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RESULTSCharacteristics of ParticipantsDuring the period from September 2015 through February 2016, we enrolled 88 pregnant women and tested blood specimens, urine specimens, or both for ZIKV by qualitative RT-PCR. Of these 88 women, 72 (82%) had positive results for ZIKV on PCR in blood, urine, or both: 60 women had positive PCR results in serum specimens, 46 had positive PCR results in urine samples, and 34 had positive PCR results in both specimens; 12 women had positive results in urine specimens only, and 26 had positive results in blood specimens only (median number of PCR cycles for serum specimens, 33.0; interquartile range, 30.0 to 34.0; range, 24.0 to 37.0; and median number of PCR cycles for urine specimens, 29.0; interquartile range, 26.0 to 31.8; range, 22.0 to 37.0). Demographic and clinical characteristics are described in Table 1TABLE 1Baseline Demographic and Clinical Characteristics of Women in the Pregnancy Cohort.. Among ZIKV-positive women, more than half reported similar illnesses in other family members, and 21% reported that their partner had been ill. ZIKV infection was present in women of all socioeconomic strata. More than half the women presented with acute infection in the second trimester of pregnancy. There were no significant differences in demographic characteristics or medical history between women who were positive for ZIKV and those who were negative for ZIKV. ZIKV-positive women resided across multiple neighborhoods and municipalities within the larger metropolitan Rio de Janeiro area (Fig. S1 in the Supplementary Appendix). Clinical PresentationAll pregnant women had rash as part of their clinical presentation, since rash was an inclusion criterion. A descending macular or maculopapular rash was the most common type of exanthem noted in ZIKV-positive women (Figure 1FIGURE 1Clinical features of Zika Virus Infection in Pregnant Women.). The maculopapular rash was seen far more frequently in ZIKV-positive women than in ZIKV-negative women (P=0.02). The other prevalent finding was pruritus, which was seen in 94% of the women in our study. The next most common finding was arthralgia, which was reported in 65% of ZIKV-positive women and in 41% of ZIKV-negative women (P=0.16). Conjunctival injection was present in 58% of ZIKV-positive women, and in a far smaller percentage (19%) of ZIKV-negative women (P=0.002), which suggests that this symptom is a specific clinical feature of ZIKV infection. Lymphadenopathy (isolated or generalized) was found more prominently in women with acute ZIKV infection than in ZIKV-negative women (41% vs. 6%, P=0.02). Fever was not a highly prominent finding, occurring in less than a third of women with acute ZIKV-infection. When fever was present, it was generally short-term and low grade (37.5 to 38.0oC). Nausea or vomiting was reported in 21% of ZIKV-positive women and was more common (38%) in ZIKV-negative women (P=0.20). Findings consistent with bleeding (primarily gingival) were present in less than 21% of all women. Respiratory findings were rare (7%) in ZIKV-positive women. Outcomes of PregnanciesTwo ZIKV-positive women miscarried during the first trimester. Of the 70 remaining women with ZIKV infection, 42 (60%) had prenatal ultrasonographic examinations, with a total of 56 studies performed; 28 women declined imaging studies either because the obstetrical facility was too far away or because of fear of possible fetal abnormalities related to ZIKV infection. ZIKV-negative women had undergone fetal ultrasonography as part of regular prenatal care, and the results were reported as normal. All the women in the cohort had received prenatal care; immunity to rubella and cytomegalovirus was documented, and none of the women had syphilis; 88% of the women had positive results for dengue-specific IgG antibodies at study entry. As seen in Figure 2FIGURE 2Week of Gestation at the Time of ZIKV Infection and Abnormal Ultrasonographic and Doppler Findings. and Table 2TABLE 2Ultrasonographic Features of Fetuses and Findings at Birth., the timing of acute ZIKV infection ranged from 6 to 35 weeks of gestation among the 42 women in whom fetal ultrasonography was performed. Abnormal results on ultrasonography or Doppler studies were seen in 12 cases (29%). Five of the 12 fetuses had intrauterine growth restriction, as determined by ultrasonography, with or without accompanying microcephaly. Cerebral calcifications were noted in 4 fetuses and other CNS alterations in 2 fetuses. Abnormal arterial flow in the cerebral or umbilical arteries was seen in 4 fetuses. Oligohydramnios and anhydramnios were seen in two cases. There were two fetal deaths after 30 weeks of gestation, which were detected by ultrasonography performed in one woman who had been infected at 25 weeks of gestation and in a second woman who had been infected at 32 weeks of gestation. One fetus was found to have additional malformations, including agenesis of the vermis, Blake’s pouch cyst, and potentially a club foot, in addition to cerebral calcifications, intrauterine growth restriction, and microcephaly (genetic findings have been negative). The mothers of this fetus and of another fetus with intrauterine growth restriction and accompanying cerebral calcifications were infected in the first trimester of pregnancy. Cerebral calcifications were also seen in fetuses of women infected as late as 27 weeks, and intrauterine growth restriction was present in fetuses of women infected within a wide range of infant gestational age. (For ultrasonographic findings and clinical features of infants born to date and for an ultrasound of a fetus with cerebral calcifications, see Table S1 and Figure S2 in the Supplementary Appendix.) Figure 3FIGURE 3Fetal Biometric Variables as Measured on Ultrasonography. shows plots of ultrasonographic measures for fetuses of ZIKV-positive pregnant women (also see Fig. S3 in the Supplementary Appendix). At the time of this preliminary report, six live births and two stillbirths have occurred (Infants 2, 3, 10, 12, 19, 23, 36, and 53) (Table 2 and Table S1 in the Supplementary Appendix). Two infants with normal ultrasonographic results had normal measures and a normal physical examination at birth (Infants 2 and 3). Two infants with an ultrasonographic diagnosis of fetal death were delivered stillborn (Infants 10 and 53). Infant 19 was born at term with severe microcephaly; computed tomography of the brain confirmed ultrasonographic findings of cerebral calcifications and global cerebral atrophy. Funduscopic exam showed macular hypoplasia of the left eye and macular scarring on the right eye. Infant 12 was delivered prematurely by cesarean section because of severe intrauterine growth restriction, oligohydramnios, and placental insufficiency and was found to be small for gestational age, with a head circumference below the 5th percentile for gestational age. Funduscopic examination showed macular hypoplasia. Infant 23 was delivered on an emergency basis owing to anhydramnios and was found to have normal growth measures despite the suggestion of intrauterine growth restriction on ultrasonography performed at 40 weeks. This infant was found to be lethargic with poor sucking reflexes at birth; electroencephalography during the infant’s stay in the neonatal intensive care unit (NICU) showed nonspecific findings, but the infant has done well. Infant 36 had intrauterine growth restriction on ultrasonography and was small for gestational age at the time of birth. The head circumference was proportional to the small body size. This infant is currently in the NICU.

