niman Posted January 28, 2016 Report Share Posted January 28, 2016 WHO director General issues update on Zika. http://who.int/dg/speeches/2016/zika-situation/en/ Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 WHO Director-General briefs Executive Board on Zika situationBriefing to the Executive Board on the Zika situationGeneva, Switzerland 28 January 2016Distinguished members of the Board, representatives of Member States, ladies and gentlemen,Welcome to this briefing on the Zika situation. I will give you a brief history of this disease and explain why WHO is so deeply concerned.The Zika virus was first isolated in 1947 from a monkey in the Zika forest of Uganda. Its historical home has been in a narrow equatorial belt stretching across Africa and into equatorial Asia.For decades, the disease, transmitted by the Aedes genus of mosquito, slumbered, affecting mainly monkeys. In humans, Zika occasionally caused a mild disease of low concern.In 2007, Zika expanded its geographical range to cause the first documented outbreak in the Pacific islands, in the Federated States of Micronesia. From 2013-2014, 4 additional Pacific island nations documented large Zika outbreaks.In French Polynesia, the Zika outbreak was associated with neurological complications at a time when the virus was co-circulating with dengue. That was a unique feature, but difficult to interpret.The situation today is dramatically different. Last year, the virus was detected in the Americas, where it is now spreading explosively. As of today, cases have been reported in 23 countries and territories in the region.The level of alarm is extremely high.Arrival of the virus in some places has been associated with a steep increase in the birth of babies with abnormally small heads and in cases of Guillain-Barre syndrome.A causal relationship between Zika virus infection and birth malformations and neurological syndromes has not yet been established, but is strongly suspected.The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions. The increased incidence of microcephaly is particularly alarming, as it places a heart-breaking burden on families and communities.WHO is deeply concerned about this rapidly evolving situation for 4 main reasons:the possible association of infection with birth malformations and neurological syndromesthe potential for further international spread given the wide geographical distribution of the mosquito vectorthe lack of population immunity in newly affected areasand the absence of vaccines, specific treatments, and rapid diagnostic tests.Moreover, conditions associated with this year’s El Nino weather pattern are expected to increase mosquito populations greatly in many areas.The level of concern is high, as is the level of uncertainty. Questions abound. We need to get some answers quickly.For all these reasons, I have decided to convene an Emergency Committee under the International Health Regulations. The Committee will meet in Geneva on Monday, 1 February.I am asking the Committee for advice on the appropriate level of international concern and for recommended measures that should be undertaken in affected countries and elsewhere. I will also ask the Committee to prioritize areas where research is most urgently needed.Decisions concerning the Committee’s advice to me will be made public on our web site.Thank you. Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 Live stream http://www.who.int/mediacentre/events/2016/webstreaming/eb138/en/ Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 WHO Media Statement on Zika virus Geneva 28 January 2016--WHO Director-General, Margaret Chan, will convene an International Health Regulations Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. The Committee will meet on Monday 1 February in Geneva to ascertain whether the outbreak constitutes a Public Health Emergency of International Concern. Decisions concerning the Committee’s membership and advice will be made public on WHO’s website. Outbreak in the Americas In May 2015, Brazil reported its first case of Zika virus disease. Since then, the disease has spread within Brazil and to 24 other countries in the region. Arrival of the virus in some countries of the Americas, notably Brazil, has been associated with a steep increase in the birth of babies with abnormally small heads and in cases of Guillain-Barré syndrome, a poorly understood condition in which the immune system attacks the nervous system, sometimes resulting in paralysis. A causal relationship between Zika virus infection and birth defects and neurological syndromes has not been established, but is strongly suspected. WHO actionWHO’s Regional Office for the Americas (PAHO) has been working closely with affected countries since May 2015. PAHO has mobilized staff and members of the Global Outbreak and Response Network (GOARN) to assist ministries of health in strengthening their abilities to detect the arrival and circulation of Zika virus through laboratory