Direct Link Between Zika and Microcephaly In Brazil

[niman]

12 of 12 Brazil microcephaly babies had Zika IgM antibodies in spinal fluid.

http://www.pbs.org/wgbh/frontline/article/new-link-between-zika-and-microcephaly-is-found-in-brazil/

Edited February 4, 2016 by niman

[niman]

New Link Between Zika and Microcephaly Is Found in Brazil

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FEBRUARY 3, 2016 

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by KATIE WORTH Tow Journalism Fellow, FRONTLINE/Columbia Journalism School Fellowships

 

Dr. Natalia Brin examines a 2-month-old with suspected microcephaly in Brazil. (Katie Worth/FRONTLINE)

RECIFE, Brazil — Researchers in the state of Pernambuco, home to a third of Brazil’s suspected cases of infant microcephaly, said on Wednesday that they have identified some of the clearest evidence yet of a direct link between the debilitating birth defect and the Zika virus.

Researchers here tested the spinal fluid of 12 babies with microcephaly, all of whom were born to mothers who reported having symptoms of Zika early in their pregnancies. In all 12 cases, the researchers found evidence of Zika — results they described as stunning.

“I was so surprised,” said Marli Tenório, an infectious disease expert at the Aggeu Magalhães Research Center. “Everybody wants to say, ‘It’s not Zika, it’s not Zika.’ I saw this and thought, ‘Wow, it’s Zika!'”

In a press conference at the Pernambuco Health Department, Secretary of Vigilance and Health Luciana Albuquerque cautioned that “this is not a scientific study,” noting that the results do not indicate a definitive causal link. “But it’s a very important suggestion of the link,” she said.

As the Zika virus has spread to more than 20 countries in the Americas, researchers in Brazil have been on the hunt for the cause of the recent wave of microcephaly, a birth defect in which babies are born with small heads, underdeveloped brains and the prospect of lifelong developmental delays. Health officials in Pernambuco say that until last year, the state saw no more than a dozen microcephaly cases annually. But beginning in late August, babies in Pernambuco began displaying symptoms by the dozens, and then by the hundreds.

As of Wednesday, Brazil’s health authorities had logged 4,783 cases of suspected microcephaly since the outbreak began. The majority of those are likely false positives: All babies with a head circumference of less than 32 centimeters are flagged as a suspected case, but many are born with small heads for other reasons. Of the 1,313 cases the government has investigated so far, 404 were confirmed to have microcephaly. The diagnosis was rejected in the remaining cases. 

Still, even the confirmed figures represent a surge in the incidence of microcephaly over prior years, particularly in northeastern Brazil where most cases have been concentrated.

“We used to have 10 cases a year in Pernambuco. Then in August we started having 10 cases a week,” said Dr. Angela Rocha, a pediatric infectious disease specialist at Recife’s largest public hospital.

In October, health officials began investigating whether the precipitous rise in microcephaly was linked to a mysterious outbreak of Zika in Brazil. The mosquito-born disease had been floating around Africa and Asia for decades, but it attracted little attention from health officials because its obvious symptoms were relatively benign and easily confused with other illnesses. In symptomatic cases, Zika can lead to a rash, a headache, red eyes, swollen joints and a light fever. Others contract the disease but never display symptoms. Zika’s mosquito-born cousins, dengue and chikungunya, are both far more debilitating and painful.

Zika is believed to have arrived in Brazil in late 2014, but it did so with such little fanfare that health officials here didn’t confirm its presence until May 2015. By then, it is thought to have infected at least tens of thousands of people. Those figures are only estimates, though, since health officials hadn’t collected data about it. In Pernambuco, for example, the reported Zika infections had been lumped in with reported dengue figures.

The outbreak took on a new urgency in October, when researchers began to wonder whether Zika may be behind the rise in suspected microcephaly cases. But definitive evidence of a link has been elusive.

The earliest indication came when microcephaly began to appear in the same areas where Zika had landed months earlier. Brazilian researchers later found traces of the virus in the amniotic fluid and the brain tissue of a small number of microcephaly babies. The Centers for Disease Control and Prevention also found Zika virus in the brains of two deceased newborns with the condition, as well as in the placentas of two women who had miscarriages.

