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Pregnant Women with Possible Zika Infection m 0 0 0 1 0 1 2 10 http://www.dallascounty.org/department/hhs/documents/DCHHS_WNV_SurveillanceReport_062016.pdf

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June 11 update Pregnant Women with Possible Zika Infection m 0 0 0 1 0 1 http://www.dallascounty.org/department/hhs/documents/DCHHS_WNV_SurveillanceReport_062016.pdf

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5/28 update Pregnant Women with Possible Zika Infection m 0 0 0 1 http://www.dallascounty.org/department/hhs/documents/DCHHS_WNV_SurveillanceReport_062016.pdf

June 20 update to 10

http://www.dallascounty.org/department/hhs/documents/DCHHS_WNV_SurveillanceReport_062016.pdf

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As of June 20, 201625 confirmed travel-related Zika cases in Georgia http://dph.georgia.gov/

As of June 20, 201625 confirmed travel-related Zika cases in Georgia

Culex must modify combat zikacontrol actions of Aedes aegypti and muriçoca are different Tue Jun 21 06:26:00 EDT 2016 - Renata Coutinho, the Folha de Pernambuco André nery // Leaf FileThe larvicide, for example, is adopted to combat Aedes has no effect against muriçocainternational, national, state and municipal managers await confirmation of the presence of zika in gnats (Culex) Wild collected in RMR and are targets of a survey of Fiocruz Pernambuco. Preliminary results of the analysis identified the insect naturally contaminated in the streets, as the Folha de Pernambuco anticipated, rekindled the possibility of this vector also have contributed to the zika epidemic, especially in vulnerable areas without basic sanitation, such as Recife, which has only 32% sanitized. In the state are about 20%. On Monday (20), at aseminar organized by the State Secretary of Health (SES), experts gathered to discuss the surveillance measures and responses to arboviruses.For all, the expected confirmation of Culex represent a change in coping strategies. "The vector control actions are different complements. What we do to control the Aedes aegypti as the larvicide, for example, is not for the Culex. They are other actions. Basic sanitation is essential. But to rethink this control only from Fiocruz information ", said the executive secretary of Health Surveillance of SES, Luciana Albuquerque. Recife, who has waged a battle against muriçoca in past decades in the fight against filariasis, should start another journey. This time to contain the possible transmission of zika. "If confirmed, we will initiate appropriate control actions. We sat with some organs like Compesa and Department of Infrastructure, depending on Aedes, to discuss improvements in environmental and health conditions. Now, this conversation should be narrowed, "said the executive secretary of Health Surveillance of Recife, Cristiane Penaforte. Another challenge ahead is to know the infestation of gnats in cities that do not have a watch as present as the Aedes. "We do not do this scouting infestation there is no national policy for this. I believe that once disclosed the possibility of transmission, we have to do, "said Earthwatch manager Recife, Jurandir Almeida. The director of the Department of Communicable Disease MS, Eduardo Hage, preferred to be measured on the condition of muriçoca as possible zika vector. "If confirmed, will be a step in the matter of elucidating other potential transmitters of these viral diseases," he said. Hage added that often are detected virus other diseases mosquitoes, but they are not good transmitters. They do not have enough vectorial capacity. "Identifying the virus exists within the insect and can reproduce here is an important step. But there are other steps to be overcome so that will have epidemiological importance.

international, national, state and municipal managers await confirmation of the presence of zika in gnats (Culex) Wild collected in RMR and are targets of a survey of Fiocruz Pernambuco. Preliminary results of the analysis identified the insect naturally contaminated in the streets, as the Folha de Pernambuco anticipated, rekindled the possibility of this vector also have contributed to the zika epidemic, especially in vulnerable areas without basic sanitation, such as Recife, which has only 32% sanitized. In the state are about 20%. http://www.folhape.com.br/cotidiano/2016/6/culex-deve-modificar-combate-ao-zika-0442.html

