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WHO Presser on Zika Neurological Disorders & Neonatal Malformations MAR 22


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WHO Media Advisory/7
18 March 2016

 
INVITATION TO A VIRTUAL PRESS CONFERENCE

 

Update on Zika virus and observed increase in neurological disorders and neonatal malformations

 
 
WHAT: WHO Virtual Press Conference
 
The Director- General of the World Health Organization (WHO), Dr Margaret Chan, will update on the recent work of the Organization on Zika virus and observed increase in neurological disorders and neonatal malformations.  WHO has recently convened several expert meetings to identify gaps in knowledge about Zika virus, potentially related complications, effective interventions, and areas of needed research and technologies. The panels have also identified partners and collaborators in the response to Zika virus who are undertaking new initiatives and studies to maximize the impact of public health action. Dr Chan will highlight findings from the meetings and next steps in the fight against Zika.
 
WHERE: India Room, WHO Headquarters
 
WHEN: Tuesday, 22 March 2016, at 16:00 CET, 15:00 GMT
 
Geneva-based journalists may participate in the India Room at WHO Headquarters.
 
Journalists outside Geneva may dial in with the numbers listed below.
 
Shortly after the press conference, an audio file will be sent to journalists and a transcript will be posted the following day.
 
How to access the WHO Virtual Press Conference – 22 MARCH 2016
 
Please try to call in at least 10 minutes before the conference begins in order to be registered correctly. From the list below, please use the number closest to you. If you have problems with a number, try the toll number from a neighbouring country or call Switzerland: +41 22 580 5970, or France +33 1 70750705, or United States +1 855 402 7766. You can also use a VoIP programme such as Skype to call the US toll-free: +1 855 402 7766
 
On connecting, type PIN code:  50066173# on your telephone keypad and then record your name and media outlet and then press again the # key.
 
To ask a question during the question and answer session, registered participants should type 01 on their telephone keypad, this will place you in the queue to ask questions.

 
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Zika virus live update

 

Tune in today, 22 March 2016, 16:00 CET

 
WHO Director-General, Dr Margaret Chan, will update the public on Zika virus and observed increase in neurological disorders and neonatal malformations.

WHO expert meetings have identified gaps in knowledge about Zika virus, potentially related complications, effective interventions, and areas of needed research and technologies. Dr Chan will highlight findings and next steps in the fight against Zika.
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Zika virus media centre

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WHO’s media centre for Zika virus disease and potential complications. The Zika virus mediacentre includes the latest news, features, infographics, photos, and videos. A historical timeline of Zika virus is also featured.
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Watch the Zika update live

Tuesday, 22 March 2016, at 16:00 CET, 15:00 GMT

http://www.who.int/emergencies/zika-virus/mediacentre/webcast-22-3-2016/en/

The Director-General of WHO, Dr Margaret Chan, will update on the recent work of the Organization on Zika virus and observed increase in neurological disorders and neonatal malformations. WHO has recently convened expert meetings to identify gaps in knowledge about Zika virus, potentially related complications, effective interventions, and areas of needed research and technologies. 

The panels have also identified partners and collaborators in the response to Zika virus who are undertaking new initiatives and studies to maximize the impact of public health action. Dr Chan will highlight findings from the meetings and next steps in the fight against Zika.

 

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WHO: Zika virus 'implicated' in large numbers of brain-damaged babies

Director general says necessary to shift from looking at individual cases to planning for impact of thousands of babies requiring care

 
Margaret Chan gives a press conference on Zika virus at the WHO headquarters in Geneva
 Margaret Chan gives a press conference on Zika virus at the WHO headquarters in Geneva. Photograph: Fabrice Coffrini/AFP/Getty Images

Zika virus is now “implicated” in the large numbers of brain-damaged babies in Brazil and the increase in the nerve disorder Guillan-Barré syndrome, according to experts at the World Health Organisation, who say urgent action is needed to deal with a growing crisis.

WHO’s director general, Margaret Chan, said on Tuesday the association was still not officially scientifically proven but a shift was needed from looking at individual cases to planning for the possible impact on health systems of the birth of many thousands of babies who will need care, treatment and support for life.