In search of better evidence, Tenório and several colleagues flew to Belém in January to meet with officials from the CDC. The agency had developed a test that could determine if a baby had been infected with the Zika virus by looking for a specific antibody in the baby’s cerebral-spinal fluid. This is not a new method of testing, but it was being newly applied to Zika. The test is not yet commercially available, but the CDC explained the methodology to Tenório and her colleagues, and upon their return, they tested samples of 12 babies whose spinal fluid had been collected shortly after birth. They all tested positive.

This test works better than others because it is looking for an antibody called immunoglobulin M, the largest antibody humans produce. It is too large to pass from mother to child, so researchers can be confident that it is an antibody produced by the baby — and can therefore infer that the baby was infected with Zika while en utero.

Its presence in the cerebrospinal fluid is key for two additional reasons, Tenório said. It indicates the virus is making its way into the nervous system, and the baby’s immune system is battling it there. And second, while immunoglobulin M disappears from the blood stream within weeks of an infection, it remains present in the cerebrospinal fluid for months or longer. This means the antibody can be detected at birth.

While her colleagues are launching a controlled study to further investigate the Zika-microcephaly link in babies, Tenório is using the CDC test for 28 more infants with suspected or confirmed microcephaly. She said she hopes to have the results by Friday, before most work in Brazil stops for the national Carnival celebrations.

[niman]

PE identifies the 1st time presence of zika in babies with microcephaly

KLEBER NUNES
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02.03.2016  19:45

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The Centre Aggeu Magellan, from Fiocruz, and the Pernambuco Department of Health were able to identify for the first time the presence of zika virus in infants with microcephaly in the state.

Samples of CSF (cerebrospinal fluid) of 12 infants with malformations revealed in all of them the existence of recent antibodies against the virus, which proves that the fetuses were infected in the womb.

For specialists, the result reinforces the evidence that the virus causes microcephaly zika a malformation of the brain that affects child development.The tests were performed with reagents granted by CDC (disease control centers), the United States.

"In the liquid that was extracted from the marrow of these babies find the IgM, which is unable to overcome the placenta antibody. This leads us to see that the own baby produced the antibody to have been infected by zika after her mother was bitten by Aedes aegypti said Marli Tenorio, a researcher at Aggeu Magellan.

Despite being only 12 confirmed cases in a universe of 1,447 microcephaly notifications in the state, the executive secretary of Health Surveillance of Pernambuco, Luciana Albuquerque, says the result shows advances in research.

"We will continue doing research for CSF analysis. There is still no scientific [because need the confirmation of more cases], but brings very strong evidence of correlation zika with microcephaly. We have 28 more samples are being analyzed, and next week we will have the results, "said Albuquerque.

The PCR test, recommended by the Ministry of Health protocol, can only find the virus in the body between the fifth and seventh day of infection in the blood, which makes its narrower range.

So far, cases of microcephaly have been confirmed by the measurement of head circumference less than 32 cm at birth, as determined by the WHO, and the presence of calcifications in the brain, detected by imaging. Within these criteria, Pernambuco accounts August until this Wednesday (3) 153 cases of the malformation.

Two CDC researchers were in Brazil in January to give training to Brazilian specialists, who are now developing the serology zika the Evandro Chagas Institute in Belém. For now, the reagents are not commercially available in Brazil, according to Marli Tenorio researcher . This means that you still can not use this method on a large scale to confirm the relationship between zika and microcephaly.

Luciana Albuquerque said the CDC said he was willing to provide, through the Ministry of Health, the reagents for Brazil. The ministry was contacted but did not respond to 19h.

BALANCE SHEET

Since the notification of cases of pregnant women with rashes (red spots on the body) became mandatory on December 2, 2015, until January 30, 2016, 88 municipalities of Pernambuco registered 994 cases. Of this total, ten pregnant women have had confirmation that the fetus has microcephaly.

In January, Pernambuco recorded 7,120 dengue suspected, 190% more than in the same period last year. Out of this, 723 were confirmed nine deaths are under investigation.

Referring to the virus zika, the State notified 1,068 suspected cases in the past month, with 14 confirmations.

Fever chikungunya were reported 1,507 suspected cases in 87 municipalities.Of these, one hundred were confirmed. There is a death under investigation.