Guyana: first case of microcephaly confirmed Friday 17 June, the Regional Health Agency (ARS) confirmed a case of brain malformation for a baby, still in the womb of his mother. The pregnant woman, a resident of Cayenne, French Guiana, a region where the Zika virus has spread, was bitten by the tiger mosquito. The 36 year old woman had not seen a doctor in their first trimester of pregnancy, according to information Site France-Guyane. Microcephaly, detected by ultrasoundTo detect this congenital malformation, expectant mothers undergo ultrasound monitoring strengthened since the arrival of the tiger mosquito . It is through an ultrasound that microcephaly baby was found. The health professionals who follow this future mother suspected microcephaly since April, after having had the results of a blood test: the latter revealed that she had been in contact with the tiger mosquito. For the ARS, the future mother will be very medically monitored in the coming weeks. Two choices are now offering this future mom: keep her baby despite this malformation likely source of heavy handicaps or terminate her pregnancy . Currently, she is in her 32th week of pregnancy , but according to Anne-Marie McKenzie doctor, medical director of the public health and safety and the day before: "his choice will be respected whatever. " Detect the disease as soon as possibleIn Guyana, we count to date 595 mothers with a positive result for the biological Zika virus, according to ARS. It is therefore very important that pregnant women be careful and adopt protective measures, recommends the Regional Health Agency. The first action is to protect the risk of bites (by removing stagnant water and using insecticides and repellents and mosquito nets), the second to be followed carefully by a midwife or gynecologist from that we know pregnant and consult as soon as it is known to have been piqued.Remember, most cases of Zika are asymptomatic (without obvious symptoms). And have protected sex if you live or reside in an area affected by the epidemic because Zika is also a sexually transmitted disease . In areas affected by the epidemic, there is a weekly decrease in the number of cases"clinically suggestive" , yet the epidemic peak remains. Prudence therefore for all moms and dads. http://www.neufmois.fr/au-fil-de-lactu/guyane-premier-cas-de-microcephalie-confirme

Zika: A case of microcephaly confirmed in GuyanaKeywords: Virus Zika , microcephaly , French GuianaBy Thomas Delozier - the 20.06.2016A first case of microcephaly linked to Zika was spotted in Guyana while 595 pregnant women are infected with the virus. A few months after the Martinique , another French department, Guyana, presents a case of microcephaly linked to Zika. The Regional Health Agency (ARS) Friday confirmed the presence of this abnormality in a fetus whose mother, infected with the virus, was under ultrasound monitoring strengthened since April.This monitoring, which allowed the diagnosis, will continue until delivery. Characterized by a perimeter and a head diameter less than normal, microcephaly causes many different disorders ranging from mild eye problems to mental impairment. According to a recent study, a pregnant woman infected with Zika during pregnancy have between 1 and 13% risk of giving birth to a child victim of this disease. Since the beginning of the epidemic, 595 pregnant women had a positive result in biological virus in Guyana. A total of 7830 cases "clinically suggestive" were reported in the department. "Despite the weekly decline in patient, the epidemic continues on the Guyana coastline and Oyapock" warns the LRA. The agency also cautions that "pregnant women should be especially careful and adopt more stringent protective measures." That requires a "protective clothing" using "repellents adapted" as well as "safe sex throughout pregnancy." Friday, June 17, Margaret Chan, Director General of WHO, called for more funding for research into Zika requesting $ 122 million to major donors: "We need a coordinated international action to improve monitoring and speed up development of diagnostic tests and vaccines to protect populations at risk, "she said. For now, only 4 million were collected by the organization. http://sante.lefigaro.fr/actualite/2016/06/20/25112-zika-cas-microcephalie-confirme-guyane