METHODSStudy PopulationIn this cohort study, pregnant women at any week of gestation who presented to the acute febrile illness clinic at the Oswaldo Cruz Foundation with a rash that had developed within the previous 5 days were offered enrollment and were included in the study after providing informed consent. After the women were enrolled, detailed demographic, medical, and prenatal history information, as well as clinical findings, were entered into case-report forms. Information in prenatal records regarding rubella, cytomegalovirus, and Venereal Disease Research Laboratory serologic testing was reviewed. Serum and urine specimens were obtained at study entry. Women had weekly follow-ups by telephone, and a second visit was scheduled within 30 days after enrollment for clinical and laboratory follow-up. Women were referred for fetal ultrasonography before 20 weeks of gestation, between 20 and 30 weeks of gestation, and after 30 weeks of gestation. No women had had diagnoses of fetal malformations in the current pregnancy before enrollment. The study population was generally healthy; the women reported no coexisting conditions or medication use. Infants born to ZIKV-positive mothers will be followed prospectively. Study OversightThe study protocol was approved by the institutional review boards at Fundação Oswaldo Cruz (Fiocruz) and the University of California, Los Angeles. Participants provided written informed consent. The authors vouch for the accuracy and completeness of the data and the analyses and for the fidelity of the study to the protocol. Laboratory TestingReal-time RT-PCR assays for ZIKV were performed with the QuantiTect Probe RT-PCR kit (Qiagen), as described previously,10 with the same primers and cycle times, at the Fiocruz Flavivirus Laboratory; assays were performed on blood specimens, urine specimens, or both that were obtained at the entry visit. The Fiocruz Flavivirus Laboratory is a reference laboratory for flavivirus infections in the region. Serologic testing for IgG antibodies to dengue (Abcam) was performed on the serum specimens obtained at the entry visit. Fetal UltrasonographyAll abdominal scanning was performed with a 4-to-8-mHz probe (Voluson 730 Expert/Voluson E6, GE) by perinatologists who were certified by the Brazilian College of Radiology and the Brazilian Federation of Societies of Gynecology and Obstetrics (Febrasgo). The variables that were measured are listed in the Supplementary Appendix, available with the full text of this article at NEJM.org. For Doppler studies, the pulsatility index of the umbilical artery and of the middle cerebral artery were used.11 Abnormalities such as cerebral calcifications and microcephaly were noted. Measured fetal ultrasonographic variables were plotted by gestational age according to the nomograms published on www.perinatology.com. Intrauterine growth restriction was defined as fetal weight estimated according to the Hadlock formula that was below the 10th percentile.12Microcephaly in fetal imaging was defined as fetal head measurements (e.g., head circumference) that were two standard deviations below the mean expected at a particular gestational age or below the third percentile.13 Statistical AnalysisWe compared the demographic and clinical variables of pregnant women who were positive for ZIKV on PCR with those who were negative for ZIKV on PCR, using Fisher’s exact test (two-sided); P values of less than or equal to 0.05 were considered to indicate statistical significance. For comparison of medians, an independent-samples median test was used.

Zika virus (ZIKV) was first identified in Brazil in 2015 by reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays of serum specimens from patients from the state of Bahia who presented with a denguelike illness that was characterized by rash, fever, myalgias, arthralgias, and conjunctivitis.1 Soon thereafter, local transmission of ZIKV was reported,2 and a link for transmission of ZIKV between French Polynesia and Brazil was described.3 In September 2015, researchers reported a substantial increase in the number of cases of neonatal microcephaly among women giving birth in northeastern Brazil,4,5 and a subsequent increase was reported in southeast Brazil.6 ZIKV has been isolated from the amniotic fluid of women who are pregnant with infants who have confirmed microcephaly4,6,7 and from the brain of a fetus with central nervous system (CNS) abnormalities.8 We have been conducting active surveillance for dengue infection in the general population of Rio de Janeiro since 2007. In 2012, we established a prospective cohort for dengue surveillance in mother–infant pairs within the Manguinhos Rio de Janeiro area. In 2015, we noted an increase in cases of a denguelike illness that was characterized by a descending rash, generally without fever; this increase coincided with a surge in the number of cases in northeastern Brazil of illness characterized by a pruriginous rash. In early 2015, most cases were originally reported to surveillance systems as dengue; however, ZIKV was eventually identified.9 To identify ZIKV cases in our population, we modified our pregnancy cohort study and enrolled women at any week of gestation who presented with a rash. Here we report demographic, clinical, laboratory, and gestational ultrasonographic findings in the cohort of pregnant women enrolled in our ZIKV study to date.