The same mosquito Aedes aegypti transmits dengue, chikungunya fever and virus zika. 

http://www1.folha.uol.com.br/cotidiano/2016/02/1736681-pe-identifica-pela-1-vez-presenca-de-zika-em-bebes-com-microcefalia.shtml

[niman]

tests confirm zika in 12 childrentest conducted in Pernambuco, in partnership with the United States, found antibody that signals the infection zika

 

By: Alice de Souza - Diario de Pernambuco

Published: 02/04/2016 07:27 Updated: 02/04/2016 07:29

Pernambuco currently has 1,447 reported cases of microcephaly. It is the leading state in detections. Photo: Ricardo Peu / Esp. DP

Serological examinations in the Cerebrospinal Fluid samples (CSF) of 12 children Pernambuco with microcephaly - malformation altering brain development - identified the presence of antibody that signals the infection zika virus. The tests were conducted by research center Aggeu Magellan with reagents sent by the Disease Control Center (CDC) in the United States. Another 28 babies are being analyzed and the results should come out by the end of the week. Pernambuco currently has 1,447 reported cases of microcephaly and 153 confirmed. 

The tests were conducted after a meeting of Pernambuco and US researchers at the Instituto Evandro Chagas, Pará in January. It was used a methodology not yet available in the country, but that is under development here, to analyze samples of 11 children born in Imip and the Baron de Lucena. All of them showed the presence of IgM molecule in the liquid, which is located in the bone marrow."Every time we find a positive IgM in newborn means that he suffered infection and produced antibodies," explained the sector's chief infectious diseases at the University Hospital Oswaldo Cruz (HUOC), Angela Rocha. "If you find the IgM is indicative that the virus replicated in the central nervous system," the virologist and researcher at Aggeu Magellan Marli Tenorio. The IgM can stay in the blood for about two months. CSF, six months to a year, experts estimate. 

Babies born analyzed all last year. Seven of them have already been notified, the other five to the Department of Health is actively seeking to find.  "It is not scientific evidence, but the findings greatly strengthen the relationship of microcephaly with the virus zika," said the executive secretary of Health Surveillance, Luciana Albuquerque. 

Numbers The arboviruses remain growing in Pernambuco. Dengue jumped 190% last week, compared to the same period last year. The state has 7100 reported cases. The zika has 1,086 cases reported this year. SES does not rule out that the data are duplicated - for more than an arbovirus - and will review notifications. After the carnival, health workers will begin work in raising public awareness. 

An application was created to transmit real-time data collected by them to the Secretariat. 

http://www.diariodepernambuco.com.br/app/noticia/vida-urbana/2016/02/04/interna_vidaurbana,625397/exames-confirmam-zika-em-12-criancas.shtml

Edited February 4, 2016 by niman

[niman]

02/03/2016 17h21 - Updated 02/03/2016 20:50

Pernambuco confirms 12 cases of microcephaly linked to zika virus

Until the 30th of January, 153 babies have been confirmed with the malformation. 
State has 1,447 cases reported since the 1st of August 2015.

 

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Pernambuco confirms 12 cases of microcephaly associated with zika virus (Photo: Arthur Ferraz / G1)

Pernambuco has 12 confirmed cases of microcephaly related zika virus. The data were transferred by the state Health Department on Wednesday (3), in a press conference. According to the latest report, by the 30th of January, 153 babies had a confirmed diagnosis of malformation through imaging tests. The diagnosis of microcephaly linked to zika was done through an alternative examination, serology, which seeks to detect the presence of a specific antibody in Net Cervicofacial Oblongata (LCR), the child's cord. The analyzes were collected by the research center Aggeu Magalhães, of the Oswaldo Cruz Foundation.
 

 

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"The ideal is to detect the virus, either by insulation or by the demand of the virus genome. The other possibility is for this examination, looking for IgM antibody, which does not cross the placenta. And these 12 children, found that antibody for microcephaly, "said Marli Tenorio researcher.

Also according to the scientist, the number of related cases is still not enough to prove that the zika can cause microcephaly in babies and inquiries continue. "We are testing 28 more samples. You have to associate the laboratory findings to the clinic", explained the researcher.Of the 12 children, 11 were born in Imip and the Hospital Barão de Lucena, both in Recife.According to the executive secretary of Health Surveillance, Luciana Albuquerque, it was necessary to be done the alternate exam because others can only detect the parasite in cases most recent. "What we have available is the PCR, which looks for the virus genome. The problem is that it can only make the diagnosis in very recent cases, and how the children were infected during pregnancy, in all of them, the result was negative, "he said.
 