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The first case of microcephaly was confirmed yesterday. This is a 36 year-old resident Cayenne.It has not consulted during the first trimester of her pregnancy. She came to the hospital for the first time in early April, at 20 weeks of pregnancy. She then received a complete balance sheet, as at first consultation (an ultrasound and a blood test are provided for each quarter). She wore no symptoms of the virus; but the first blood test revealed that she had been in contact with the zika. http://www.franceguyane.fr/actualite/education-sante-environnement/premier-cas-de-microcephalie-298948.php

topicality - Education / Health / EnvironmentReduce text sizeEnlarge text sizeTo printSend to a friend1Subscribe to RSS feed France-Antilles.fr Share this article on FacebookShare this article on TwitterShare this item on LinkedInShare this article on Google +First case of microcephalyLara DUPUYSaturday, June 18, 2016(FAM illustration photo)Regional Health Agency (ARS) yesterday confirmed the first case of brain malformation in children of pregnant women with the virus zika Guyana. He is a resident of Cayenne, which was not consulted in the first trimester. Since the beginning of the epidemic zika, 595 pregnant women had a positive result for biological virus zika Guyana. The first case of microcephaly was confirmed yesterday. This is a 36 year-old resident Cayenne.It has not consulted during the first trimester of her pregnancy. She came to the hospital for the first time in early April, at 20 weeks of pregnancy. She then received a complete balance sheet, as at first consultation (an ultrasound and a blood test are provided for each quarter). She wore no symptoms of the virus; but the first blood test revealed that she had been in contact with the zika.The protocol was immediately set up by medical personnel.The reviews have suspected a brain malformation in children, later confirmed. It must indeed follow the development of a month and a half to two months to eliminate other possible causes of malfunctions. What choice remains to this woman?ABORT OR KEEPAccompanied and informed she is currently considering two difficult options to it: choose whether it prefers an abortion or give birth to a child with a severe brain malformation. She is now 32 weeks pregnant. "It's complicated for everyone, including medical teams who will perform the procedure.But his choice will be respected whatever "says Dr. Anne-Marie McKenzie, Director of Public Health and the day before and sanitary safety. Teams to explain and mother to choose, supported by his entourage to pass this difficult test in which religious beliefs may play a role.The ARS will revive the communication campaign on pregnant women and also insist on their surroundings and the sexual transmission of the virus. The agency states that "Guyana is the only department where all pregnant women have a test to see if they had the zika. Once you know that you are pregnant, consult. And if in doubt, check if you're pregnant. "For microcephaly can be detected in the first ultrasound. Medical supervision should therefore begin as soon as possible. Terminate a pregnancy is thus revealed less painful, if any.Consult as soon as possibleIf the risk to a mother infected with the virus in the first trimester of pregnancy to have a baby with microcé-Westphalia is quantified approximately 1%, estimates are much lower than in Guiana, which "benefits from the experience of others and so was able to detect cases before the birth, "says Anne-Marie McKenzie.Despite the weekly decline in the number of cases "clinically suggestive", the epidemic continues in the department, especially in sectors of the coast and the Oyapock.7830 case "clinically suggestive" of zika have been reported to date.The Guyana Regional Agency of Health said that pregnant women should be especially careful and adopt protective measures. It emphasizes safe sex, the use of repellents as protective clothing and mosquito net. Equally important preventive measures for the environment and the general population to prevent the spread of the disease. Only those who have already had the zika can not contract it again.IN NUMBERSIn BrazilIf Guyana is in its first case in Brazil, more than 7500 suspected cases, 1384 cases of microcephaly were found, including 207 with a confirmation of the presence of zika.In French PolynesiaIn French Polynesia, where the population is about the same in Guyana, zika risks for pregnant women was not known when the virus spread there over two years.The estimate is 13 malformations including 10 micro-céphalies.In MartiniqueIn Martinique, other consequences of the disease are regrettable: 23 patients with Guillain-Barré syndrome, death is regrettable and March 22, the first case was detected microcephaly.

