The Zika virus (ZIKV) outbreak in French Polynesia, in 2013, and in Brazil, in 2015, was correlated with neurological complications, which comprised, among others, congenital microcephaly and Guillain-Barré syndrome (GBS), which includes a group of acute autoimmune neuropathies generally reported after respiratory or gastrointestinal infectious diseases. Despite being relatively rare, the incidence rate of GBS rises with age, which makes GBS more frequent in the elderly, in whom it is also a more severe disease with slower recovery than in younger patients. Different forms of GBS have been described having diagnostic confirmation of a previous infection with the ZIKV virus. Although we do not have enough evidence that elderly people are a particularly susceptible population to developing GBS following ZIKV infection, this is plausible. We should consider this possibility, particularly taking into account that aging subjects are more susceptible to infections. In this context, a deeper understanding of how the immune system in the elderly functions in relation to ZIKV infection is necessary, as well as an understanding of what kind of alterations of the nervous system such an infection triggers in the elderly, beyond GBS. This will be relevant for better therapeutic interventions and for designing vaccine candidates that can be applied in an aging population, particularly those prone to develop ZIKV-induced autoimmunity.

Lessler J, Chaisson L, Kucirka L, Bi Q, Grantz K, Salje H, et al: Assessing the global threat from Zika virus. Science 2016;353:aaf8160.
Basarab M, Bowman C, Aarons EJ, Cropley I: Zika virus. BMJ 2016;352:i1049.
Petersen E, Wilson ME, Touch S, McCloskey B, Mwaba P, Bates M, et al: Unexpected and rapid spread of Zika virus in the Americas - implications for public health preparedness for mass gatherings at the 2016 Brazil Olympic Games. Int J Infect Dis 2016;44:11-15.
Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al: Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 2014;19:20761.
Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM: Potential sexual transmission of Zika virus. Emerg Infect Dis 2015;21:359-361.
Besnard M, Lastère S, Teissier A, Cao-Lormeau V, Musso D: Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill 2014;19:20751.
Calvet G, Aguiarv RS, Melo AS, Sampaio SA, de Filippis I, Fabri A, et al: Detection of Zika virus genome in amniotic fluid of affected fetuses: association with microcephaly outbreak in Brazil. Lancet Infect Dis 2016;16:653-660.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, et al: Zika virus associated with microcephaly. N Engl J Med 2016;374:951-958.
Bonaldo MC, Ribeiro IP, Lima NS, dos Santos AAC, Menezes LSR, da Cruz SOD, et al: Isolation of infective Zika virus from urine and saliva of patients in Brazil. PLoS Negl Trop Dis 2016;10:e0004816.
Brazilian Ministry of Health: Microcefalia: 1.749 casos confirmados no Brasil. 2016. (accessed August 15, 2016).
Brazilian Ministry of Health: Ministério da Saúde investiga aumento de casos de microcefalia em Pernambuco. 2015. (accessed July 6, 2015).
World Health Organization: WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain-Barré syndrome. WHO, 2016. (accessed July 6, 2016).
Muller L, Pawelec G: As we age: does slippage of quality control in the immune system lead to collateral damage? Ageing Res Rev 2015;23:116-123.
Goronzy JJ, Weyand CM: Immune aging and autoimmunity. Cell Mol Life Sci 2012;69:1615-1623.
Jagger A, Shimojima Y, Goronzy JJ, Weyand CM: Regulatory T cells and the immune aging process: a mini-review. Gerontology 2014;60:130-137.
Yang S, Fujikado N, Kolodin D, Benoist C, Mathis D: Immune tolerance. Regulatory T cells generated early in life play a distinct role in maintaining self-tolerance. Science 2015;348:589-594.
Tabibian-Keissar H, Hazanov L, Schiby G, Rosenthal N, Rakovsky A, Michaeli M, et al: Aging affects B-cell antigen receptor repertoire diversity in primary and secondary lymphoid tissues. Eur J Immunol 2016;46:480-492.
Dunn-Walters DK: The ageing human B cell repertoire: a failure of selection? Clin Exp Immunol 2016;183:50-56.
Wakerley BR, Uncini A, Yuki N: Guillain-Barré and Miller Fisher syndromes - new diagnostic classification. Nat Rev Neurol 2014;10:537-544.
Rocha MSG, Brucki SMD, Carvalho AA de S, Lima UWP: Epidemiologic features of Guillain-Barré syndrome in São Paulo, Brazil. Arq Neuropsiquiatr 2004;62:33-37.
van Koningsveld R, Rico R, Gerstenbluth I, Schmitz PI, Ang CW, Merkies IS, et al: Gastroenteritis-associated Guillain-Barré syndrome on the Caribbean island Curaçao. Neurology 2001;56:1467-1472.
Dourado ME, Félix RH, da Silva WKA, Queiroz JW, Jeronimo SMB: Clinical characteristics of Guillain-Barré syndrome in a tropical country: a Brazilian experience. Acta Neurol Scand 2012;125:47-53.
Sejvar JJ, Baughman AL, Wise M, Morgan OW: Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology 2011;36:123-133.
Peric S, Berisavac I, Tamas OS, Rajic S, Babic M, Cvijanovic M, et al: Guillain-Barré syndrome in the elderly. J Peripher Nerv Syst 2016;21:105-110.
van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA: Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-482.