testing and rapid reporting. The aim has been to ensure accurate clinical diagnosis and treatment for patients, to track the spread of the virus and the mosquito that carries it, and to promote prevention, especially through mosquito control. The Organization is supporting the scaling up and strengthening of surveillance systems in countries that have reported cases of Zika and of microcephaly and other neurological conditions that may be associated with the virus. Surveillance is also being heightened in countries to which the virus may spread. In the coming weeks, the Organization will convene experts to address critical gaps in scientific knowledge about the virus and its potential effects on fetuses, children and adults. WHO will also prioritize the development of vaccines and new tools to control mosquito populations, as well as improving diagnostic tests. Media contacts: Gregory Härtl, Coordinator, News, Social Media and Monitoring, Tel: +41 22 791 4458, Mob: +41 79 203 67 15; E-mail: [email protected] Christian Lindmeier, Tel: +41 22 791 1948; Mob: +41 79 500 65 52; E-mail: [email protected] Media hotline: +41 22 791 2222 or E-mail: [email protected] More information on Zika can be found at: http://who.int/csr/disease/zika/en/ Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 NEWS JAN 28 2016, 8:11 AM ETZika Virus Outbreak: WHO Chief Convenes Emergency Committee Meetingby ALEXANDER SMITH SHARE The World Health Organization said Thursday it will convene an emergency committee on the Zika virus, which is "spreading explosively" and suspectedof causing birth defects.The meeting scheduled for Monday will examine whether the Zika outbreak should be classified as an international health emergency, WHO said in a statement.WHO's Director General Dr. Margaret Chan said the virus is "spreading explosively" in the Americas. "The level of alarm is extremely high," she said.FacebookTwitterGoogle PlusEmbed CDC to Doctors: Monitor Women Returning From Zika Virus Hot Zones 1:59Experts strongly suspect that Zika is causing a severe birth defect called microcephaly, in which babies' brains are underdeveloped. It's not certain yet, but evidence is building.'The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions," Chan said in remarks to WHO's executive board."The increased incidence of microcephaly is particularly alarming, as it places a heart-breaking burden on families and communities."On Wednesday, two experts on international health matters accused Chan and WHO of acting far too slowly in raising the alarm about Zika.Twenty-four countries have reported cases of the virus and the WHO has predicted it will eventually end up in virtually every Western Hemisphere country.Until last year, the virus had not been a major concern for health officials, causing mostly mild symptoms in around 20 percent of those infected.http://www.nbcnews.com/news/world/zika-virus-outbreak-who-chief-convenes-emergency-committee-meeting-n505706 Dr. Vanessa Van Der Linden, the neuro-pediatrician who first recognized and alerted authorities over the microcephaly crisis in Brazil, measures the head of a 2-month-old baby with microcephaly on Wednesday in Recife, Brazil. The baby's mother was diagnosed with having the Zika virus during her pregnancy. Mario Tama / Getty Images Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 Zika virus: Up to four million Zika cases predictedBy James GallagherHealth editor, BBC News website4 minutes ago From the sectionHealthJump media playerMedia player help Out of media player. Press enter to return or tab to continue.Media captionWHO director general Dr Margaret Chan: "The level of concern is high as is the level of uncertainty"The World Health Organization has set up a Zika "emergency team" after the "explosive" spread of the virus.It expects three to four million cases of Zika virus disease in the Americas.WHO director general Dr Margaret Chan said Zika had gone "from a mild threat to one of alarming proportions" and was having a "heart-breaking" impact.The team will meet on Monday to decide whether Zika should be treated as a global emergency.The last time an international emergency was declared was for the Ebola outbreak in West Africa which has killed more than 11,000 people.Zika: What you need to knowZika was first detected in Uganda in 1947, but has never caused an outbreak on this scale.Brazil reported the first cases of Zika in South America in May 2015.Most cases result in no symptoms and it is hard to test for, but WHO officials said an estimated 1.5 million people had been infected in the country.The virus, which is spread by mosquitoes, has since spread to more than 20 countries in the region.At the same time there has been a steep rise in levels of microcephaly - babies born with abnormally small heads - and the rare nervous system disorder Guillain-Barre syndrome.The link between the virus and these disorders has not been confirmed, but Dr Chan said it was "strongly suspected" and "deeply