BACKGROUNDZika virus (ZIKV) has been linked to neonatal microcephaly. To characterize the spectrum of ZIKV disease in pregnancy, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in fetuses. Full Text of Background... METHODSWe enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase–polymerase-chain-reaction assays. We followed the women prospectively and collected clinical and ultrasonographic data. Full Text of Methods... RESULTSA total of 88 women were enrolled from September 2015 through February 2016; of these 88 women, 72 (82%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 5 to 38 weeks of gestation. Predominant clinical features included pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 28% had fever (short-term and low-grade). Women who were positive for ZIKV were more likely than those who were negative for the virus to have maculopapular rash (44% vs. 12%, P=0.02), conjunctival involvement (58% vs. 13%, P=0.002), and lymphadenopathy (40% vs. 7%, P=0.02). Fetal ultrasonography was performed in 42 ZIKV-positive women (58%) and in all ZIKV-negative women. Fetal abnormalities were detected by Doppler ultrasonography in 12 of the 42 ZIKV-positive women (29%) and in none of the 16 ZIKV-negative women. Adverse findings included fetal deaths at 36 and 38 weeks of gestation (2 fetuses), in utero growth restriction with or without microcephaly (5 fetuses), ventricular calcifications or other central nervous system (CNS) lesions (7 fetuses), and abnormal amniotic fluid volume or cerebral or umbilical artery flow (7 fetuses). To date, 8 of the 42 women in whom fetal ultrasonography was performed have delivered their babies, and the ultrasonographic findings have been confirmed. Full Text of Results... CONCLUSIONSDespite mild clinical symptoms, ZIKV infection during pregnancy appears to be associated with grave outcomes, including fetal death, placental insufficiency, fetal growth restriction, and CNS injury.

Patrícia Brasil, M.D., Jose P. Pereira, Jr., M.D., Claudia Raja Gabaglia, M.D., Luana Damasceno, M.S., Mayumi Wakimoto, Ph.D., Rita M. Ribeiro Nogueira, M.D., Patrícia Carvalho de Sequeira, Ph.D., André Machado Siqueira, M.D., Liege M. Abreu de Carvalho, M.D., Denise Cotrim da Cunha, M.D., Guilherme A. Calvet, M.D., Elizabeth S. Neves, M.D., Maria E. Moreira, M.D., Ana E. Rodrigues Baião, M.D., Paulo R. Nassar de Carvalho, M.D., Carla Janzen, M.D., Stephanie G. Valderramos, M.D., James D. Cherry, M.D., Ana M. Bispo de Filippis, Ph.D., and Karin Nielsen-Saines, M.D. March 4, 2016DOI: 10.1056/NEJMoa1602412 OURCE INFORMATIONFrom Fundação Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N., P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C., A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V., J.D.C., K.N.-S.). Address reprint requests to Dr. Nielsen-Saines at the Division of Pediatric Infectious Diseases, David Geffen School of Medicine at UCLA, MDCC 22-442, 10833 LeConte Ave., Los Angeles, CA 90095, or at [email protected].

ORIGINAL ARTICLE Zika Virus Infection in Pregnant Women in Rio de Janeiro — Preliminary Reporthttp://www.nejm.org/doi/full/10.1056/NEJMoa1602412

Zika-linked microcephaly in Colombiaan hour agoAAP Zika-linked microcephaly in Colombia The first case of infant microcephaly linked to the mosquito-borne Zika virus has appeared in Colombia, a doctor says, although the national health institute said it had no information on the case and could not confirm it. Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition defined by unusually small heads that can result in developmental problems. Colombia, seen as a key test case of the impact of the virus, has 42,706 cases of Zika, including 7653 pregnant women. A study of 28 women in Colombia's Sucre province infected with Zika during pregnancy has so far yielded one baby with microcephaly, said Alfonso Rodriguez-Morales, a doctor and researcher at the Technical University of Pereira. It was not immediately known when the child was born. "The only infection that would explain what is happening is the Zika virus," he said on Friday. http://www.heraldsun.com.au/news/breaking-news/zikalinked-microcephaly-in-columbia/news-story/930a5e0f252aa9b3cf1e9c55653045dc

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March 4, 2016 SURGEON GENERAL DR. JOHN ARMSTRONG'S DAILY ZIKA UPDATE: ONE NEW CASE TODAY IN MIAMI-DADE COUNTY Contact:Communications [email protected](850) 245-4111 Tallahassee, Fla.—In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, State Surgeon General and Secretary of Health Dr. John Armstrong will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. There is one new case today in Miami-Dade County. Of the travel-related cases confirmed in Florida, six cases are still exhibiting symptoms. According to the CDC, symptoms associated with the Zika virus last between seven to 10 days. Based on CDC guidance, several pregnant women who have traveled to countries with local-transmission of Zika have received antibody testing, and of those, four have tested positive for the Zika virus. The CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. It is recommended that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas. County Number of Cases (all travel related) Alachua 1 Brevard 1 Broward 6 Hillsborough 3 Lee 3 Miami-Dade 23 Orange 3 Osceola 1 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 48 *Counties of pregnant women will not be shared. Yesterday, Governor Rick Scott announced that the Centers for Disease Control fulfilled the request he made last week for more antibody tests for the Zika virus and provided an additional 500 tests. On Feb. 12, Governor Scott directed State Surgeon General Dr. John Armstrong to activate a Zika Virus Information Hotline for current Florida residents and visitors, as well as anyone planning on traveling to Florida in the near future. The hotline, managed by the Department of Health, has assisted 909 callers since it launched. The number for the Zika Virus Information Hotline is 1-855-622-6735. All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here. State Surgeon General and Secretary of Health Dr. John Armstrong urges Floridians to drain standing water weekly, no matter how seemingly small. A couple drops of water in a bottle cap can be a breeding location for mosquitoes. Residents and visitors also need to use repellents when enjoying the Florida outdoors. More Information on DOH action on Zika: On Feb. 3, Governor Scott directed State Surgeon General and Secretary of Health Dr. John Armstrong to issue a Declaration of Public Health Emergency for the counties of residents with travel-associated cases of Zika.The Declaration currently includes the 11 effected counties – Alachua, Brevard, Broward, Hillsborough, Lee, Miami-Dade, Orange, Osceola, Santa Rosa, Seminole and St. Johns – and will be updated as needed. DOH encourages Florida residents and visitors to protect themselves from all mosquito-borne illnesses by draining standing water; covering their skin with repellent and clothing; and covering windows with screens.DOH has a robust mosquito-borne illness surveillance system and is working with the CDC, the Florida Department of Agriculture and Consumer Services and local county mosquito control boards to ensure that the proper precautions are being taken to protect Florida residents and visitors.Florida currently has the capacity to test 4,558 people for active Zika virus and 1,500 for Zika antibodies.Federal Guidance on Zika: According to the CDC, Zika illness is generally mild with a rash, fever and joint pain. CDC researchers are examining a possible link between the virus and harm to unborn babies exposed during pregnancy.The FDA released guidance regarding donor screening, deferral and product management to reduce the risk of transfusion-transmission of Zika virus. Additional information is available on the FDA website here.For more information on Zika virus, click here. About the Florida Department of Health The department works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health, please visit www.FloridaHealth.gov. http://www.floridahealth.gov/newsroom/2016/03/030416-zika-update.html

