[MUSIC] So I'm going to tell you the story of the emergence of Guillain-Barre syndrome at the time of the Zika outbreak in French Polynesia. We were very fortunate to collaborate with different groups over there. [FOREIGN] and Institute as well as the which had been involved in the Zika outbreak from it's very beginning. The [FOREIGN] had put in place surveillance of acute fever which was based on network of general practitioners. And they were able to detect very early a rise in unexplained acute fevers, which, after confirmation, turned out to be Zika infections. About two to three weeks later, at the Centre Hospitalier de Polynesie francaise, neurologists saw the first cases of Guillain-Barre syndrome. Guillain-Barre syndrome is a form of paralysis, what we call ascending paralysis. Starting in the feet, with weakness in the lower limbs and when it goes up, it finally reach the chest and at that time, patients may no longer be able to breathe and have to be sent to intensive care unit for respiratory assistance. So it's a potentially very severe complications. It is estimated that about one-third of patients with Guillain-Barre syndrome will have to go to intensive care units. And altogether, 5% of them die in intensive care unit due to complications of these prolonged stays. Here in the French Polynesia, during the outbreak, they ended up having 42 patients with Guillain-Barre syndrome, which is one the largest Guillain-Barre syndrome outbreak ever seen up to today. What is really special and what really attracted the attention of the virologists over there was the fact that the patients were deteriorating very rapidly. From the time patients has a first neurological symptoms and weakness in the limbs, most of the time, to the time they had to go to intensive care unit, for those who had to be sent to intensive care unit, and it was about 40% of our patients, it took only 4 days. This is much shorter than what is usually seen with Guillain-Barre syndrome where it takes about one to two weeks before patients have to be sent to intensive care units. So clinicians and neurologists working in areas where Zika is circulating have to be aware of this possibility of very rapid deterioration. So the patients are examined as quickly as possible and, if needed, sent for proper care, particularly if it has to end up in intensive care units. But the good news was that for the patients after they had gone through this very rapid deterioration, for the patients who survived, and in French Polynesia, it was all patients, they were recovering rapidly. After three months, more than half of them could walk without assistance. Whereas it is known that it may take up to one year for patients with Guillain-Barre syndrome before full recovery. And some of them may have. So the message we learned from the clinicians of French Polynesia was to say, be careful about the very rapid deterioration of patients. But good news is, once the acute phase is over, they tend to recover rapidly. Then one of the questions that we asked ourselves was, how common are Guillain-Barre syndrome among all patients twho have Zika infection. There we could utilize a cross-sectional survey which has been performed at the end of the epidemic in French Polynesia, which informed us that two-thirds of the population of French Polynesia got infected with Zika during the time of the epidemic. So, it tells you first about how rapidly this virus is spreading, it took only six months. And in the context of an island, I mean more than half of the population may end up being infected. The useful information we got was that two-third of the population got infected with Zika in French Polynesia. And, therefore, with the 42 patients we had, we could estimate that out of 10,000 of patients, 2 will develop Guillain-Barre, and that tells us a little bit about how risky it is for adults who have Zika infection to develop this type of fever nuerological complications. It is about similar to what is seen for other agents who are known to cause Guillain-Barre syndrome. If you consider campylobacter jejuni bacteria which is known for, responsible for gastroenteritis, and which is the main cause of Guillain-Barre syndrome, we are about the same range, two to five Guillain-Barre Syndrome for 10,000 infections with campylobacter jejuni. So here we have severe nervous complications, Guillain-Barre syndrome. Fortunately relatively rare.but because we have a very large number of people in the population who are infected, I remind you for French Polynesia, two-thirds of the population, you wind up with significant numbers of Guillain-Barre syndrome. What is important is that countries or regions have to get prepared for sending to hospitals and wherever possible, intensive care unit, those patients who need respiratory assistance. And our team together with has been recently collaborating with the French authorities in the Caribbeans in predicting the number of patients who would develop Guillain-Barre syndrome during the course of the outbreak in the Caribbeans. In order to increase the number of beds equipped for respiratory assistance, in case this patients would develop these complications of the Zika infection. It also important to say that Guillain-Barre syndrome are not the only neurological complication in adults Associated with zika infection. It has been described since and it was already seen in French Polynesia that patients can develop a very large variety of neurological complications including meningoencephalitis for instance. So of course we should keep in mind the Guillain-Barre syndrome but also have eyes open for other type of complications. Based on the data of French Polynesia we would say we saw about as many patients with Guillaine-Barre syndrome as patients with other type of complications. [MUSIC]