The first case of microcephaly was confirmed yesterday. This is a 36 year-old resident Cayenne.It has not consulted during the first trimester of her pregnancy. She came to the hospital for the first time in early April, at 20 weeks of pregnancy. She then received a complete balance sheet, as at first consultation (an ultrasound and a blood test are provided for each quarter). She wore no symptoms of the virus; but the first blood test revealed that she had been in contact with the zika. http://www.franceguyane.fr/actualite/education-sante-environnement/premier-cas-de-microcephalie-298948.php

REFERENCESINTRODUCTION | ARTICLE INFORMATION | REFERENCES 1Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol. 2016;47(1):6-7. PubMed | Link to Article2Cavalheiro S, Lopez A, Serra S, et al. Microcephaly and Zika virus: neonatal neuroradiological aspects [published online April 14, 2016]. Childs Nerv Syst. doi:10.1007/s00381-016-3074-6. PubMed3Guillemette-Artur P, Besnard M, Eyrolle-Guignot D, Jouannic JM, Garel C. Prenatal brain MRI of fetuses with Zika virus infection [published online April 18, 2016]. Pediatr Radiol. doi:10.1007/s00247-016-3619-6. PubMed4de Fatima Vasco Aragao M, van der Linden V, Brainer-Lima AM, et al. Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study. BMJ. 2016;353:i1901. PubMed | Link to Article5Russell LJ, Weaver DD, Bull MJ, Weinbaum M. In utero brain destruction resulting in collapse of the fetal skull, microcephaly, scalp rugae, and neurologic impairment: the fetal brain disruption sequence. Am J Med Genet. 1984;17(2):509-521. PubMed | Link to Article6Hughes HE, Miskin M. Congenital microcephaly due to vascular disruption: in utero documentation. Pediatrics. 1986;78(1):85-87. PubMed7Moore CA, Weaver DD, Bull MJ. Fetal brain disruption sequence. J Pediatr. 1990;116(3):383-386. PubMed | Link to Article8Calvet G, Aguiar RS, Melo AS, et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study [published online February 18, 2016].Lancet Infect Dis. doi:10.1016/S1473-3099(16)00095-5. PubMed9Martines RB, Bhatnagar J, Keating MK, et al. Notes from the field: evidence of Zika virus infection in brain and placental tissues from two congenitally infected newborns and two fetal losses: Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(6):159-160. PubMed | Link to Article10Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects: reviewing the evidence for causality. N Engl J Med. 2016;374(20):1981-1987. PubMed | Link to Article11Cauchemez S, Besnard M, Bompard P, et al. Association between Zika virus and microcephaly in French Polynesia, 2013-15: a retrospective study [published online March 15, 2016]. Lancet. doi:10.1016/S0140-6736(16)00651-6. PubMed12Faria NR, Azevedo RdoS, Kraemer MU, et al. Zika virus in the Americas: early epidemiological and genetic findings. Science. 2016;352(6283):345-349. PubMed | Link to Article13Wang L, Valderramos SG, Wu A, et al. From mosquitos to humans: genetic evolution of Zika virus. Cell Host Microbe. 2016;19(5):561-565. PubMed | Link to Article14Tang H, Hammack C, Ogden SC, et al. Zika virus infects human cortical neural progenitors and attenuates their growth. Cell Stem Cell. 2016;18(5):587-590. PubMed | Link to Article15Hotez PJ. Zika is coming. New York Times. April 9, 2016:A19.16Kraemer MU, Sinka ME, Duda KA, et al. The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus. Elife. 2015;4:e08347. PubMed | Link to Article17Messina JP, Kraemer MU, Brady OJ, et al. Mapping global environmental suitability for Zika virus. Elife. 2016;5:e15272. PubMed | Link to Article18Carteaux G, Maquart M, Bedet A, et al. Zika virus associated with meningoencephalitis. N Engl J Med. 2016;374(16):1595-1596. PubMed | Link to Article19Joseph A. What’s behind the prediction of 3 to 4 million cases of Zika virus this year?https://www.statnews.com/2016/01/29/zika-case-estimate-4-million/. Accessed May 2, 2016.