County Number of Cases (all travel related) Alachua 1 Brevard 1 Broward 6 Hillsborough 3 Lee 3 Miami-Dade 23 Orange 3 Osceola 1 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 48

First case of secondary microcephaly by zika in TolimaLOCALTOLIMAMarch 4, 2016 - 1:34 Pm - Photo: AFPMore than 3,600 people have been affected by the virus of which 329 women who are pregnant have symptoms and 189 have been diagnosed by the National Institute of Health. Special monitoring a possible case of secondary microcephaly by zika in a woman who is in the sixth month of pregnancy, provide the health authorities of Tolima. Sandra Liliana Torres, secretary of health of the region indicated that the established protocols were activated to provide priority attention and also notified the National Institute of Health. An interdisciplinary team of doctors, epidemiologists and psychologists will monitor the biopsychosocial conditions of the pregnant mother. The numbers Zika 3,635 cases have been recorded in Tolima of which 329 women who are pregnant, have symptoms of the disease which is transmitted by the aedes aegypti vector. Ibagué According to the report of the health authorities to date 918 people have been diagnosed with the virus. RCN Radio learned that of the 189 pregnant women who have zika, 60 percent are below 24 weeks of pregnancy. Torres added that Chaparral, Espinal, Flanders and Melgar also been considered hyper endemic localities by the proliferation of mosquito that carries. recommendations Intensify the elimination of vector breeding sites through washing and brushing pools and water tanks and the collection and disposal of unusable items in homes. http://www.rcnradio.com/locales/primer-caso-microcefalia-segundaria-zika-en-el-tolima/

Doctors in Venezuela reported first case of microcephaly in fetus of pregnant infected with Zika ReutersMarch 4, 2016CARACAS (Reuters) - Doctors in Venezuela confirmed the first case of microcephaly and death of the fetus of a mother who was infected in the country with Zika virus early in her pregnancy, she reported on Friday the International Society for Infectious Diseases. The case adds to the evidence in Brazil on the relationship between Zika and microcephaly in infants, which investigates the World Health Organization (WHO), and a report in Colombia of a "probable" case of this anomaly in the fetus of a mother interrupted her pregnancy after suffering the virus. The baby patient, 24 years old, and had no life in week 17 of gestation and presented "a diagnosis of microcephaly and severe oligoamnios" the medical report signed by four Venezuelan doctors. The mother showed symptoms of the virus in the first trimester of pregnancy, but at that time or the placenta or the fetus had abnormalities, the study added. the presence of dengue virus, rubella or chikungunya discarded. The Ministry of Health in Venezuela has not yet informed about this case and did not immediately return a request for information made Reuters. In a test that was made to the umbilical cord tissue doctors found genetic material Zika virus. An official of the World Health Organization (WHO) said on Friday that there is "growing evidence" about the relationship between Zika virus and two neurological disorders microcephaly and Guillain-Barre syndrome. In early February, Venezuela reported three deaths and about 5,221 patients suspected of having the virus Zika, but doctors and non-governmental organizations believe that cases may be many more in a country suffering from an acute shortage of medicines and repellents to avoid the bite of the infected mosquito. The outbreak has been confirmed this year in Panama, Venezuela, El Salvador, Mexico, Suriname, Colombia, Guatemala and Paraguay. "In the circumstances we are living, the situation could be much more dramatic than in other countries in the region," said Jaime Torres infectious disease specialist at an academic conference that was broadcast on the Internet in February. Torres, who participated in the study reported the first case Zika's relationship with microcephaly in Venezuela, made the warning as 60 percent of the 600,000 pregnant women do not receive adequate prenatal annual control. In most cases, the virus occurs without symptoms that cause alarm. In Venezuela abortion laws consider as illegal unless threatened the life or health of the woman, but not in the case of the baby. (Reporting by Corina Pons, with additional information from Alexandra Ulmer Edited by Javier Leira.) https://es-us.noticias.yahoo.com/médicos-en-venezuela-reportan-primer-caso-microcefalia-en-170222392.html?soc_src=social-sh&soc_trk=tw

Venezuela detected the first case of microcephaly linked with zikaThe baby patient no longer had life in week 17 of gestation and presented "a diagnosis of microcephaly," said the doctors12:21 03/04/2016 REUTERS In a test that was made to the umbilical cord tissue doctors they found genetic material from the virus zika. CARACAS. Doctors in Venezuela confirmed the first case of microcephaly and fetal death a mother who was infected in the country with the virus zika the beginning of their pregnancy , reported the International Society forInfectious Diseases . The case adds to the evidence in Brazil on the relationship between zika and microcephaly in infants, which investigates the World Health Organization (WHO), and a report in Colombia of a "probable" case of this anomaly in the fetus of a mother interrupted her pregnancy after suffering the virus. The baby patient, 24 years old, and had no life in week 17 of gestation and presented "a diagnosis of microcephaly and severe oligoamnios" the medical report signed by four Venezuelan doctors. The mother showed symptoms of the virus in the first trimester of pregnancy, but at that time or the placenta or the fetus had abnormalities, the study added. the presence of dengue virus, rubella or chikungunya discarded. In a test that was made to the umbilical cord tissue doctors they found genetic material from the virus zika. An official of the World Health Organization (WHO) said there is a "growing evidence" about the relationship between the virus and two neurological disorders zika microcephaly and Guillain-Barre syndrome. In early February, Venezuela reported three deaths and about 5 000 221 patients suspected of having the virus zika, but doctors and non-governmental organizations believe that cases may be many more in a country suffering from an acute shortage of medicines and repellents to avoid the bite of the infected mosquito. The outbreak was confirmed this year in Panama, Venezuela, El Salvador, Mexico, Suriname, Colombia, Guatemala and Paraguay. Torres, who participated in the study reported the first case of zika relationship with microcephaly in Venezuela, made the warning as 60 percent of the 600,000 pregnant women do not receive adequate prenatal annual control. In most cases, the virus occurs without symptoms that cause alarm. In Venezuela abortion laws consider as illegal unless threatened the life or health of the woman, but not in the case of the baby. http://www.excelsior.com.mx/global/2016/03/04/1078837#.VtnVoCF88Ms.twitter

