Wednesday, January 13, 2016

Brazil MOH: Updated Microcephalic Birth Numbers - Epi Week 1

# 18,880

For each of the two final reporting weeks of 2015 Brazil announced roughly 200 new suspected microcephalic births under investigation - a substantial drop over the numbers we were seeing in early December - but still 70 times greater than normal (average 3/wk).

Today, in the first full reporting week after the Christmas/New Year's holidays, we see a substantial jump (75%) in suspected cases, with 356 new cases announced. 

Although the link has not yet been fully established, Brazilian scientists strongly suspect these thousands of recent excess microcephalic births are likely due to maternal infection with the Zika virus during the first and second trimester .   

Assuming that theory is correct - since Zika is carried and transmitted by mosquitoes, and microcephalic births are a trailing indicator (by 3 to 9 months on average) - we are presumably now seeing the results of Mosquito borne infections that occurred between May and September of last year. 

This is particularly worrisome as last year was the first year that the Zika Virus was detected in Brazil, and since that May-September window occurred during Brazil's winter; a cooler, dryer season when mosquito activity is generally lessened.

Brazil's  summer season began three weeks ago, and their rainy season generally runs through March, meaning this will be the first full summer of Zika in Brazil.

With Carnival in Rio just three weeks away, many scientists warn this may afford the virus an excellent opportunity to spread, as 500,000 visitors are expected for the celebration (see  Rio Worries Over A `Zika Summer'). The CDC recently issued a travel notice (see  Zika Virus in South America) for those planning a trip to South America.

Although Brazil has been, by far, the hardest hit - the Zika virus has now shown up in 13 countries and territories in the Americas, and its spread is expected to continue.
While Zika infection is normally milder than Dengue, in recent months infection has been linked to a rise in neurological illness, including Guillain–Barré syndrome (GBS) (see ECDC: Complications Potentially Linked To The Zika Virus Outbreaks In Brazil & French Polynesia).

Again, as with the microcephalic births, the link between Zika and GBS is not fully established.
So far, only imported cases have been reported in the United States, but as we've seen with  Chikungunya and Dengue, limited local transmission seems likely as the virus moves north.

This from the Brazilian MOH:

Registration Date: 01/12/2016 19:01:42 changed in the 12.1.2016 the 19:01:42
3,530 cases are under investigation recorded in 724 municipalities in 21 Brazilian states. Research result confirms four malformation deaths related to Zika virus

New epidemiological report released on Tuesday, (11) by the Ministry of Health indicates microcephaly 3,530 suspected cases related to the Zika virus. Suspected cases of the disease in newborns are computed from the beginning of the investigation (on 22 October 2015) until January 9 this year and occurred in 724 municipalities in 21 Brazilian states. Also under investigation 46 babies with microcephaly deaths possibly related to the Zika virus, all in the Northeast.

The state of Pernambuco, the first to identify an increase of microcephaly, continues with the greatest number of suspected cases (1,236), representing 35% of total registered across the country. Next are the states of Paraíba (569), Bahia (450), Ceará (192), Rio Grande do Norte (181), Sergipe (155), Alagoas (149), Mato Grosso (129) and Rio de Janeiro ( 122).

The report also presents the results of laboratory investigation of four cases of deaths which occurred in Rio Grande do Norte, with congenital malformation, who had the relationship with confirmed Zika virus. These cases were being investigated by the Control and the US Center for Disease Prevention (CDC), which sent the results to the Ministry of Health.

Two of these cases are miscarriages and two newborns at term (37-42 weeks gestation) who died in the first 24 hours of life. The samples were positive in the PCR test laboratory Zika virus. Furthermore, tissue samples of both newborns were positive in immunohistochemistry test, carried out by the CDC.

According to the clinical and epidemiological investigations carried out previously by the Federal University of Rio Grande do Norte (UFRN), all four patients presented fever and rashes during and pregnancy. These results add to the other evidence obtained in 2015 and reinforce the hypothesis relationship between the Zika virus infection and the occurrence of microcephaly and other congenital malformations. However, the Ministry highlights the need for further investigations and research of changing the number of microcefalias and other malformations due to infectious processes.

VIRUS ZIKA - Currently, the movement of the Zika is confirmed by PCR with molecular biology technology. From the confirmation in a particular locality, the other diagnoses are made ​​clinically, for medical assessment of symptoms.

So far, they are with indigenous circulation of Zika virus 20 units of the federation. They are: Federal District, Mato Grosso do Sul, Roraima, Amazonas, Para, Rondonia, Mato Grosso, Tocantins, Maranhao, Piaui, Ceara, Rio Grande do Norte, Paraiba, Pernambuco, Alagoas, Bahia, Espírito Santo, Rio de Janeiro, São Paulo and Paraná.

ORIENTATION - The Ministry of Health advises pregnant women to adopt measures to reduce the presence of disease-transmitting mosquitoes by eliminating breeding sites, and protect themselves from mosquito exposure, such as keeping doors and closed or screened windows, wear pants and shirt long-sleeved and use repellents allowed for pregnant women.

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