As Zika virus infection spreads across the Latin American and Caribbean region and then into the southern United States, we can expect to see thousands of additional children born with microcephaly and possibly many more newborns or even older infants with signs of more subtle but significant neurologic defects and developmental delays. Just as human immunodeficiency virus (HIV)/AIDS created a “new normal” in the field of pediatrics beginning in the 1990s, can we expect new paradigms in child health from Zika virus? By the end of last year we had all seen the pictures of severely microcephalic Brazilian and Colombian newborns, subsequently followed by devastating images of perinatal outcomes even worse than first imagined. The first cranial ultrasonograms of Zika virus–associated microcephaly published in January 2016 revealed cerebral calcifications and ventriculomegaly, consistent with a congenital infection.1 Follow-up radiologic studies confirmed these findings but also showed us a profoundly diminished brain parenchymal volume due to absent brain tissue and interruptions in cortical development, in addition to a hypoplasia of the cerebellum, brainstem, and corpus callosum.2- 4 It was observed that congenital Zika virus infection and microcephaly resembled a fetal brain disruption sequence that was first described in the 1980s and 1990s by pediatric geneticists who found destruction or loss of brain tissue, reductions in intracranial pressure, and then subsequent collapse of the fetal skull.5- 7 The link between Zika virus, microcephaly, and this fetal brain disruption sequence was then confirmed,8- 10 as was a link to a previous 2013 outbreak of Zika virus infection in French Polynesia.11 We are beginning to understand the sequence of events at the molecular and cellular levels responsible for Zika virus’ destructive power. Decades after it was first identified in Africa, Zika virus underwent mutations that transformed it from a virus that caused focal epidemics into one with pandemic properties and the ability to infect almost entire Pacific Island populations in a period of weeks or months, before entering Brazil in 2013.12,13 Many of the mutations appear in the virus gene encoding nonstructural protein 1, which is linked to flavivirus replication and pathogenicity, presumably allowing it to replicate more efficiently in human tissues.13 Human neuronal tissue is the particular target based on evidence showing that the virus selectively infects cortical neural progenitor cells that give rise to the fetal brain.14 A pre-M protein involved in virus assembly and maturation has also been shown to be affected.14 Thus, within less than a year after the first microcephaly cases were reported in northeastern Brazil, the scientific and medical communities identified, isolated, and elucidated the microbial pathogenic properties of what I call “the virus from hell.” It is every parent’s nightmare—a virus that can cause an explosive epidemic, infecting hundreds if not thousands of pregnant women, crossing their placenta, and ultimately halting the development of the fetal brain. After ripping through the island populations of Micronesia and French Polynesia, the Asian strain of Zika virus infected 1.5 million Brazilian individuals in less than 2 years. The fact that urban centers in northeastern Brazil—cities such as Recife and Salvador—were the ones affected the most is not a coincidence. We have learned that 3 major factors determine where Zika virus infection will emerge: high concentrations of the Aedes aegypti mosquito, urban crowding, and poverty.15 All of these factors were in play in northeastern Brazil cities where the first clusters of microcephaly cases were noted, as they were in Colombia, the second major Latin American country to be affected. From there we can predict where the virus will strike next. High concentrations of the A aegypti mosquito, crowding, and poverty converge in the Central American countries of El Salvador, Guatemala, Honduras, and Nicaragua; parts of Mexico such as the Mayan villages in Yucatan; and in the Caribbean nation of Haiti, where owing to its depleted health system we can expect a humanitarian catastrophe to unfold. Poor areas of Puerto Rico will be affected, as will urban centers of the continental United States where A aegypti numbers are their highest and poverty is at its worst. Those factors combine mostly in poor neighborhoods of major Gulf Coast cities such as Houston and Galveston, Texas, and New Orleans, Louisiana, as well as Florida16(Figure). With a combined population of approximately 60 million individuals, more than 1 million pregnancies