alarming".And she warned the situation could yet deteriorate as "this year's El Nino weather patterns are expected to increase mosquito populations greatly in many areas".The BBC's David Shukman, reporting from Recife in north-east Brazil, said doctors were "overwhelmed" by cases of microcephaly.Image copyrightMario TamaImage captionOne hospital in the city of Recife has seen a sharp rise in cases of microcephaly in the past six monthsOne hospital in the city had gone from dealing with an average of five cases a year to 300 in the past six months.Emergency teamEarlier, doctors writing in the Journal of the American Medical Association said Zika had "explosive pandemic potential" and said the WHO's failure to act swiftly on Ebola probably cost thousands of lives.In a statement to the executive board meeting of the WHO, Dr Chan said: "The level of concern is high, as is the level of uncertainty."Questions abound - we need to get some answers quickly."For all these reasons, I have decided to convene an Emergency Committee."I am asking the Committee for advice on the appropriate level of international concern and for recommended measures that should be undertaken in affected countries and elsewhere."Dr Carissa Etienne, the regional-director for the WHO Pan American Health Organization, said the link between the abnormalities and Zika had not been confirmed.But she added: "We cannot tolerate the prospect of more babies being born with neurological and other malformations and more people facing the threat of paralysis."Follow James on Twitter.Image copyrightUS CDCImage captionAedes aegyptiWhat is the Zika virus:Spread by the Aedes aegyptimosquito, which also carries dengue fever and yellow feverFirst discovered in Africa in the 1940s but is now spreading in Latin AmericaScientists say there is growing evidence of a link to microcephaly, that leads to babies being born with small headsCan lead to fever and a rash but most people show no symptoms, and there is no known cureOnly way to fight Zika is to clear stagnant water where mosquitoes breed, and protect against mosquito bitesZika: What you need to knowhttp://www.bbc.com/news/health-35427493 Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 Live stream http://live.reuters.com/Event/Reuters_Live_Video Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 The Opinion Pages | EDITORIALZika Virus Requires an Urgent ResponsePhoto Workers in Recife, Brazil, sprayed insecticide to combat mosquitoes that transmit the Zika virus.CreditFelipe Dana/Associated PressAdvertisementContinue reading the main storyContinue reading the main storyShare This PageEmailShareTweetSaveMoreContinue reading the main storyNo sooner was the Ebola virus subdued in Africa than another virus, Zika, began sweeping through South and Central America. It has been linked toserious birth defects and is threatening to invade the United States. It is imperative that the World Health Organization not repeat its sluggish response to the Ebola crisis and act urgently this time to mobilize international action.Until it reached the Western Hemisphere, the Zika virus — related to dengue, yellow fever and West Nile virus and named after the Ugandan forest where it was first identified almost 70 years ago — had caused little more than relatively mild, flulike infections. But in the nine months since it came to the Americas, it has moved swiftly through Brazil and two dozen other countries and territories, spread by mosquitoes of the Aedes species, which can breed in the tiniest pools of water and usually bite during the day, making them especially hard to control.Though not particularly dangerous to the person infected, the spread of Zika has been accompanied by a huge spike in microcephaly, a congenital and irreversible deformation of the skull in newborn babies. The number of reported cases in Brazil jumped from 147 in 2014 to nearly 4,000 in 2015, leaving health officials with little doubt — although no firm scientific proof — that Zika was responsible. Scientists have also identified a possible link between the virus and the neurological disorder known as the Guillain-Barré syndrome.At present there is no vaccine, no cure and no widely available test for Zika infection. In their absence, the obvious course is to avoid mosquito bites by wearing clothes that cover arms and legs, and using air-conditioning and screens and insect repellents containing DEET. Brazil, which is hosting the Olympic Games this summer, has begun an extensive campaign to eradicate mosquitoes, including the deployment of 220,000 soldiers to search for breeding sites, and has urged women to avoid getting pregnant until the outbreak is brought under control.El Salvador has advised women to delay pregnancy until 2018. In the United States, the Centers for Disease Control and Prevention has issued a list of countries pregnant women would be wise to avoid and has urged pregnant women who have traveled to affected areas to see a doctor and determine whether a test is required. None of that is likely to quickly end the scourge, and no country can do that on its own. On the contrary, the virus could migrate to southern areas of the United States when winter ends.Regrettably, despite these actions, the World Health Organization seems, once again, to be dozing and has yet to generate a broad and coordinated international response. By coincidence, the W.H.O. executive board is currently meeting in Geneva, so this is the perfect time for the agency to show leadership by convening an emergency committee of experts to take stock of the Zika pandemic and advise the W.H.O. director general, Dr. Margaret Chan, on how best to combat it. Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 Editorial Meet dengue's cousin, ZikaErin Archer Kelser, Show more doi:10.1016/j.micinf.2015.12.003Get rights and content It's too early to know how alarmed we should be about the spread of Zika virus (ZIKV). The good news is that ZIKV currently presents as a relatively mild and self-limiting illness, with low hospitalization rates [1], [2], [3], [4], [5], [6] and [7]. The bad news is that ZIKV is spreading rapidly worldwide [1], [4], [8] and [9], is challenging to diagnose [1], [2], [3], [4],[5], [6], [7], [9] and [10], and may have effects following the illness including autoimmune diseases like Guillain-Barré syndrome (GBS) [2], [4], [5] and [11], other neurological disorders [2] and [4] and birth defects [12]. The World Health Organization (WHO) has warned its Member States that ZIKV has the potential to place an additional burden on local health systems and recommends development of ZIKV testing capabilities and public education campaigns for prevention of ZIKV [1], [8] and [13].1. About ZIKVZIKV is a mosquito-borne ssRNA flavivirus of the Flaviviridae family that includes dengue virus (DENV), West Nile Virus (WNV), Japanese encephalitis and Yellow Fever. ZIKV's closest relative is Spondweni virus [1], [3] and [6]. Comprehensive genetic comparison has revealed subclades reflecting 2 lineages, one African and one Asian [4]. ZIKV is suspected of having widespread occurrence in Africa and Southeast Asia [5]. Humans and non-human primates are the only known reservoir [3] and [9] but one study did find antibody in rodents [3].ZIKV has the ability to infect multiple species of the Aedes genus of mosquito [1], [5], [6],[9], [11] and [15], the same genus that spreads DENV [3], [6], [7] and [8] and Chikungunya (CHIK) [7]. Perinatal and transfusion transmission of ZIKV are theoretically possible [1], [2] and [7], and sexual transmission has also been reported [1], [4],[7] and [15].2. History and outbreaksFirst identified in a rhesus monkey in the Zika forest of Uganda in 1947, the first human cases were identified in Nigeria in 1954. Although a small cluster of 7 cases was reported in Java, Indonesia, in 1977 [5] and [14], no significant human outbreaks had been documented before an outbreak on Yap Island in the Federated States of Micronesia in 2007 [1], [2], [3], [5], [6], [9] and [14]. Duffy et al. estimate that approximately 900 people were affected, three-fourths of Yap's population at the time [9]. 2013–2014 had an outbreak in French Polynesia and New Caledonia [2], [3], [4], [10] and [11]. In French Polynesia, there were over 8750 suspected cases and 383 cases confirmed [4], an estimated 11% of the population [1].In February 2014, autochthonous transmission was reported on Easter Island, marking ZIKV's arrival in the Americas. By May 2015, WHO warned of ZIKA in Brazil [4], and October 2015 brought WHO warnings of ZIKA transmission in Colombia [8]. On November 11, 2015, WHO warned of another country in South America with local ZIKV transmission, Suriname [13]. In 2015, outbreaks in Vanautu, the Solomon Islands and New Caledonia have also been reported [4].3. Diagnostic challengesZIKV is difficult to diagnose because it shares vectors, geographic distribution and symptoms with DENV [1], [2], [5] and [6] and CHIK [5] and [6], making diagnosis by clinical signs and epidemiology unreliable [5] and [6]. DENV, ZIKV and CHIK all present clinically with fever, maculopapular rash, conjunctivitis and arthralgia, and are sometimes co-circulating in the same areas [5] and [6] or co-infecting patients [10]. Given the potential severity of illness from dengue virus (DENV), it is particularly important to distinguish between the two (see Table 1). Table 1.Comparison of the symptoms, morbidity and mortality, clinical management, sequelae and vectors for dengue virus (DENV) versus Zika virus (ZIKV), 2015. (Table by Erin Archer Kelser). Dengue virus (DENV)Zika virus (ZIKV)Signs and symptoms-Maculopapular rash, myalgias and arthralgias, conjunctivitis-Temp >40 °C, plus 2 of the following:severe headache, retro-orbital pain, myalgias and arthralgias, nausea, vomiting [21]-Can have 3 phases: 1)the acute febrile phase, 2) on day 3–7, a critical (plasma leak) phase that often presents with defervescence and