For secretary, for now, only serology, it was possible to detect the presence of the virus more accurately. "There is evidence of scientific study, but now we come close to discovering the relationship between zika and microcephaly," he said. Since August 1, 1447 cases of babies with microcephaly have been reported in Pernambuco. Of these, 153 were confirmed by imaging and other 135 were discharged by doctors. Were also recorded 12 deaths of children with microcephaly, which does not mean that the defect was the cause of the deaths. Of the total notified babies, 543 (37.5%) meet the criteria of the World Health Organization (WHO) for microcephaly , which identifies the malformation in babies with head circumference equal to or less than 32 centimeters.investments Since the World health Organization (wHO) has classified the spread of zika virus as international public health emergency case , the secretary expects further investments in research in Pernambuco. "When the WHO launches an emergency declaration opens up new possibilities for investment in vaccines. There will be more cooperation with Brazil. So the expectation is good," said the secretary. In relation to the suspicion that the zika virus can be transmitted sexually , Luciana Albuquerque did not rule out the idea of investigating the evidence in the state. "It is likely that there is research on this, but now we will focus on children and pregnant women. The United States is already investigating," he reiterated. Dengue, chikungunya and zika viruses According to the latest bulletin from the Health Department, between 3 and 23 January, were reported 7,120 cases of dengue in the state, which represents an increase of 90% compared to the same period last year. Also according to the SES, nine deaths are being investigated and 142 municipalities had reports of the disease. In the same period, there were 1,507 notifications of chikugunya. Of this total, 450 cases were confirmed, and 589 discarded. In relation to zika virus, provided that the notifications of the disease became mandatory, on December 10, 2015, there were 1,386 reported cases. Also last year, 14 cases were confirmed. Twelve were discarded.

http://g1.globo.com/pernambuco/noticia/2016/02/pernambuco-confirma-12-casos-de-microcefalia-ligados-ao-virus-zika.html

[niman]

 

PE identifies the 1st time presence of zika in babies with microcephaly

 

02.03.16 at 20:06 Folhapress

Textos, fotos, artes e vídeos da odiario.com estão protegidos pela legislação brasileira sobre direito autoral. Não reproduza o conteúdo em qualquer meio de comunicação, eletrônico ou impresso, sem autorização de odiario.com. As regras têm como objetivo proteger o investimento que odiario.com faz na qualidade de seu jornalismo. Para compartilhar este conteúdo, utilize o link:http://maringa.odiario.com/geral/2016/02/pe-identifica-pela-1a-vez-presenca-de-zika-em-bebes-com-microcefalia/2078301/Textos, fotos, artes e vídeos da odiario.com estão protegidos pela legislação brasileira sobre direito autoral. Não reproduza o conteúdo em qualquer meio de comunicação, eletrônico ou impresso, sem autorização de odiario.com. As regras têm como objetivo proteger o investimento que odiario.com faz na qualidade de seu jornalismo. Para compartilhar este conteúdo, utilize o link:http://maringa.odiario.com/geral/2016/02/pe-identifica-pela-1a-vez-presenca-de-zika-em-bebes-com-microcefalia/2078301/Textos, fotos, artes e vídeos da odiario.com estão protegidos pela legislação brasileira sobre direito autoral. Não reproduza o conteúdo em qualquer meio de comunicação, eletrônico ou impresso, sem autorização de odiario.com. As regras têm como objetivo proteger o investimento que odiario.com faz na qualidade de seu jornalismo. Para compartilhar este conteúdo, utilize o link:http://maringa.odiario.com/geral/2016/02/pe-identifica-pela-1a-vez-presenca-de-zika-em-bebes-com-microcefalia/2078301/Textos, fotos, artes e vídeos da odiario.com estão protegidos pela legislação brasileira sobre direito autoral. Não reproduza o conteúdo em qualquer meio de comunicação, eletrônico ou impresso, sem autorização de odiario.com. As regras têm como objetivo proteger o investimento que odiario.com faz na qualidade de seu jornalismo. Para compartilhar este conteúdo, utilize o link:http://maringa.odiario.com/geral/2016/02/pe-identifica-pela-1a-vez-presenca-de-zika-em-bebes-com-microcefalia/2078301/Textos, fotos, artes e vídeos da odiario.com estão protegidos pela legislação brasileira sobre direito autoral. Não reproduza o conteúdo em qualquer meio de comunicação, eletrônico ou impresso, sem autorização de odiario.com. As regras têm como objetivo proteger o investimento que odiario.com faz na qualidade de seu jornalismo. Para compartilhar este conteúdo, utilize o link:http://maringa.odiario.com/geral/2016/02/pe-identifica-pela-1a-vez-presenca-de-zika-em-bebes-com-microcefalia/2078301/KLEBER NUNES RECIFE, PE (Folhapress) - The Center for Aggeu Magellan, from Fiocruz, and the Pernambuco Department of Health were able to identify for the first time the presence of zika virus in babies with microcephaly in the state. Samples of CSF (cerebrospinal fluid) of 12 infants with malformations revealed in all of them the existence of recent antibodies against the virus, which proves that the fetuses were infected in the womb. 