Susuki K, Rasband MN, Tohyama K, Koibuchi K, Okamoto S, Funakoshi K, et al: Anti-GM1 antibodies cause complement-mediated disruption of sodium channel clusters in peripheral motor nerve fibers. J Neurosci 2007;27:3956-3967.
McGonigal R, Rowan EG, Greenshields KN, Halstead SK, Humphreys PD, Rother RP, et al: Anti-GD1a antibodies activate complement and calpain to injure distal motor nodes of Ranvier in mice. Brain 2010;133:1944-1960.
Yuki N, Hartung H-P: Guillain-Barré syndrome. N Engl J Med 2012;366:2294-2304.
Hafer-Macko CE, Sheikh KA, Li CY, Ho TW, Cornblath DR, McKhann GM, et al: Immune attack on the Schwann cell surface in acute inflammatory demyelinating polyneuropathy. Ann Neurol 1996;39:625-635.
Willison HJ, Jacobs BC, van Doorn PA: Guillain-Barré syndrome. Lancet 2016;388:717-727.
Schmidt B, Toyka K V, Kiefer R, Full J, Hartung HP, Pollard J: Inflammatory infiltrates in sural nerve biopsies in Guillain-Barre syndrome and chronic inflammatory demyelinating neuropathy. Muscle Nerve 1996;19:474-487.
Harness J, McCombe PA: Increased levels of activated T-cells and reduced levels of CD4/CD25+ cells in peripheral blood of Guillain-Barré syndrome patients compared to controls. J Clin Neurosci 2008;15:1031-1035.
Han RK, Cheng YF, Zhou SS, Guo H, He RD, Chi LJ, et al: Increased circulating Th17 cell populations and elevated CSF osteopontin and IL-17 concentrations in patients with Guillain-Barré syndrome. J Clin Immunol 2014;34:94-103.
Nyati K, Prasad K, Rizwan A, Verma A, Paliwal V: TH1 and TH2 response to Campylobacter jejuni antigen in Guillain-Barre syndrome. Arch Neurol 2011;68:445-452.
Cencioni MT, Notturno F, Caporale CM, Creati B, Prencipe V, Battistini L, et al: T cell response in acute motor axonal neuropathy. Int J Immunopathol Pharmacol 2009;22:1043-1050.
Araujo LM, Ferreira MLB, Nascimento OJ: Guillain-Barré syndrome associated with the Zika virus outbreak in Brazil. Arq Neuropsiquiatr 2016;74:253-255.
Watrin L, Ghawché F, Larre P, Neau J-P, Mathis S, Fournier E: Guillain-Barré syndrome (42 cases) occurring during a Zika virus outbreak in French Polynesia. Medicine (Baltimore) 2016;95:e3257.
Brasil P, Sequeira PC, Freitas AD, Zogbi HE, Calvet GA, de Souza RV, et al: Guillain-Barré syndrome associated with Zika virus infection. Lancet 2016;387:1482.
Ferreira da Silva IR, Frontera JA, Moreira do Nascimento OJ: News from the battlefront: Zika virus-associated Guillain-Barré syndrome in Brazil. Neurology 2016;87:e180-e181.
Parra B, Lizarazo J, Jiménez-Arango JA, Zea-Vera AF, González-Manrique G, Vargas J, et al: Guillain-Barré syndrome associated with Zika virus infection in Colombia. N Engl J Med 2016, DOI: 10.1056/NEJMoa1605564.
Kassavetis P, Joseph J, Francois R, Perloff M, Berkowitz A: Zika virus-associated Guillain-Barré syndrome variant in Haiti. Neurology 2016;87:336-337.
Rozé B, Najioullah F, Fergé J-L, Apetse K, Brouste Y, Cesaire R, et al: Zika virus detection in urine from patients with Guillain-Barré syndrome on Martinique, January 2016. Eurosurveillance 2016;21:30154.
Thomas D, Sharp T, Torres J, Armstrong P, Munoz-Jordan J, Ryff K, et al: Local transmission of Zika virus - Puerto Rico, November 23, 2015-January 28, 2016. Morb Mortal Wkly Rep 2016;65:154-158.
Oehler E, Watrin L, Larre P, Leparc-Goffart I, Lastere S, Valour F, et al: Zika virus infection complicated by Guillain-Barre syndrome - case report, French Polynesia, December 2013. Euro Surveill 2014;19:20720.
Fontes C, Dos Santos A, Marchiori E: Magnetic resonance imaging findings in Guillain-Barré syndrome caused by Zika virus infection. Neuroradiology 2016;58:837-838.
Cao-Lormeau V-M, Blake A, Mons S, Lastère S, Roche C, Vanhomwegen J, et al: Guillain-Barré syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 2016;387:1531-1539.
World Health Organization: Guillain-Barré syndrome. 2016. (accessed August 15, 2016).
Leis AA, Stokic DS: Zika virus and Guillain-Barre syndrome: is there sufficient evidence for causality? Front Neurol 2016;7:170.
Dejnirattisai W, Supasa P, Wongwiwat W, Rouvinski A, Barba-Spaeth G, Duangchinda T, et al: Dengue virus sero-cross-reactivity drives antibody-dependent enhancement of infection with Zika virus. Nat Immunol 2016;17:1102-1108.
Pessôa R, Patriota JV, de Lourdes de Souza M, Felix AC, Mamede N, Sanabani SS: Investigation into an outbreak of dengue-like illness in Pernambuco, Brazil, revealed a cocirculation of Zika, chikungunya, and dengue virus type 1. Medicine (Baltimore) 2016;95:e3201.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.