Speaking in Geneva, Chan said nobody could predict how far the Zika virus would spread, causing more and more cases of Guillan-Barré and microcephaly, but “if this pattern is confirmed in and beyond Latin America and the Caribbean, the world will face a severe public health crisis”.

A substantial proportion of the babies diagnosed with microcephaly because of their small head circumference in north-east Brazil, whose mothers had been infected by the Zika virus, are being confirmed by CT scans as brain-damaged, said Anthony Costello, WHO’s director of maternal and child health. Out of 6,480 suspected cases in Brazil, most of them in the north-east, 2,212 have been fully investigated and 863 confirmed with brain abnormalities, a rate of 39%.

“If that rate continues, we would expect just over 2,500 cases will emerge of babies with brain damage and the clinical signs of microcephaly,” said Costello. More and more suspect cases will be reported as time goes on. “We must expect the burden to increase substantially.”

The proportion of pregnant women infected with Zika giving birth to a baby with microcephaly is much lower – a study in French Polynesia estimated it at 1%. That study, however, looked only at women infected in the first three months of pregnancy and microcephaly only defined as a small head circumference.

“There is a changing pattern of defects in Brazil,” said Costello. “Children are born with unusual brain scans as well as microcephaly and hearing and visual defects.”

Chan has asked member states for $56m (£39m) to help WHO tackle the crisis, but only $3m has so far been handed over to the Pan-American Health Organisation, the regional division which deals with Latin America. She said she was in discussions over $4m more. If necessary, she said, she would borrow from other WHO departments and repay them later.

The implications for health systems in affected countries are severe, she said. “We need a whole systems approach and a much longer term approach [to help] countries to prepare the capacity to deal with it. It would be very difficult to estimate what would be the funding requirement.”

More than half the world’s population lives in countries where the Aedes aegyptimosquito, which transmits the virus, breeds. WHO’s experts say there are effective tools against mosquitoes, but are recommending “carefully planned” pilot studies of two of the most novel approaches. One is infecting mosquitoes with Wolbachia, a bacteria that lives only in insect cells and impairs the mosquito’s ability to transmit infections such as dengue and Zika. The other is the use of genetic manipulation to reduce the populations of mosquitoes.

http://www.theguardian.com/world/2016/mar/22/who-zika-virus-implicated-in-large-numbers-of-brain-damaged-babies

 

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Zika: More than 2,500 babies born with microcephaly in Brazil, WHO predicts

 
   

The World Health Organization said Tuesday that it expects Brazil will have more than 2,500 babies born with a severe birth defect known as microcephaly if current trends continue in the Zika virus outbreak.

Data from Brazil, the epicenter of an epidemic that has hit more than three dozen countries and territories in the Americas, show that about 39 percent of 2,212 investigated cases of microcephaly are already confirmed for the rare congenital condition. To date, that's 863 babies born with the characteristic abnormally small heads and underdeveloped brains, WHO detailed at a news conference in Geneva.

 
 

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"If that rate continues, we expect more than 2,500 cases will emerge of babies with brain damage and clinical signs of microcephaly," said Anthony Costello, who heads WHO's department of maternal, newborn, child and adolescent health.

WHO Director-General Margaret Chan said new evidence is becoming clear daily about the mosquito-borne virus. A pattern seems to be emerging: Initial detection of Zika is followed within about three weeks by an unusual increase of Guillain-Barré syndrome, a rare condition that can cause paralysis and sometimes death. Detection of microcephaly and other fetal abnormalities typically comes about six months later, WHO officials said, as pregnancies of infected women come to term.

Brazil and Panama are now reporting cases of microcephaly -- including 6,480 suspected cases in Brazil. Panama has one reported case. Colombia is investigating many cases for a possible link. A WHO team is currently in Cape Verde to investigate that country's first reported case of microcephaly, Chan said.

A total of 12 countries and territories have now seen an increase in the incidence of Guillain-Barré or actual lab confirmation of Zika among cases with the syndrome, she said.

Although Zika has hit countries in Latin America and the Caribbean the hardest, Chan warned that no one can predict if it will spread to other parts of the world and trigger the same pattern of health complications. In other affected countries, the virus has not been circulating long enough for pregnancies to come to term, she said.