could be at risk in US Gulf Coast states. Figure.Environmental Suitability for Human Zika Virus Infection in the Western HemisphereAdapted from Messina et al.17 View Large | Save Figure | Download Slide (.ppt)Within 9 months from now—by the end of 2016 and into early 2017—pediatricians working in poor urban areas of the Americas (including the US Gulf Coast) where Zika virus is now emerging can expect to see babies with microcephaly and the full-blown fetal brain disruption sequence. However, we might also expect many additional newborns to show evidence of significant but less obvious neurologic and cognitive deficits. Possibly some of these infants will have been infected with Zika virus later in gestation, allowing them to avoid the full force of the virus’ neurotropic properties. Based on evidence that Zika virus can pass through the blood-brain barrier to cause meningoencephalitis in adults,18 is it also possible that an infant or young child infected with Zika virus could also show evidence of neurodegenerative disease and developmental delays? Beyond Zika virus, many neglected tropical diseases exhibit important mental health effects.19 The full pediatric neurologic and psychiatric impact of Zika virus infection will take time to sort out and may not be fully realized for years. Pediatricians and pediatric subspecialists, including child neurologists, psychiatrists, physiatrists, and behavioral and infectious disease experts, as well as physician-scientists will need to mobilize quickly to get ahead of this fast-moving train. According to the World Health Organization, up to 4 million people could be infected with Zika virus by the end of 2016. Therefore, it is likely that tens of thousands of children could be affected by a spectrum of neurologic and psychiatric illness in the next year and beyond. Could this new virus emerging in the western hemisphere change pediatric practice? As a new pediatric infectious diseases fellow and attending physician during the 1990s, I was impressed by the rapid rise of pediatric HIV/AIDS and our steep learning curve on how to manage and treat this new disease. Both Zika virus and HIV are neurotropic viruses with long-term consequences for childhood neurologic and developmental outcomes. Given the possibility of 4 million Zika virus cases across the Americas, we might revisit how the specialty of pediatrics responded to the HIV/AIDS crisis 30 years ago and possibly look to that model for how we might establish a road map for addressing this new virus infection. We are just now waking up to a new normal as we learn more about the complete mental health effects of Zika virus infection. We will likely need to educate and train a new generation of primary care providers, including pediatricians and pediatric nurse practitioners. We will need to assemble interdisciplinary teams of pediatric specialists in neonatology, neurology, psychiatry, rehabilitation medicine, and infectious diseases to organize diagnostic, clinical management, and treatment approaches and algorithms for this new illness. We will need new programs of child advocacy. Because Zika virus may equally affect North America, Central America, and South America, we will need to expand how we work together across international boundaries. Zika virus will require us to dissolve any existing north-south divisions across pediatrics in the Americas. The next few years will be a challenging period as the number of congenital and pediatric Zika virus infections continues to increase from the current epidemic that first exploded in the western hemisphere in 2013.

Corresponding Author: Peter J. Hotez, MD, PhD, National School of Tropical Medicine, Baylor College of Medicine, 1 Baylor Plaza, MS 320, Houston, TX 77030 ([email protected]). Accepted for Publication: April 6, 2016. Published Online: June 20, 2016. doi:10.1001/jamapediatrics.2016.1465. Conflict of Interest Disclosures: None reported.

Special Communication | June 20, 2016What Does Zika Virus Mean for the Children of the Americas? FREE ONLINE FIRSTPeter J. Hotez, MD, PhD1,2,3,4,5[-] Author Affiliations1Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 2Department of Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas 3Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston 4Department of Biology, Baylor University, Waco, Texas 5James A. Baker III Institute for Public Policy, Rice University, Houston, Texas http://archpedi.jamanetwork.com/article.aspx?articleid=2529146#ArticleInformation JAMA Pediatr. Published online June 20, 2016. doi:10.1001/jamapediatrics.2016.1465

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