capillary permeability, an increase in hematocrit and drop in platelets, bleeding, shock, organ failure and respiratory distress, congestive heart failure, 3) a recovery (reabsorbtion) phase [20] and [21]-Symptoms usually 2–7 days [21]-Maculopapular rash, myalgias and arthralgias, conjunctivitis-Temp <38.5 [1]--joint swelling (especially hands and feet), headache, retro-orbital pain [1],[2], [3], [4] and [14]-Self-limiting, with symptoms 2–7 days[1], [2], [4] and [14]Morbidity and mortality-Suspected 390 million infected/year-Approx 1/4 infected symptomatic-Approx 500,000 hospitalizations/year where 2.5% die (approx 12,500 deaths/year) [22]-# cases not yet known-Approx 1/4 of infections believed to be symptomatic[1], [7] and [11]-Hospitalization is rare [1], [2], [3], [4],[5], [6] and [7]Clinical management-No NSAIDS because of risk of bleeding-Close assessment of hydration, bleeding status and signs of organ failure or respiratory distress-If severe/hemhorragic disease, see detailed WHO guidelines [20] and [21]-Symptom management with analgesics and anti-pyretics [7], [8], [9],[10], [11], [12],[13] and [14]NSAIDs acceptable if dengue ruled out[14]Long-term effects and sequelae-Long-term effects documented up to 2 years after illness [17]-Link to Guillan-Barre, encephalitis and other neuro syndromes, autoimmune disease [17] and [18]-No long-term effects known.-Possible link to Guillain-Barre, encephalitis, other neuro syndromes, autoimmune diseases, especially if previously infected with DENV [2],[4] and [11]Primary vectorsAedes aegypti, Ae. Albopictus [21] and [22]Multiple Aedes spp [1],[5], [6], [9] and [11].Table options Lab confirmation is recommended for ZIKV diagnosis, but lab confirmation presents its own set of challenges. Although it is unlikely that IgM results will cross-react with an alphavirus like CHIK [9], cross-reactivity of ZIKV IgM with other flaviruses (especially DENV) has been widely reported [1], [2], [3], [5], [7], [9], [10], [14] and [16].Current testing recommendations are to obtain RT-PCR by urine or saliva within the first 5 or 6 days of illness [1], [4], [5], [14] and [16], with highest concentrations found in saliva early in the disease course, but possibly remaining detectable for longer in the urine[4] and [5]. In the French Polynesia outbreak, some cases had positive ZIKV RT-PCR urine results more than 10 days after symptom onset [4].If serology is performed, an acute phase should be drawn from day 6 onward with a convalescent serum drawn 2–3 weeks later [3] and [16]. Lanciotti notes that false positives for ZIKV seem more likely if ZIKV is not the first flavivirus that the patient has encountered [5], but cross-reactivity has also been reported in primary infected patients[1]. If cross-reactivity is suspected, plaque reduction neutralization testing (PRNT) can help to discriminate between cross-reacting antibodies [5], [6], [7], [9], [11] and [16]. If an isolated DENV positive titer presents with other negative results, diagnostic suspicion should be raised for other flaviviruses [1] and [2]. Pan-flavivirus assays with subsequent sequencing analysis can also be performed [4].4. Possible sequelaeThere have been reports of an increase in Guillain-Barré syndrome (GBS) syndrome (GBS) [2], [4] and [5] and other autoimmune [4] and neurological syndromes [2] in the context of ZIKV outbreaks, but it is not known how many of these patients may have been co-infected or previously infected with DENV, which may increase the risk [2], [11],[17] and [18]. In the French Polynesia outbreak, 74 patients presented with neurological or autoimmune illness who had symptoms consistent with ZIKV in the previous days; 42 of these patients were diagnosed with GBS [4]. This was a 20-fold increase over baseline[5]. Oeler et al. speculate that this increase in GBS cases in the presence of ZIKV may reveal the genetic evolution of the virus to a more pathogenic genotype, a particular susceptibility in the Polynesian population, or that previous DENV illness may predispose patients to GBS via sequential arboviral immune stimulation [11].Most recently, Brazil has declared a state of emergency because of an alarming increase this year of microcephaly in Pernambuco. The baseline rate for this area of microcephaly is 10 cases per year [19]. As of November 9, 141 cases of microcephaly have been reported in Pernambuco. Although the cause is undetermined at this time, ZIKV was isolated from the amniotic fluid of two of the mothers. On November 24, 2015, health officials in French Polynesia also reported an increase of congenital central nervous system malformations, coinciding with their own outbreak from 2013 to 2014 [12].5. Vectors and vector controlPrevention of ZIKV is directed at minimizing breeding sites and contact with Aedesmosquitoes Fig. 1. Aedes often live around buildings and in urban areas. They are active during daylight hours, especially near dawn and dusk, and they have a variety of artificial and natural breeding sites. People in endemic areas are encouraged to use insect repellent, wear light-colored long sleeves and pants and inhabit buildings that utilize air conditioning or window and door screens [1], [8] and [4]. Bed nets are recommended for residents and travelers who sleep during the day [1] and infants under 3 months old, upon whom insect repellent should not be used [6].Fig. 1. Aedes aegypti mosquito. (Photo by James Gathany, Centers for Disease Control and Prevention. 