"If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis," she said. Chan said the Zika virus initially looked "reassuringly mild," with no hospitalizations or deaths reported when it first showed up in Brazil last May.

In Brazil, single mothers face reality of microcephaly

 
Play Video1:57
 
These three mothers in the Brazilian city of Recife all have children with microcephaly. Brazil has seen an outbreak of thousands of suspected cases of the birth defect. The mothers impacted mostly come from poorer families and are now dealing with the difficult reality of caring for children with special needs. (Dom Phillips,Jason Aldag/The Washington Post)

But in less than a year, she said, "the status of Zika has changed from a mild medical curiosity to a disease with severe public health implications." The possibility that a mosquito bite could be linked to severe fetal abnormalities "alarmed the public and astonished scientists," she said.

The world community needs to shift thinking and preparations for the long term, she said. Countries need to build health capacity and social support to help families cope with the "heartbreaking strain" from caring for such babies.

The Cape Verde archipelago off West Africa has more than than 7,000 Zika infections, including its first case last week of a newborn with microcephaly.

Although the link between Zika and fetal abnormalities has not been proven, "the circumstantial evidence is now overwhelming," she said. Urgent action should not wait for definitive proof, she added.

Recent studies have detailed how the pathogen could attack fetal brain development as well as trigger complications at any stage of pregnancy.

In a study published last week the Lancet medical journal, researchers analyzed a 2013-2014 Zika outbreak in French Polynesia and said the risk of microcephaly is about one for every 100 women infected with the virus during the first trimester of pregnancy. The research, based on statistical and mathematical models, was conducted after the outbreak was over.

Researchers cautioned, however, that outbreaks differ, and the risk will depend on how the virus spreads and the makeup of the affected population. WHO officials said they don't have enough information yet to say what the risk of microcephaly is for pregnant women in Brazil or elsewhere. Between 2001 and 2014, Brazil had, on average, about 163 cases of microcephaly a year.

 

The global health agency has convened three meetings in recent weeks to receive updates on the science, mosquito control tools and management of health complications. Chan said the most urgently needed medical priority is a reliable diagnostic test for Zika. More than 30 companies are working on, or have developed potential new tests for the virus. The U.S. Food and Drug Administration last week approved a tool developed by the Centers for Disease Control and Prevention that can test for Zika and two related viruses carried by the same mosquito -- dengue and chikungunya. Hundreds of those test kits are being shipped to labs in affected countries and around the United States.

For vaccines, there are more than 23 projects underway by 14 vaccine developers in the United States, France, Brazil, India and Austria, WHO officials said. Although clinical trials might start before the end of the year, including one underway at the National Institutes of Health, health authorities have said it will be several years at least before a fully tested, licensed Zika vaccine is ready.

Although the "first explosive wave" of Zika's spread may be over before a vaccine is available, Chan said there will continue to be need for a vaccine in the years ahead."We expect it to be a long haul," she said.

https://www.washingtonpost.com/news/to-your-health/wp/2016/03/22/zika-in-brazil-more-than-2500-births-with-microcephaly-who-predicts/

 

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WHO Director-General briefs the media on the Zika situation

WHO statement 
22 March 2016

Ladies and gentlemen,

I welcome this opportunity to update you on developments in science and the Zika evidence base that have built up since 1 February.

The world was alerted to the first appearance of Zika in the Western Hemisphere on 7 May 2015, when Brazil confirmed that a mysterious outbreak of thousands of cases of mild disease with rash was caused by the Zika virus.

The appearance of an infectious disease with epidemic potential in a new part of the world is always cause for concern.

The absence of population immunity gives the virus license to spread rapidly and behave in possibly unexpected ways.

At the time of the May announcement, the disease looked reassuringly mild, with no hospitalizations or deaths reported. Past experience has taught us to expect more from emerging viruses than what is initially observed.

This came from Brazil in July with a reported increase in cases of Guillain-Barré syndrome, followed by an unusual increase in microcephaly among newborns, reported to WHO in late October.

The possibility that a mosquito bite could be linked to severe fetal malformations alarmed the public and astonished scientists.