5 MAR 2016 - 6:10AMZika-linked microcephaly in Columbia A doctor in Columbia has reported the first case of a Zika-linked birth defect, following the birth of a baby with microcephaly.Source: AAP5 MAR 2016 - 6:06 AM UPDATED 45 MINS AGOThe first case of infant microcephaly linked to the mosquito-borne Zika virus has appeared in Colombia, a doctor says, although the national health institute said it had no information on the case and could not confirm it. Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition defined by unusually small heads that can result in developmental problems. Colombia, seen as a key test case of the impact of the virus, has 42,706 cases of Zika, including 7653 pregnant women. A study of 28 women in Colombia's Sucre province infected with Zika during pregnancy has so far yielded one baby with microcephaly, said Alfonso Rodriguez-Morales, a doctor and researcher at the Technical University of Pereira. It was not immediately known when the child was born. "The only infection that would explain what is happening is the Zika virus," he said on Friday. One case does not prove an overall link between the virus and microcephaly, Rodriguez-Morales told Reuters in a phone interview, but his team has ruled out other potential causes of the defect in this child, including rubella, herpes, syphilis and toxoplasmosis. The two other babies born to women in the study had cranial defects that are being investigated and could not so far be linked to Zika, Rodriguez-Morales said. The virus is present in all three babies and the women, whose infections have been confirmed by lab tests, remain under observation. The country's national health institute said it could not confirm the case because no samples from the patients had been sent to its laboratories. The institute currently is monitoring 28 children with potential microcephaly, not all related to Zika, but so far no case of the defect is linked to the virus, the institute told Reuters. Rodriguez-Morales said researchers have sent the samples to the institute. "We'll really see the impacts of Zika on newborns and pregnancy during the next two or three months," Rodriguez-Morales said. Colombian health officials last week reported a "probable" case of microcephaly possibly linked to Zika in an aborted fetus. http://www.sbs.com.au/news/article/2016/03/05/zika-linked-microcephaly-columbia

By MARY BROPHY MARCUS CBS NEWS March 4, 2016, 2:28 PMIs Colombia on the verge of a Zika-linked wave of birth defects?Sueli Maria holds her newborn daughter, who has microcephaly, at a hospital in Recife, Brazil, January 28, 2016. The first cases of newborns with Zika-related birth defects have been found in Colombia now. REUTERS Comment Share Tweet Stumble EmailBrazil was the first country to report a surge in newborns with microcephaly that parallels the recent outbreak of Zika virus. But Colombia may not be far behind. The Nature news site reported today that researchers in Colombia have identified their first cases of birth defects believed to linked to Zika. The findings could signal the beginning of a wave of Zika-related birth defects in that country, which lies in the upper northwest corner of South America, adjacent to Brazil. The virus was first reported in Brazil in the spring of 2015, although it's believed to have started spreading the year before. It wasn't reported in Colombia until last September. 26 PHOTOSZika virus takes heartbreaking tollOne newborn baby in Colombia has now been diagnosed with microcephaly -- an abnormally small head -- and two other babies have congenital brain abnormalities, Alfonso Rodriguez-Morales, told Nature. Rodriguez-Morales chairs the Colombian Collaborative Network on Zika (RECOLZIKA), which made the diagnoses. He said all three babies tested positive for the presence of Zika virus. The scientists have submitted a report about their findings to a scientific journal. Scientists have found the Zika virus in amniotic fluid, in the cerebrospinal fluid of affected babies and in the brains of stillborn and aborted fetuses after the detection of severe malformations during pregnancy. Rodriguez-Morales, an infectious-diseases epidemiologist at the Technological University of Pereira in western Colombia, told Nature they expect to see an uptick in cases of Zika-linked birth defects in the next two or three months. Play VIDEOBaby born with microcephaly in U.S. after mother's travelsThe RECOLZIKA network of researchers and public-health institutions across Colombia are investigating a handful of other suspected cases of Zika-related microcephaly. The concern is that Colombia will follow the pattern of Brazil, which first reported a microcephaly link to Zika in October 2015. Since then, health officials in Brazil have reported more than 4,000 suspected cases of microcephaly, which can result in mental disability and lifelong health problems. The World Health Organization says health officials in French Polynesia, which was also affected by a Zika outbreak, identified an increase in the number of fetuses and babies with unusually small heads there, too. There is "very high suspicion" of a link between the Zika virus and microcephaly in French Polynesia, Dr. Didier Musso, an infectious disease specialist at the archipelago's Institut Louis Malardé, told The New York Times. But he said additional research was still needed. Meanwhile, Columbian officials have in place health monitoring efforts for pregnant women as the mosquito-borne outbreak continues to unfold. http://www.cbsnews.com/news/is-colombia-on-the-verge-of-a-zika-linked-wave-of-birth-defects/