For specialists, the result reinforces the evidence that the virus causes microcephaly zika a malformation of the brain that affects child development. The tests were performed with reagents granted by CDC (disease control centers), the United States. "In the liquid that was extracted from the marrow of these babies find the IgM, which is unable to overcome the placenta antibody. This leads us to see that the own baby produced the antibody to have been infected by zika after her mother was bitten by Aedes aegypti said Marli Tenorio, a researcher at Aggeu Magellan.

Despite being only 12 confirmed cases in a universe of 1,447 microcephaly notifications in the state, the executive secretary of Health Surveillance of Pernambuco, Luciana Albuquerque, says the result shows advances in research. "We will continue doing research for CSF analysis. It is not yet unscientific [because need the confirmation of more cases], but brings very strong evidence of zika correlation with microcephaly.

We have 28 more samples are being analyzed, and next week we will have the results, "said Albuquerque. The PCR test, recommended by the Ministry of Health protocol, can only find the virus in the body between the fifth and seventh day of infection blood, which makes its narrower range.

So far, cases of microcephaly have been confirmed by the measurement of head circumference less than 32 cm at birth, as determined by the wHO, and the presence of calcifications in the brain detected by through imaging studies. Within these criteria,

Pernambuco accounts August until this Wednesday (3) 153 cases of malformation. Two CDC researchers were in Brazil in January to give training to Brazilian specialists, who are now developing serology zika the Instituto Evandro Chagas in Belém. for now, the reagents are not commercially available in Brazil, according to Marli Tenorio researcher. This means that you still can not use this method on a large scale to confirm the relationship between zika and microcephaly. Luciana Albuquerque said the CDC said he was willing to provide, through the Ministry of Health, the reagents for Brazil.The ministry was contacted but did not respond to 19h. 

BALANCE Since the notification of cases of pregnant women with rashes (red spots on the body) became mandatory on December 2, 2015, until January 30, 2016, 88 municipalities of Pernambuco registered 994 cases. Of this total, ten pregnant women have had confirmation that the fetus has microcephaly. In January, Pernambuco recorded 7,120 dengue suspected, 190% more than in the same period last year.Out of this, 723 were confirmed nine deaths are under investigation. 

Referring to the virus zika, the State notified 1,068 suspected cases in the past month, with 14 confirmations. Of chikungunya fever were reported 1,507 suspected cases in 87 municipalities. Of these, one hundred were confirmed. There is a death under investigation. The same Aedes aegypti mosquito transmits dengue, chikungunya fever and virus zika.

https://www.bemparana.com.br/noticia/427410/pe-identifica-pela-1a-vez-presenca-de-zika-em-bebes-com-microcefalia

Edited February 4, 2016 by niman

[niman]

SES presents new study that strengthens the relationship between the zika and microcephaly

1,447 cases of microcephaly were reported from 1/08/15 to 30/1/16. Of this total, 543 probable cases and 153 confirmed cases

Published in 02.03.2016 at 17:36

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Radio Journal

 

Photo: Isabela Days / Radio Journal 

Representatives of the State Department of Health, infectious disease specialists and members of the Epidemiological Surveillance departments and Women's Health met on the afternoon of Wednesday (3) to present the microcephaly numbers in Pernambuco. 

According to the information submitted, were notified 1,447 cases of microcephaly of August 1 last year to January 30, 2016. Of this total, there are 543 probable cases and 153 confirmed cases.