The association with Guillain-Barré syndrome and other severe disorders of the central nervous system has expanded the risk group well beyond women of child-bearing age.

We now know that sexual transmission of the virus occurs.

In less than a year, the status of Zika has changed from a mild medical curiosity to a disease with severe public health implications.

The knowledge base is building very rapidly. I want to thank all countries and their scientists who have worked so hard in helping WHO build up the evidence base.

The more we know the worse things look.

A pattern has emerged in which initial detection of virus circulation is followed, within about three weeks, by an unusual increase in cases of Guillain-Barré syndrome.

Detection of microcephaly and other fetal malformations comes later, as pregnancies of infected women come to term.

In the current outbreak, Brazil and Panama have reported microcephaly. Colombia is investigating several cases of microcephaly for a possible link to Zika. In other countries and territories, the virus has not been circulating long enough for pregnancies to come to term. A WHO team is currently in Cabo Verde to investigate the country’s first reported case of microcephaly.

To date, 12 countries and territories have now reported an increased incidence of Guillain-Barré syndrome or laboratory confirmation of Zika infection among GBS cases.

Additional effects on the central nervous system have been documented, notably inflammation of the spinal cord and inflammation of the brain and its membranes.

The virus is currently circulating in 38 countries and territories. On present knowledge, no one can predict whether the virus will spread to other parts of the world and cause a similar pattern of fetal malformations and neurological disorders.

If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis.

Ladies and gentlemen,

We need to build the knowledge base quickly, very quickly.

Since 1 February, WHO has convened seven international meetings and published 15 documents that translate the latest research into interim practical guidance to support countries as they respond to this outbreak and its neurological complicatoins.

Over the past two weeks, WHO convened three high-level meetings to look at the science, the convention and new tools for mosquito control, and what we know about the management of complications, including microcephaly and Guillain-Barré syndrome. These meetings help answer pressing scientific questions and gather advice on the best ways to respond to a situation that is rapidly evolving.

The science meeting looked at the evidence linking Zika infection with fetal malformations and neurological disorders. Though the association is not yet scientifically proven, the meeting concluded that there is now scientific consensus that Zika virus is implicated in these neurological disorders. The kind of urgent action called for by this public health emergency should not wait for definitive proof.

In terms of new medical products, the experts agreed that a reliable, point-of-care diagnostic test is the most urgent priority. At present, more than 30 companies are working on, or have developed, potential new diagnostic tests.

For vaccines, 23 projects are being worked on by 14 vaccine developers in the US, France, Brazil, India, and Austria. As the vaccine will be used to protect pregnant women or women of child-bearing age, it must meet an extremely high standard of safety.

WHO estimates that at least some of the projects will move into clinical trials before the end of this year, but several years may be needed before a fully tested and licensed vaccine is ready for use.

Several scientists warned that the first explosive wave of spread may be over before a vaccine is available. However, all agreed that development of a vaccine is imperative. More than half of the world’s population lives in an area where the Aedes aegypti mosquito is present.

During the meeting on mosquito control, the experts concluded that well-implemented control programmes using existing tools and strategies are effective in reducing the transmission of Aedes-borne diseases, including Zika. However, they also identified a number or challenges in implementing these tools.

The experts evaluated the potential impact of five new tools for mosquito control. None was judged ready for full-scale implementation.

While investigations of all five should continue, the experts recommended carefully planned pilot deployment of two: namely, microbial control, using Wolbachia bacteria, of human pathogens in adult mosquitoes, and the use of genetic manipulation to reduce mosquito populations.

The third meeting looked at the management of complications, including fetal malformations and neurological disorders, and the heavy burden this places on health systems. Evidence supports the likelihood that Zika infection during pregnancy will have a broad range of effects on the developing fetus, beyond microcephaly.

As the experts concluded, a shift in thinking is needed, away from the management of individual cases and towards the longer-term building of capacities to cope with these added burdens.

Fetal malformations place a heart-breaking strain on families and communities as well as systems for health care and social support. Neurological disorders like Guillain-Barré syndrome call for added capacity to provide life-saving intensive care.

