A lesson learnt from the emergence of Zika virus: What flaviviruses can trigger Guillain-Barre syndrome?

While Zika virus outbreaks raised the concern about rare viral infections in human, attention should also be paid to other Guillain-Barre syndrome (GBS) inducing viruses. This study aims to search for other flaviviruses likely to be associated with GBS. Amino acid (aa) sequence matching analysis was conducted to identify viruses molecularly similar to the Zika virus and human GBS-related proteins. A systematic review of clinical literature was performed to summarize the clinical findings of the GBS-associated flaviviruses identified in the aa sequence matching analysis. It was found that more than 10 pentapeptides were shared between 9 flaviviruses, Zika virus, and human GBS-related proteins. Twenty-six articles totaling 42 clinical cases were eligible for inclusion in the systematic review concerning the nine flaviviruses identified. While some patients showed signs of encephalitis, 5 out of 42 cases demonstrated typical GBS symptoms. Public health professionals should be aware of other GBS-associated flaviviruses and GBS cases with mild symptoms.