Colombia researchers discover first cases of Zika virus linked to birth defectsCountry had until now not confirmed any cases of defects related to the virus, though Brazil has seen a marked rise in areas where the disease is widespread The new study provides experimental evidence that once the virus reaches the developing brain, it can infect and harm cells that are key for further brain development. Photograph: Ivan Alvarado/ReutersSibylla Brodzinsky in Bogotá Friday 4 March 201614.29 ESTLast modified on Friday 4 March 201614.36 EST Share on PinterestShare on LinkedInShare on Google+Shares3Comments0 Save for laterResearchers in Colombia have discovered the country’s first cases of birth defects linked to the mosquito-borne Zika virus. One researcher in the city of Sincelejo in northern Colombia diagnosed one newborn child with microcephaly. Two other children were born with congenital brain abnormalities, according to Nature. All three tested positive for the Zika virus. Zika virus can be carried by more common mosquito, scientists say Read moreDr Wilmer Villamil, of the Sincelejo University Hospital, who made the diagnosis of microcephaly, could not immediately be reached for comment. Nature reported that the Colombian Collaborative Network on Zika (Recolzika), a group of researchers studying the virus, expects a rise in cases of Zika-linked birth defects starting in two or three months and that researchers are investigating several other suspected cases of Zika-linked microcephaly. With more than 42,000 cases of Zika infection, including 7,653 in pregnant women, Colombia had until now not confirmed any cases of birth defects related to the virus, although Brazil has seen a marked rise in areas where the disease is widespread. However, the dimensions of the surge in microcephaly in Brazil are not yet clear. Some 5,909 microcephaly cases have been reported since November, a month after the Zika outbreak there was detected, and only 82 have been confirmed to be Zika related. Colombia, which sounded the alarm over possible microcephaly, and recommended women put off pregnancy before the first case was found could be better prepared to study the links between the birth defect and Zika by establishing a baseline for the annual numbers of birth defects. The Colombian government originally projected it could see some 500-600 cases of Zika-related microcephaly but later revised the projection downward as the link between the two came under more scrutiny. Zika usually causes only mild flu-like symptoms, with aches, fever and a rash in adults. But a lab study in America has found that Zika can infect embryonic cells that help form the brain, adding to evidence that the virus causes a serious birth defect. Colombia confirms first three deaths of patients infected with Zika virus Read moreThe new work provides experimental evidence that once the virus reaches the developing brain, it can infect and harm cells that are key for further brain development, said Hengli Tang of Florida State University, a lead author of the work, which was released Friday by the journal Cell Stem Cell. But he stressed that his study does not prove that Zika causes microcephaly, nor that it works by that route. A number of other viruses are known to trigger the condition. Colombia’s health ministry has linked Zika with the death of thee adults with a neurological condition known as Guillain-Barré which causes temporary paralysis. http://www.theguardian.com/world/2016/mar/04/colombia-researchers-discover-zika-virus-link-birth-defects

Map update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU

On 3/4/16, ACPHD confirmed an Alameda County resident has tested positive for the Zika virus. The person was infected with Zika virus while traveling in a Zika-affected country. http://www.acphd.org/zika.aspx

Updated March 2, 2016As of 2/5/2016, many countries and territories in Latin America, the Caribbean, Oceania/Pacific Islands and Cape Verde in Africa have reported active Zika virus transmission. See http://www.cdc.gov/zika/geo/index.html for updated countries and http://wwwnc.cdc.gov/travel/notices/ for travel notices In California, six travel-associated Zika cases were reported between 2013 and 2015. On 2/9/16, ACPHD confirmed an Alameda County resident has preliminarily tested positive for the Zika virus. The person was infected with Zika virus while traveling in a Zika-affected country. Updated case counts will be available weekly on Fridays. For statewide case counts, see the CDPH Zika Website: https://www.cdph.ca.gov/HealthInfo/discond/Pages/Zika.aspx.Alameda County Public Health Department has issued a Public Health Zika Health Advisory Update for health care providers on 2/11/16 with updated guidance for exposures, clinical symptoms, and testing via public health laboratories. For additional details, and to see the full Advisory click on the following link: http://www.acphd.org/health-alerts.aspxOn 3/4/16, ACPHD confirmed an Alameda County resident has tested positive for the Zika virus. The person was infected with Zika virus while traveling in a Zika-affected country. Updated case counts will be available weekly on Fridays. For statewide case counts, see the CDPH Zika Website: https://www.cdph.ca.gov/HealthInfo/discond/Pages/Zika.aspx

Fri Mar 4, 2016 1:45pm ESTRelated: HEALTHCAREColombia doctor reports first case of Zika-linked microcephaly The first case of birth defect microcephaly linked to the mosquito-borne Zika virus has appeared in Colombia, a doctor said on Friday, although the national health institute said it had no information on the case and could not confirm it. Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition defined by unusually small heads that can result in developmental problems. Colombia, seen as a key test case of the impact of the virus, has 42,706 cases of Zika, including 7,653 pregnant women. A study of 28 women in Colombia's Sucre province infected with Zika during pregnancy has so far yielded one baby with microcephaly, said Alfonso Rodriguez-Morales, a doctor and researcher at the Technical University of Pereira. It was not immediately known when the child was born. "The only infection that would explain what is happening is the Zika virus," he said. One case does not prove an overall link between the virus and microcephaly, Rodriguez-Morales told Reuters in a phone interview, but his team has ruled out other potential causes of the defect in this child, including rubella, herpes, syphilis and toxoplasmosis. The two other babies born to women in the study had cranial defects that are being investigated and could not so far be linked to Zika, Rodriguez-Morales said. The virus is present in all three babies and the women, whose infections have been confirmed by lab tests, remain under observation. The country's national health institute said it could not confirm the case because no samples from the patients had been sent to its laboratories. The institute currently is monitoring 28 children with potential microcephaly, not all related to Zika, but so far no case of the defect is linked to the virus, the institute told Reuters. Rodriguez-Morales said researchers have sent the samples to the institute. The potential case was first reported by science journal Nature. "We'll really see the impacts of Zika on newborns and pregnancy during the next two or three months," Rodriguez-Morales said. "One will be able to see the real magnitude of the problem." Colombian health officials last week reported a "probable" case of microcephaly possibly linked to Zika in an aborted fetus. The health minister has said original estimates of microcephaly cases may be too high. Brazil said it has confirmed more than 640 cases of microcephaly, and considers most of them to be related to Zika infections in the mothers. It is investigating more than 4,200 additional suspected cases. (Reporting by Julia Symmes Cobb; Editing by Bill Trott) http://www.reuters.com/article/health-zika-colombia-idUSL2N16C1DF