Thank you.

http://www.who.int/mediacentre/news/statements/2016/zika-update-3-16/en/

 

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Latest press briefings

22 March 2016: WHO Director-General briefs the media on the Zika situation

Dr Margaret Chan, WHO Director-General
Dr. Florence Fouque, Unit Leader, Vectors, Environment & Society; Tropical Diseases Research
Dr. Anthony Costello, Director, Maternal, Newborn, Child and Adolescent Health Department
Dr. Bernadette Murgue, Project Manager, Health Systems and Innovation
Dr. Tarun Dua, Coordinator, Evidence, Research, Action on Mental & Brain Disorders
Dr. Chris Dye, Director, Strategy, Policy and Information

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A health worker fumigated in Veracruz on the outskirts of Panama City last month. CreditCarlos Jasso/Reuters

WASHINGTON — Panama has reported its first case of birth defectsassociated with the Zika virus, the World Health Organization said on Tuesday — new evidence of the epidemic’s potentially dangerous effects spreading throughout the region.

Dr. Margaret Chan, the director general of W.H.O., said a baby with an unusually small head and brain damage — a condition called microcephaly— was born at 30 weeks’ gestation in Panama and died a few hours later. Local investigators found evidence of the Zika virus in the umbilical cord.

Dr. Chan was providing an update on the Zika virus and its spread in the Americas.

Scientists around the world are waiting to see whether more pregnant women who become infected eventually give birth to babies withmicrocephaly.

Photo
 
Dr. Margaret Chan, the director general of W.H.O., at a news conference in Geneva on Tuesday.CreditFabrice Coffrini/Agence France-Presse — Getty Images

“The knowledge base is building very rapidly,” Dr. Chan said. “The more we know, the worse things look.”

So far, a surge of cases has been documented only in Brazil. In most other countries where Zika infections have spread, pregnant women who might have been exposed have yet to give birth.

The virus is circulating in 38 countries and territories, Dr. Chan said.

“No one can predict whether the virus will spread to other parts of the world,” she added.

Brazil and Panama are the only countries that have documented microcephaly cases linked to Zika infection from mosquito bites, Dr. Chan said, but Colombia is investigating several cases with a possible connection.

Officials have said that if there is a link, as most scientists believe, they expect to start seeing birth defects in Colombia in June.

Dr. Chan said Colombia had set up “a very robust mechanism” to determine whether microcephaly in newborns there was linked to Zika infection.

Cape Verde, a small nation of islands off the coast of Senegal, reported a case of suspected microcephaly last week, and Dr. Chan said W.H.O. has sent investigators to help analyze it. The team includes epidemiologists, laboratory experts, maternal health specialists and communication staff members.

W.H.O. said last week that there had been 7,490 suspected cases of infection with the Zika virus reported in Cape Verde from Oct. 21 to March 6, and that 165 were in pregnant women. Officials said 44 women had given birth without any abnormalities.

In Brazil, the numbers still lack clarity.

Dr. Anthony Costello, the director of the maternal, newborn, child and adolescent health department at W.H.O., estimated that 39 percent of the approximately 2,200 suspected microcephaly cases that were carefully investigated, including with brain scans, were eventually confirmed.

Using that ratio and the current count of about 6,500 suspected cases, Dr. Costello said he would expect a total of about 2,500 confirmed cases.

“Given the rapid spread of this,” he added, “we must expect that burden to increase substantially.”

Dr. Chan said funding to address the Zika outbreak had been slow in coming. The organization has received about $3 million out of a requested $25 million, and officials are in “active discussion” over $4 million more.

“The situation is still pretty serious in terms of lack of funding,” she said.

http://www.nytimes.com/2016/03/23/health/zika-colombia-microcephaly-world-health-organization.html?_r=0

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Concerns grow over care of patients with serious Zika complications

As the evidence linking maternal Zika virus infections with microcephaly and other birth defects continues to grow—along with the number of countries and territories reporting cases—a shift in focus is needed away from individual cases and toward building health system capacities to care for affected patients and families, World Health Organization (WHO) Director-General Margaret Chan, MD, MPH, said today.

