ProMED submittal is first online indicator of Zika outbreak: Maranhao, Brazil: Reports of outbreaks of undiagnosed illness - February 2015 + - MOH confirms Zika Virus - Now in 8 States

[alert]

Published Date: 2015-02-09 16:52:03
Subject: PRO/EDR> Undiagnosed illness - Brazil: (MA) RFI
Archive Number: 20150209.3152894
UNDIAGNOSED ILLNESS - BRAZIL: (MARANHAO) REQUEST FOR INFORMATION
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Date: Wed 4 Feb 2015
Source: Caxias [a report of the Caxias city government, Maranhao state, in Portuguese, summ & trans. Mod.TY, edited]

http://caxias.ma.gov.br/noticia/secretario-de-saude-adota-providencias-sobre-surto-de-virose-em-caxias

An outbreak of a viral disease causing fever, red rash over the body, and joint pain is keeping the Caxias health authorities on alert. The Municipal Secretary of Health is now aware of the outbreak and is commenting about hundreds of [affected] people in the municipality.

According to the Secretary of Health, Vinicius Araujo ... provided a note stating, "Regarding the viral disease outbreak that is occurring in the city, it is not reported as chikungunya fever. All the serological tests conducted by LACEN (reference diagnostic laboratory for tropical disease of the Ministry of Health in Sao Luis) up to now have been negative.

We have requested that the State Secretariat of Health send technicians to our municipality to carry out virus isolation to clarify which virus could be circulating. The teams should be arriving in the coming week [week of 9 Feb 2015].

--
Communicated by:
ProMED-PORT


[As is always the case, absence of information concerning time, people, and place makes detailed discussions concerning the apparent outbreak of this acute, febrile, rash disease in Maranhao state difficult. Dengue and chikungunya certainly are the main suspected agents to be investigated.

The current scenario, [diagnosis] depends on better clinical and demographic characterization; measles and rubella must be considered, although one would not expect "hundreds of people" affected in a period time (not specified), without any suspicion. Other possibilities, although less likely, include: parvovirus, enterovirus, Oropouche (previously described in Maranhao (see "1st register of an epidemic caused by Oropouche virus in the states of Maranhao and Goias, Brazil. Rev Inst Med Trop Sao Paulo. 1989; 31(4):271-8 -- Portuguese).

Caxias is the 5th largest city in the state of Maranhao, with a population of 155 129 inhabitants and an area of 5 150 667 sq. km [1 988 684 sq mi] - Mod.RNA [in Portuguese, trans., summ. - Mod.TY

In addition to Oropouche, Mayaro virus is another possible virus to rule out. ProMED-mail will be very interested in receiving the results of the investigation and, especially results of any virus isolations. Blood samples could be sent to the Evandro Chagas Laboratory in Belem, for diagnostic serology to rule out Oropouche or Mayaro virus infections.

[alert]

Whatever this is, it's continuing and spreading:

Published Date: 2015-03-27 11:41:31
Subject: PRO/AH/EDR> Undiagnosed outbreak - Brazil: (MA) RFI
Archive Number: 20150327.3257279
UNDIAGNOSED OUTBREAK - BRAZIL: (MARANHAO) REQUEST FOR INFORMATION
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Date: Wed 18 Mar 2015
Source: Globo [in Portuguese, trans. Mod.TY, edited]
http://g1.globo.com/ma/maranhao/noti...endimento.html


After admitting that the Maranhao [state] capital [Sao Luis] is undergoing an outbreak of virus disease for at least 2 weeks, the Municipal Secretary of Health, Helena Dualibe, stated that medical attention in the health posts and hospitals in the capital has been strengthened. "We have increased the number of teams on night shifts so that the population will effectively be better attended," said the Secretary.

Since the beginning of the rainy season, the Maranhao capital has been accompanied by a significant increase in the number of people infected by viruses, which have left public hospitals and health posts in Sao Luis crowded. Those seeking medical attention have had to have much patience.

Medical attention in Socorrinho, a neighborhood in Sao Francisco, for example, increased from 150 to 300 patients per day in recent weeks. According to the Municipal Secretariat of Health, 90 per cent of those receiving attention are people with some sort of virus infection.

The physician Julia Bacelar explained that during this [rainy] season, the number of cases of virus infections increase due to the change in climate. She stated that dengue fever cases increase as well, which can be confused with [other] virus diseases.

--
Communicated by:
ProMED-PORT


[The official position in relation to the outbreak of "virus disease" is worrisome.