First Zika-Linked Birth Defects Detected in ColombiaCases may signal start of anticipated wave of birth defects in country already hit hard by outbreak By Declan Butler, Nature magazine on March 4, 2016 ©iStock.comResearchers have found Colombia's first cases of birth defects linked to the Zika virus, Nature has learned—which are likely forerunners of a widely anticipated wave of Zika-related birth defects in the country. The discovery is perhaps no surprise: the virus arrived in Colombia last September, and the country is second only to Brazil in terms of the number of people infected with Zika. But Colombian researchers hope that plans put in place to closely monitor pregnant women can help to better establish the magnitude of the threat posed to fetuses by Zika. That is a crucial question that scientists have not so far been able to answer with the data from Brazil. Researchers have diagnosed one newborn with microcephaly—an abnormally small head—and two others with congenital brain abnormalities, says Alfonso Rodriguez-Morales, who chairs the Colombian Collaborative Network on Zika (RECOLZIKA), which made the diagnoses. All three tested positive for the presence of Zika virus. The researchers have submitted a report of their detections to a scientific journal. Rodriguez-Morales, an infectious-diseases epidemiologist at the Technological University of Pereira in western Colombia, says that he expects to see a rise in cases of Zika-linked birth defects starting in two or three months' time. The RECOLZIKA group—a network of researchers and public-health institutions across Colombia—are already investigating a handful of other suspected cases of microcephaly, which have a possible link to Zika. THE NEXT WAVE?Brazil is the only country so far to report a large surge in newborns with microcephaly that coincides with outbreaks of Zika virus. By the time the alarm over a possible microcephaly link was raised there (in October 2015), Zika infections had already peaked in many parts of the country, because the virus first reached Brazil at the beginning of last year. In Colombia, by contrast, researchers detected the first Zika cases in September, and by December had set up national tracking programmes to monitor pregnant women for signs of infection, and to spot early signs of birth defects in fetuses. Since then, researchers have been waiting attentively to see whether their country might experience a similar rise in birth defects. The true size of Brazil's surge in microcephaly cases is unknown. The country's health ministry says that 5,909 suspected microcephaly cases have been registered since early November, but only 1,667 of them have been investigated so far. Of those, 1,046 have been discarded as false positives, and 625 have been confirmed. (A link with the Zika virus has been confirmed by molecular-lab tests in 82 cases.) Given that Brazil reported only 147 cases of microcephaly in 2014, the reported increase in cases since November suggests a marked rise in the number of babies born with the condition. But the 2014 figure is a “huge underestimate”, says Lavinia Schüler-Faccini, a geneticist who specialises in birth defects at the Federal University of Rio Grande do Sul, Brazil, and president of the Brazilian Society of Genetic Medicine. She says that according to the frequency of microcephaly typically observed in regions around the world, one would expect to see 300–600 cases of severe microcephaly in any given year in Brazil, and around 1,500 less-severe ones. The search for cases of microcephaly in Brazil since October is probably turning up many mild cases that previously went unnoticed—so that the reported surge looks higher than it really is. Still, Schüler-Faccini and other clinicians say there is a real problem. They have observed first-hand a marked increase in the number of unusually severe cases of microcephaly, they say. To be prepared to better interpret any imminent peak in birth defects in Colombia, RECOLZIKA plans to look at historical cases to establish a baseline for the annual numbers of birth defects in different regions. It is also setting up a study to analyse patterns in the distribution of head-circumference measurements recorded in obstetrics units regionally throughout the country, to get a better idea of the local range of normal values. ZIKA'S LINK TO MICROCEPHALYIt has also not been possible so far from Brazilian data to quantify the extent to which Zika virus is linked to the rise in microcephaly. The latest data from Brazil's ministry of health show that increased cases of microcephaly and/or congenital malformations of the central nervous system are still concentrated in the northeast—raising questions as to whether other factors, perhaps specific to this region, might also be in play. Clinical evidence leaves little doubt that a link between Zika and microcephaly exists: the virus has been detected in amniotic fluid, in the cerebrospinal fluid of affected babies and in the brains of stillborn fetuses and those aborted after the detection of severe malformations during pregnancy. But there are also many other possible causes of microcephaly, including a group of infections that are collectively called STORCH (syphilis, toxoplasmosis, other infections, rubella, cytomegalovirus infection and herpes simplex), which are known to cause birth defects. Exposure to toxic chemicals and the consumption of alcohol during pregnancy can also cause the condition. “There is a clear need for a full assessment of other detailed causes of microcephaly, such as STORCH, and even non-infectious causes,” says Rodriguez-Morales. Brazil’s health ministry has stated that it is carrying out tests for such causes, but it has not made public how many of the confirmed microcephaly cases are attributable to these. HEALTHY COMPARISONSA key question in assessing the scale of the threat that Zika may pose to fetuses is how many pregnant women infected with Zika—in particular during the first trimester, when the fetus is most vulnerable—nonetheless give birth to healthy babies. RECOLZIKA researchers hope to help to answer this through their monitoring programme. The risk posed by Zika may well be lower than that of other diseases that are known to cause microcephaly such as toxoplasmosis and rubella, says Rodriguez-Morales. That is a preliminary estimate, he says, based on back-of-the-envelope calculations of the reported numbers of confirmed cases of microcephaly and congenital disorders, compared to the number of pregnant women in regions experiencing Zika epidemics. But even if its risk does turn out to be low, Zika could still lead to many cases because a large number of pregnant women in the Americas are likely to become infected with the virus. The biggest risk to pregnant women is right now, rather than in the long term. The epidemic is sweeping so quickly through the Americas that much of the population, including young women, will become naturally vaccinated by their exposure to the virus. As population immunity increases, the Zika epidemic is likely to fade quickly, and it will become endemic with only occasional flare ups. In a modelling study posted to the preprint server bioRxiv on February 29, US researchers noted that the risk of prenatal Zika virus exposure “should decrease dramatically following the initial wave of disease, reaching almost undetectable levels”. This article is reproduced with permission and was first published on March 4, 2016. http://www.scientificamerican.com/article/first-zika-linked-birth-defects-detected-in-colombia/