Martinique is the latest area to report its first suspected microcephaly case, according to an Agence France-Presse (AFP) report citing France's health minister. The development comes just days after Panama announced its first such case and as a WHO-led joint mission is investigating the first report in Cape Verde of microcephaly, which manifests as babies born with small heads and brain defects.

In other developments, the WHO marked the first suspected Zika-linked instances of Guillain-Barre syndrome (GBS) outside the outbreak area, a pair of cases from the United States, both in people who had been in Zika-hit areas. Earlier reports have already described a few Zika-linked microcephaly cases in countries outside the outbreak area, all involving women with a history of travel to affected areas.

Funding gap undermines care

Microcephaly and other reported serious neurologic complications—especially GBS, but with case reports also hinting at meningitis and myelitis—can be expected to take a toll on health systems, Chan said. Though in mid February the WHO said $56 million was needed for the response and to help countries strengthen their health systems to care for patients, member countries have donated only $3 million, with discussions under way for $4 million more.

US health officials are also facing a lukewarm response from Congress to President Obama's $1.8 billion emergency fund request, and have warned that representatives and senators are having to shift funds from other important health initiatives such as dengue and HIV.

Chan told reporters that the WHO is also facing a situation of having to borrow from other health activities. "We will not allow money to stand in the way of doing the right thing," she said, adding that resources have already been tapped to send experts, lab testing materials, and equipment to the outbreak area.

US reports pair of Zika-associated GBS cases

US health officials recently notified the WHO about the Zika-linked GBS cases, according to a statement yesterday. The WHO said they are the first Zika-linked GBS cases to be reported outside of a Zika transmission area, but it added that both cases are still under investigation to determine of they meet the Brighton Collaboration case definition for GBS.

One of the patients is an older man who got sick with a febrile illness after returning from Central America and was hospitalized in January with progressive extremity weakness and diminished reflexes. The patient's polymerase chain reaction test was positive for Zika virus. The man's condition improved with treatment, but he experienced a brain aneurysm and died before his discharge from the hospital.

The other patient is a man from Haiti who sought medical care in the United States after experiencing symptoms consistent with GBS in early January, with no earlier illness reported. A serology test was positive for past Zika infection. The man's illness improved with intravenous immunoglobulin therapy, and he was discharged from the hospital.

Though the WHO said the cases add more evidence for the link between Zika virus and GBS, more research is needed to explore a possible role for earlier dengue infection along with Zika infection in GBS development. The agency added that it's crucial to assess if increases of GBS reported in countries with local Zika transmission reflect a real change or enhanced surveillance.

CDC updates, research news

  • Though Zika transmission to healthcare workers and patients from exposure to body fluids in healthcare settings hasn't been documented, the US Centers for Disease Control and Prevention (CDC) today addressed the possible threat and the importance of implementing standard precautions in labor and delivery settings. In an early Morbidity and Mortality Weekly Report (MMWR) release, the CDC said use of standard precautions is especially important in labor and delivery, because of exposure to large volumes of body fluids and the sometimes unpredictable and fast-paced nature of obstetric care.
     
  • The CDC today added Dominica to its level 2 travel alert for pregnant women and those considering getting pregnant. The development comes just a few days after the CDC added Cuba to the list of travel destinations reporting local Zika virus spread.
     
  • The University of Manchester yesterday announced that one of its research teams has received about $252,000 in funding to develop and test a Zika virus vaccine based on a pre-existing smallpox vaccine model. In a statement, the UK university said study results are due within 18 months and that the funding is part of a request for proposals as part of a $5.7 million rapid response initiative announced in early February from the Medical Research Council, the Wellcome Trust, and the Newton Fund.
     
  • Health officials in Bangladesh shared more details about a retrospective Zika virus case detected from a blood sample collected in 2014, Xinhua reported today. The WHO briefly mentioned the finding in its Mar 17 Zika situation update. The patient is a man in his 60s, and his blood sample was part of a group collected in 2013 and 2014 in patients with diseases such as dengue fever. Samples from 159 of the man's close contacts were negative for the virus.

See also:

Mar 22 AFP report

Mar 21 WHO statement on US GBS cases

http://www.cidrap.umn.edu/news-perspective/2016/03/concerns-grow-over-care-patients-serious-zika-complications

 

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