The executive secretary of Health Surveillance, Luciana Albuquerque, said a new test to identify the zika virus in infants with microcephaly. According to the secretary, 12 cases were investigated and confirmed the presence of the virus, which strengthens the virus compared with microcephaly. "Although these 12 children are not representative of a total of 1,400 children we have reported, was an important discovery was important evidence that strengthens the virus zika's relationship with microcephaly," he said. 

The researcher of Haggai Magalhães Laboratory, Marli Tenorio explains how the test is done. "In the case of the serological testing, we do in the liquid and reap the backbone, we seek this liquid an antibody that would be the child's response to infection by this virus," he explained. "If we try this antibody in the liquid column, the backbone, have some tests that we use the antigen zika and there we detect whether the antibody is present or not," he added, also stating that if it is found antibody in the liquid, means that the virus grew and was present in the child's brain.   

The material for the exams was provided by the US Disease Control Center. Also according to the department, 28 new samples are being tested.

On Monday (1), the World Health Organization (WHO) declared international emergency by microcephaly. In Dallas, in the United States, was detected the first place in case of virus transmission in the country, according to the agency, the contamination was through sexual intercourse with a person who traveled to Venezuela. 

http://m.radiojornal.ne10.uol.com.br/noticia/2016/02/03/ses-apresenta-novo-estudo-que-reforca-relacao-entre-o-zika-e-a-microcefalia--44684

[niman]

New link between Zika virus and microcephaly is found in Brazil

KATIE WORTH, FRONTLINE

FRONTLINE-Columbia Tow Journalism Fellow

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BY KATIE WORTH, FRONTLINE  February 4, 2016 at 7:14 AM EST

Dr. Natalia Brin examines a 2-month-old with suspected microcephaly in Brazil. Photo by Katie Worth/FRONTLINE

Editor’s note: This report is part of a special series with Katie Worth, who is embedded in Brazil, and our partners at PBS Frontline/WGBH.

RECIFE, Brazil — Researchers in the state of Pernambuco, home to a third of Brazil’s suspected cases of infant microcephaly, said on Wednesday that they have identified some of the clearest evidence yet of a direct link between the debilitating birth defect and the Zika virus.

Researchers here tested the spinal fluid of 12 babies with microcephaly, all of whom were born to mothers who reported having symptoms of Zika early in their pregnancies. In all 12 cases, the researchers found evidence of Zika — results they described as stunning.

“I was so surprised,” said Marli Tenório, an infectious disease expert at the Aggeu Magalhães Research Center. “Everybody wants to say, ‘It’s not Zika, it’s not Zika.’ I saw this and thought, ‘Wow, it’s Zika!’”

In a press conference at the Pernambuco Health Department, Secretary of Vigilance and Health Luciana Albuquerque cautioned that “this is not a scientific study,” noting that the results do not indicate a definitive causal link. “But it’s a very important suggestion of the link,” she said.

“Everybody wants to say, ‘It’s not Zika, it’s not Zika.’ I saw this and thought, ‘Wow, it’s Zika!’”

As the Zika virus has spread to more than 20 countries in the Americas, researchers in Brazil have been on the hunt for the cause of the recent wave of microcephaly, a birth defect in which babies are born with small heads, underdeveloped brains and the prospect of lifelong developmental delays. Health officials in Pernambuco say that until last year, the state saw no more than a dozen microcephaly cases annually. But beginning in late August, babies in Pernambuco began displaying symptoms by the dozens, and then by the hundreds.

As of Wednesday, Brazil’s health authorities had logged 4,783 cases of suspected microcephaly since the outbreak began. The majority of those are likely false positives: All babies with a head circumference of less than 32 centimeters are flagged as a suspected case, but many are born with small heads for other reasons. Of the 1,313 cases the government has investigated so far, 404 were confirmed to have microcephaly. The diagnosis was rejected in the remaining cases.

Still, even the confirmed figures represent a surge in the incidence of microcephaly over prior years, particularly in northeastern Brazil where most cases have been concentrated.

“We used to have 10 cases a year in Pernambuco. Then in August we started having 10 cases a week,” said Dr. Angela Rocha, a pediatric infectious disease specialist at Recife’s largest public hospital.