Zika virus: updated guidance for pregnant womenPHE and NaTHNaC have updated their guidance relating to travel to areas where there is active transmission of Zika virus, including areas in South and Central America and the Caribbean. A new recommendation is that pregnant women should postpone all non-essential travel to those areas [1,2]. This reflects increasing evidence that supports an association between Zika virus infection and microcephaly in developing foetuses. Where travel to areas with active transmission cannot be postponed, pregnant women and those planning pregnancy should avail themselves of advice from their healthcare provider about the risks that Zika may present before they travel, and in some circumstances after they return. The principal, protective advice applicable to all travellers, but particularly pregnant women who cannot postpone travel, is to practise scrupulous mosquito bite avoidance. PHE, the British Medical Association and the Royal College of General Practitioners have issued joint guidance for healthcare professionals in primary care who may be consulted by patients, including pregnant women, who are travelling to or returning from the affected areas [3]. This includes guidance on pre-departure travel advice, medical complications that may be associated with Zika virus infection, and management of returning travellers including assessment and diagnosis of patients with current symptoms suggestive of Zika virus infection. Additionally, new advice is available about Guillain-Barré syndrome, and also Zika virus and immunosuppressed patients. Adopting a precautionary approach, guidance from PHE and its partners recommends measures to decrease the risk of male-to-female sexual transmission of Zika virus, particularly transmission to pregnant women and women planning pregnancy. This includes recommendations on condom use for men who have returned from affected areas (for a six-month period in the case of a male partner who has experienced symptoms compatible with Zika virus infection, and 28 days for men who have not had symptoms). Additionally, returned male travellers who are partners of pregnant women are advised to use condoms for the duration of pregnancy. Links to all professional guidance produced by PHE and its partners are available onPHE’s main Zika guidance webpage [4]. 1.1References‘Zika virus: updated travel advice for pregnant women’, PHE website news story, 1 March 2016. National Travel Health Network and Centre (2 March). Zika - Risk Assessment. PHE, BMA, RCGP (February 2016). Zika virus infection: guidance for primary care(updated 1 March). PHE. Zika virus: health protection guidance collection (updated 3 March). https://www.gov.uk/government/publications/health-protection-report-volume-10-2016/hpr-volume-10-issue-9-news-4-march#zika-virus-updated-guidance-for-pregnant-women

Zika Kills Cells Key to Fetal Brain Development, Study SaysBy CATHERINE SAINT LOUISMARCH 4, 2016 The Zika virus destroys cells that give rise to the brain cortex in the developing fetus, scientists reported on Friday. The finding, published in the journal Cell Stem Cell, may help explain how the virus might cause microcephaly, or unusually small heads, in infants whose mothers are infected during pregnancy. “It’s an important advance and a step forward to clearly demonstrate that the virus kills brain cells,” said Dr. Mark R. Schleiss, the director of pediatric infectious diseases and immunology at the University of Minnesota Medical School, who was not involved in the study. But other experts cautioned that it was conducted with cells cultured in a laboratory and may not reflect the virus’s effects in humans. “It might be that the results wouldn’t be the same in a living system of actual cortical stem cells,” said Dr. Catherine Y. Spong, the acting director of the National Institute of Child Health and Human Development. “The act of culturing these cells to evaluate them in an in vitro system may make them more susceptible to infection,” she said. In their experiments, researchers at Johns Hopkins and elsewhere cultured cells that eventually form the cortex, the outer layer responsible for many higher functions, of the fetal brain. In the laboratory, the scientists exposed the so-called cortical neural progenitor cells to the Zika virus, along with two other types of cells present in early fetal development. Three days after exposure, 90 percent of the progenitor cells were infected, while the two other types were much less compromised. “We found the cell types responsible for forming the cortex are the target of the Zika virus,” said Hongjun Song, a senior author of the new paper and a professor of neurology and neuroscience at Johns Hopkins University School of Medicine. Infected cortical neural progenitor cells were unable to divide normally and died more often, the researchers found. The number of viable cells decreased 72 hours after infection, compared with those not infected with the Zika virus. Dr. William B. Dobyns, a pediatric neurologist at Seattle Children’s Research Institute, called the new paper “highly significant.” If the cells that should form the brain’s cortex in a fetus “aren’t growing fast enough,” he said, “you get a small brain, but on top of that there’s cell death, which means whatever the size the brain is, it will shrink.” That reduction may lead to a conspicuous space between the skull and brain. Dr. Dobyns recently reviewed the brain scans of infants with microcephaly in Brazil. “This paper fits like a glove what I’m seeing on the brain scans,” Dr. Dobyns said, including abnormalities like an unusual space between severely shrunken brains and the inner skull, and a relatively smooth brain surface. But the new study does not prove that the Zika virus is responsible for a reported increase in microcephaly in Brazil. Experts await more convincing evidence from a study of roughly 5,000 pregnant women, mostly in Colombia, who all were infected with the Zika virus early in their pregnancies. The World Health Organization does not expect the results from that study until June at the earliest. Sara Cherry, an associate professor of microbiology at the University of Pennsylvania, called the new study “really important” but noted that Dr. Song and his colleagues “used a virus strain that’s quite distinct from what is circulating in Latin America.” The research team, which includes scientists from Florida State University and Emory, nonetheless believes its experimental model can help explain how Zika affects nervous system development and can help provide a way to screen drugs that may “stop the entry of the virus into these brain cells,” said Dr. Guo-li Ming, a senior author of the study and a neurology professor at Johns Hopkins. http://www.nytimes.com/2016/03/05/health/zika-virus-microcephaly-fetus-birth-defects.html?_r=0