2006).Figure options Concerns exist that other Aedes spp. will become competent vectors for ZIKV [1], [3],[4] and [5]. Outbreaks in Yap and other regions have shown that even physically isolated communities can experience rapid ZIKV spread via travel and commerce [3], [5] and [9]. The Asian lineage particularly seems to have high epidemic potential [4].Until recently, it may have been easy to write off ZIKV as a mild illness, part of the differential diagnosis for mild rash illness, but ZIKV is showing itself to be more than that. It has become a confounding variable in the fight against DENV, a marker of rapid arboviral disease spread in the age of jet travel and commerce, and ZIKV continues to present us with mysteries—Does ZIKV cause GBS or other autoimmune syndromes, and is it more likely when combined with DENV or other flaviruses? Can ZIKV cause congenital microcephaly or other birth defects? On November 29, 2015, the Brazilian health ministry reported the first three suspected deaths to be caused by ZIKV. Until we test and observe more cases of ZIKV, morbidity and mortality from ZIKV will remain unclear.Conflict of interestNo conflicts to declare. References[1]World Health OrganizationWestern Pacific region (WPRO) Zika virus(2015) http://www.wpro.who.int/mediacentre/factsheets/fs_05182015_zika/en/ [2]European Centre for Disease Prevention and ControlRapid risk assessment: zika virus infection outbreak, French Polynesia(14 February 2014) http://docs.google.com/viewer?url=http://ecdc.europa.eu/en/publications/Publications/Zika-virus-French-Polynesia-rapid-risk-assessment.pdf?time=0 [3]E.B. HayesZika virus outside AfricaEmerg Infect Dis, 15 (2009), pp. 1347–1350View Record in Scopus | Full Text via CrossRef | Citing articles (48)[4]European Centre for Disease Prevention and ControlRapid risk assessment: zika virus infection outbreak, Brazil and the Pacific region(25 May 2015) http://ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-Zika%20virus-south-america-Brazil-2015.pdf [5]R.S. Lanciotti, O.L. Kosoy, J.J. Laven, J.O. Velez, A.J. Lambert, A.J. Johnson, et al.Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007Emerg Infect Dis, 14 (2008), pp. 1232–1239View Record in Scopus | Full Text via CrossRef | Citing articles (47)[6]G.S. Campos, A.C. Bandeira, S.I. SardiZika virus outbreak, Bahia, BrazilEmerg Infect Dis, 21 (2015), pp. 1885–1886View Record in Scopus | Full Text via CrossRef | Citing articles (4)[7]Centers for Disease Control and PreventionZika virus(2015) http://www.cdc.gov/zika/index.html [8]World Health OrganizationZika virus infection – Brazil and Colombia(21 Oct 2015) http://www.who.int/csr/don/21-october-2015-zika/en/ [9]M.R. Duffy, T.H. Chen, W.T. Hancock, A.M. Powers, J.L. Kool, R.S. Lanciotti, et al.Zika virus outbreak on Yap island, Federated States of MicronesiaN Engl J Med, 360 (2009), pp. 2536–2543View Record in Scopus | Full Text via CrossRef | Citing articles (79)[10]M. Dupont-Rouzeyrol, O. O'Connor, E. Calvez, M. Daures, M. John, J.P. Grangeon, et al.Co-infection with Zika and dengue viruses in 2 patients, New Caledonia, 2014Emerg Infect Dis, 21 (2015), pp. 381–382View Record in Scopus | Full Text via CrossRef | Citing articles (6)[11]E. Oehler, L. Watrin, P. Larre, I. Leparc-Goffart, S. Lastere, F. Valour, et al.Zika virus infection complicated by Guillain-Barré syndrome – case report, French Polynesia, December 2013Euro Surveill, 19 (2014) pii 20720 [12]European Centre for Disease Prevention and ControlRapid risk assessment: microcephaly in brazil potentially linked to the Zika virus epidemic(24 Nov 2015) http://ecdc.europa.eu/en/publications/Publications/zika-microcephaly-Brazil-rapid-risk-assessment-Nov-2015.pdf [13]World Health OrganizationZika virus infection – suriname(13 Nov 2015) http://www.who.int/csr/don/13-november-2015-zika/en/ [14]European Centre for Disease Prevention and ControlZika virus infection: factsheet for health professionals(2015) http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx [15]B.D. Foy, K.C. Kobylinski, J.L. Chilson Foy, B.J. Blitvich, A. Travassos da Rosa, A.D. Haddow, et al.Probable non–vector-borne transmission of Zika virus, Colorado, USAEmerg Infect Dis, 17 (2011), pp. 880–882View Record in Scopus | Full Text via CrossRef | Citing articles (35)[16]World Health Organization and Pan American Health OrganizationZika Virus (ZIKV) surveillance in the Americas: interim guidance for laboratory detection and diagnosis(2015) Available at: http://www.paho.org/hq/index.php?option=com_topics&view=article&id=427&Itemid=41484&lang=en [17]G. Garcia, N. Gonzalez, A.B. Perez, B. Sierra, E. Aguirre, D. Rizo, et al.Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disordersInt J Infect Dis, 15 (2011), pp. e38–e43Article | PDF (189 K) | View Record in Scopus | Citing articles (28)[18]O. SimonAcute polyradiculoneuropathy and dengue fever infectionPresentation at Journée Scientifique de l'IPNC (21 November 2013) Available at: http://www.institutpasteur.nc/wp-content/uploads/2013/11/S2-03-O-Simon.pdf [19]World Health Organization and Pan American Health OrganizationEpidemiological Alert: Increase of Microcephaly in the Northeast of Brazil(17 November 2015) http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32285=en [20]Centers for Disease Control and Prevention. Clinical guidance: dengue virus. http://www.cdc.gov/dengue/clinicalLab/clinical.html. [21]World Health Organization and Special Programme for Research and Training in Tropical DiseasesDengue guidelines for diagnosis, treatment, prevention and control(2009) http://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf [22]World Health OrganizationDengue and severe dengueFactsheet, 117 (2015) http://www.who.int/mediacentre/factsheets/fs117/en/ Tel.: +1 415 609 3608.Copyright © 2015 Institut Pasteur. Published by Elsevier Masson SAS All rights reserved. Note to users:Corrected proofs are Articles in Press that contain the authors' corrections. Final citation details, e.g., volume and/or issue number, publication year and page numbers, still need to be added and the text might change before final publication.Although corrected proofs do not have all bibliographic details available yet, they can already be cited using the year of online publication and the DOI , as follows: author(s), article title, Publication (year), DOI. Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names and use of punctuation.When the final article is assigned to volumes/issues of the Publication, the Article in Press version will be removed and the final version will appear in the associated published volumes/issues of the Publication. The date the article was first made available online will be carried over.http://www.sciencedirect.com/science/article/pii/S1286457915002592 Link to comment Share on other sites More sharing options...
niman Posted January 28, 2016 Author Report Share Posted January 28, 2016 A new mosquito-borne threat to pregnant women in BrazilMarcia TriunfolPublished Online: 23 December 2015DOI: http://dx.doi.org/10.1016/S1473-3099(15)00548-4 Article Info SummaryFull Text An apparent connection between the emergence of Zika virus and an unusual rise in microcephaly has alarmed Brazilian authorities. Marcia Triunfol reports.In April, 2015, a few cases of Zika virus infection were reported in Bahia, a state to the northeast of Brazil. Patients developed a rash, conjunctivitis, arthralgia, and mild fever. Initially, it seemed that the newcomer would be just one more virus causing a dengue-like illness in a population that has been struggling against dengue for too long.However, in October that year, doctors and health authorities in Brazil noticed an increasing number of newborn babies with microcephaly in Pernambuco, another state in the northeast region, while new cases of microcephaly continued to appear in other states. On Dec 15, the Ministry of Health confirmed 134 cases of microcephaly believed to be associated with Zika virus infection—a further 2165 cases in 549 counties in 20 states are under investigation. All confirmed cases are limited to four states in the northeast region of Brazil. Rio Grande do Norte, the state with the highest incidence of congenital microcephaly, jumped from one case in 2014 to 35 cases in 2015. From 2010 to the beginning of 2015, the incidence of microcephaly in the country had been around 180 cases per year.Interestingly, Bahia, which was one of the first states where Zika virus was isolated, does not have any confirmed cases of microcephaly yet reported. Amilcar Tanuri, a virologist at the Federal University of Rio de Janeiro, is yet to be convinced about the direct association between Zika and congenital microcephaly. “The contrasting outcome of Zika infection in mothers and their babies is intriguing”, he says. Although the mother develops an almost imperceptible rash and mild cold-like symptoms, the baby can develop microcephaly and even die, yet Tanuri feels other elements, and possibly other viruses, are contributing to the high incidence of microcephaly.Ana Bispo, a virologist and head of the Flavivirus Laboratory at Instituto Oswaldo Cruz in Rio de Janeiro and the first researcher to partly sequence the virus from the amniotic fluid of two mothers whose babies were affected by microcephaly, believes that the finding is a “strong indication of the correlation between Zika virus and the increasing number of microcephaly cases observed in Brazil”.Zika is an arbovirus mainly transmitted by the Aedes