A municipal worker sprays insecticide at the neighborhood of Afogados in Recife, Brazil, February 2, 2016. The operation is part of the city’s effort to prevent the spread of Zika’s vector, the Aedes aegypti mosquito, according to a statement from Municipal Health Secretary. Photo by Ueslei Marcelino/Reuters

In October, health officials began investigating whether the precipitous rise in microcephaly was linked to a mysterious outbreak of Zika in Brazil. The mosquito-borne disease had been floating around Africa and Asia for decades, but it attracted little attention from health officials because its obvious symptoms were relatively benign and easily confused with other illnesses. In symptomatic cases, Zika can lead to a rash, a headache, red eyes, swollen joints and a light fever. Others contract the disease but never display symptoms. Zika’s mosquito-born cousins, dengue and chikungunya, are both far more debilitating and painful.

Zika is believed to have arrived in Brazil in late 2014, but it did so with such little fanfare that health officials here didn’t confirm its presence until May 2015. By then, it is thought to have infected at least tens of thousands of people. Those figures are only estimates, though, since health officials hadn’t collected data about it. In Pernambuco, for example, the reported Zika infections had been lumped in with reported dengue figures.

The outbreak took on a new urgency in October, when researchers began to wonder whether Zika may be behind the rise in suspected microcephaly cases. But definitive evidence of a link has been elusive.

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The earliest indication came when microcephaly began to appear in the same areas where Zika had landed months earlier. Brazilian researchers later found traces of the virus in the amniotic fluid and the brain tissue of a small number of microcephaly babies. The Centers for Disease Control and Prevention also found Zika virus in the brains of two deceased newborns with the condition, as well as in the placentas of two women who had miscarriages.

In search of better evidence, Tenório and several colleagues flew to Belém in January to meet with officials from the CDC. The agency had developed a test that could determine if a baby had been infected with the Zika virus by looking for a specific antibody in the baby’s cerebral-spinal fluid. This is not a new method of testing, but it was being newly applied to Zika. The test is not yet commercially available, but the CDC explained the methodology to Tenório and her colleagues, and upon their return, they tested samples of 12 babies whose spinal fluid had been collected shortly after birth. They all tested positive.

This test works better than others because it is looking for an antibody called immunoglobulin M, the largest antibody humans produce. It is too large to pass from mother to child, so researchers can be confident that it is an antibody produced by the baby — and can therefore infer that the baby was infected with Zika while en utero.

Its presence in the cerebrospinal fluid is key for two additional reasons, Tenório said. It indicates the virus is making its way into the nervous system, and the baby’s immune system is battling it there. And second, while immunoglobulin M disappears from the blood stream within weeks of an infection, it remains present in the cerebrospinal fluid for months or longer. This means the antibody can be detected at birth.

While her colleagues are launching a controlled study to further investigate the Zika-microcephaly link in babies, Tenório is using the CDC test for 28 more infants with suspected or confirmed microcephaly. She said she hopes to have the results by Friday, before most work in Brazil stops for the national Carnival celebrations.

Katie Worth is Frontline’s inaugural PBS Frontline-Columbia Tow journalism fellow.

• 
  Katie Worth, FRONTLINE

  Katie Worth is FRONTLINE's inaugural FRONTLINE-Columbia Tow Journalism Fellow.

  •  @katieworth
  • http://www.pbs.org/newshour/updates/new-link-between-zika-virus-and-microcephaly-is-found-in-brazil/

[emlee]

Anyone know why they didn't test babies born without microcephaly whose mothers contracted Zika during pregnancy? It seems to me they're trying to make the link regardless of the science.

[niman]

The best test for the babies is an antibody test on the CSF (cerebral spinal fluid),which involves an invasive procedure.  Doing an invasive procedure on a normal baby, which is not beneficial to the baby, is problematic.

[emlee]

That makes perfect sense. I know I wouldn't agree to it as a parent. Just seems like you can't prove a link without that information. I'm very interested to see how this turns out as the media hypes it up I become more and more skeptical. I'm not sure if you're Brazilian but I know the people there are very skeptical of these findings, especially since they can no longer trust their government.

[niman]

Table 

IgM against Zika virus and dengue virus in the serum and CSF of neonates with microcephaly, Pernambuco State, Brazil, 2015, by age (days) at testing

ELISA values are patient optical densities divided by negative control densities (P/N); values less than 2 were considered negative, 2–3 equivocal, and more than 3 positive. CSF=cerebrospinal fluid.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30253-7/fulltext