed by the gram panchayat, but it came under the Pune Municipal Corporation (PMC) three years ago, and since then nothing has been done."

"We visited the water filtration unit of the corporation... The drainage lines that were put 20 years ago have not been upgraded. The lines have percolated completely. There was no net which they have just installed now after the cases."

Avinash Lagade

Rahul says, "We are still getting the same water. They are just adding a large drum of chlorine to it without proper measurement. We have been told to boil the water and drink."

"The government is not interested in fixing this issue. The state health minister and the MP visited here after the outbreak was reported. They just saw and took pictures and left. We haven't been assured of any relief," he alleges.

"This is a matter of people's lives. What is the point of fixing things after people have died?"

Rahul Ghule

Speaking to The Quint, Pune Municipal Commissioner Rajendra Bhosle said, "This is how it has been for years. The water is treated with chlorine and supplied. This is routine."

When asked about the installation of a proper filtration system, he said, "It has only come under the PMC's jurisdiction in 2021. We have requested for funds in the past as well but haven't got it yet. Upgrading infrastructure is a slow process and it will take time."

Treatment is Possible, But Expensive

GBS itself is a serious illness and it can be fatal if it progresses to the respiratory muscles, which is why the treatment involves keeping the disease from progressing, says Dr Rohatgi.

Dr Chaudhari adds, "If caught within the first one or two days before the condition affects the neck or respiratory muscles, it can help avoid the need for ventilator support due to respiratory muscle paralysis."

Until 30 years ago, there was no treatment for GBS.

"But with IGIV (Intravenous Immunoglobulin) and plasma exchange, it has become a manageable disease."

Dr Anshu Rohatgi

But the catch is that both these treatments are very expensive.

"My nephew's treatment will cost Rs 8 to 10 lakh," says Avinash.

PMC has announced that in an effort to help affected patients receive timely treatment, financial aid will be provided; the IGIV injections will made available free of cost in government and private hospitals; and free treatment will be given at Pune's Kamla Nehru Hospital.

Rahul alleges, "Though they have said we can get free treatment there (Kamala Nehru Hospital), there is no neurologist present in that hospital. We are still waiting for them to do something concrete to tackling this crisis."

(This is a developing story. It will be updated.)