aegypti mosquito. The virus is closely related to other flaviviruses, including dengue and chikungunya. Two types of Zika virus, the African and the Asian, have been identified. Phylogenetic analysis has showed that the virus circulating in Brazil is of the Asian type, and is similar to the one associated with an outbreak in French Polynesia in 2013.Although there are no reports in the scientific literature of an association between Zika virus and congenital microcephaly, a Rapid Risk Assessment alert from the European Centre for Disease Prevention and Control states that health authorities in French Polynesia have recently reported increasing numbers of cases of CNS malformations and polymalformative syndrome during 2014–15. Didier Musso, director of the Emerging Infectious Diseases Unit at Institut Louis Malardé in Papeete, French Polynesia, feels it is possible that co-circulation of Zika virus and other viruses are involved. This possibility could explain not only the potential association between Zika and microcephaly but also the high incidence first noted in French Polynesia and now in Brazil of Guillain–Barré syndrome—an autoimmune disorder that is also being associated with Zika infection.According to a recent study uploaded to bioRxiv, a biological research preprint server, researchers at the University of São Paulo and Institut Pasteur de Dakar suggest that the Zika virus has gone through important changes that might aid its recent urban expansion. According to Caio Cesar de Melo Freire, “the virus has adapted to use the same cellular machinery used by its host, increasing its replication and titers. For instance, it uses the same codons used by the host's housekeeping genes”.Zika outbreaks are also being reported in other countries in South and Central America. According to WHO and the Pan American Health Organization, autochthonous cases of Zika have been detected in Colombia, El Salvador, Guatemala, Mexico, Paraguay, Suriname, and Venezuela. Yet, among all countries where Zika has been detected, Brazil is currently the only one where the outbreak seems to be strongly associated with a very high incidence of microcephaly.However, the high incidence of microcephaly is not the only peculiarity associated with Zika virus in Brazil. An initial study done in the state of Bahia shows that most individuals (six of seven) infected at the beginning of the outbreak were women aged around 30 years. Later, data analysis of 40 women presented by Alexander Vargas, at the Ministry of Health, showed that all mothers whose newborn babies had microcephaly, between August and October, 2015, in Pernambuco, belong to low-income families. More data is needed to establish if Zika has any preference for particular hosts.For now, the Ministry of Health has recommended that pregnant women use repellents at all times. Cláudio Maierovitch, the director of the communicable disease surveillance department at the Ministry of Health has stated that now is not a good time to get pregnant in high-risk areas in Brazil.It is not clear how exactly the virus arrived in Brazil. Although some suspect that the Football World Cup in 2014 might have brought to Brazil an even greater disgrace than the 7-1 loss against Germany, researchers in French Polynesia highlight that none of the Pacific countries with circulating Zika participated in the games and suggest that the Va'a World Sprint Championship canoe race is a more likely factor. The canoe race took place in Rio de Janeiro in August, 2014, and athletes from French Polynesia, New Caledonia, the Cook Islands, and Easter Island—all countries with high incidence of Zika at the time—participated in the event.More recently, cases of chikungunya infection, which is also transmitted by A aegypti, are increasing in the country. The strategy adopted by health authorities to combat all three viruses at once, is to educate the population on how to tackle mosquito proliferation. On the scientific front, studies are underway on the dissemination of mosquitoes infected with wolbachia, a bacterium that infects arthropod species including A aegypti. Pedro Lagerblad de Oliveira of the Molecular Entomology Unit of the National Institute of Science and Technology says studies have shown that virus infection and transmission to human beings is impaired in mosquitoes infected with wolbachi because the bacterium does not coexist with other pathogens. Also, the offspring of an infected female mosquito, of either sex, carry the wolbachi infection, and the offspring of a non-infected female with an infected male are sterile. In time, wolbachia-infected mosquitoes are expected to become predominant. The strategy seems effective against dengue, chikungunya, and malaria; whether it will also work against Zika virus remains to be seen.http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00548-4/fulltext Link to comment Share on other sites More sharing options...
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