There is no information about time/dates-people-places that would permit identification of possible etiologies. Also, there is an absence of more specific information, in terms of the dengue epidemic season, against the risk (or impending risk) of spread of chikungunya from the areas in the country (or from outside it) where transmission is already a reality, or against risk of the spread of measles from the state of Ceara, with ever-present respiratory viruses, [or] noroviruses. Until there is a proven (or otherwise disclosed) etiology, as they say, "it could be anything."

Lets continue to watch this situation. - Mod.RNA [in Portuguese, trans. Mod.TY]

Mod.RNA's comments are spot on. No evidence is presented to substantiate that the outbreak is, in fact, due to infection by one or more viruses. Nor is there adequate epidemiological information provided that could be helpful in establishing a list of potential etiological agents. ProMED-mail would appreciate receiving additional clinical information currently available from health posts and center, and new information, especially laboratory results, as it becomes available.

An undiagnosed outbreak of a presumed virus disease was reported before, in Para state in 2003. The definitive diagnosis was never reported subsequently. One hopes that there will be adequate follow up in this Sao Luis outbreak to establish a diagnosis and a more complete picture of what is occurring there.

[alert]

Published Date: 2015-05-01 10:36:31
Subject: PRO/AH/EDR> Undiagnosed illness - Brazil: (Northeast, RJ) Zika virus susp, RFI
Archive Number: 20150501.3334749
UNDIAGNOSED ILLNESS - BRAZIL: (NORTHEAST, RIO DE JANEIRO) ZIKA VIRUS SUSPECTED, REQUEST FOR INFORMATION
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In this posting:
[1] Brazil: (Northeast) official information
[2] Brazil: (Rio de Janeiro) RFI

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[1] Brazil: (Northeast) official information
Date: Wed 29 Apr 2015
Source: Secretariat of Health Surveillance, Ministry of Health of Brazil [in Portuguese, trans. Mod.JW, edited]
http://portalsaude.saude.gov.br/inde...ca-no-nordeste


SVS (Secretariat of Health Surveillance) monitors cases of rash illness in the Northeast
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SVS communicates that since the end of February [2015] it has been monitoring reported cases of a rash illness in the Northeast. According to reports shared by the Health Departments of the states of Bahia, Maranhao, Pernambuco, Rio Grande do Norte, Paraiba, and Sergipe, all cases have a benign course with spontaneous recovery, even without treatment. According to information passed to the Ministry of Health, 6807 cases of rash illness so far have been identified in the region. It is noteworthy that there have been no serious cases or deaths.

The most common signs and symptoms are rash (red spots) and pruritus (itching). To a lesser extent, cases with low-grade fever or no fever, with or without headache, pain or swelling in the joints, and muscle pain. The age group 20-40 years was the most affected. But there are reports of a patients 4 months old and another 98 years old.

According to the clinical features, the main assumptions in the investigations are: dengue, rubella, parvovirus B19, chikungunya, and measles, and other arboviruses and enteroviruses. So far, among 425 samples collected and tested, approximately 13 percent were positive for dengue. However, the clinical features available for now are not only characteristic of dengue cases. However, some samples tested for measles, rubella, chikungunya, and parvovirus were negative.

In order to identify the causative agent of this rash illness and to propose appropriate prevention and control measures, the SVS is conducting field investigations in collaboration with the Health Departments of Maranhao, Rio Grande do Norte, and Paraiba. In these investigations, they are including clinical aspects of patients and collecting samples, principally blood, which will be forwarded to the state and national reference laboratories.

Simultaneously, all health surveillances states and Northeast municipalities continue investigating and monitoring cases. The SVS and the Health Departments of the states of Alagoas, Bahia, Ceara, Maranhao, Paraiba, Piaui, Rio Grande do Norte, and Sergipe are conducting systematic monitoring through the Strategic Information Centres of Health Surveillance (CIEVS).

--
Communicated by:
ProMED-PORT


[Maps of Brazil can be seen at http://s13.postimg.org/jumnalk87/map_of_Brazil.gif edit (s.s) - Sr.Tech.Ed.MJ]

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[2] Brazil: (Rio de Janeiro) RFI
Data: Mon 13 Apr 2015
Source: Globo [in Portuguese, trans. Mod.JW, edited]
http://g1.globo.com/rj/sul-do-rio-co...-de-saude.html


Allergy outbreak reaches residents of Pinheiral, RJ [Rio de Janeiro], says Health Surveillance
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Pinheiral residents in southern Rio de Janeiro state are facing an allergy outbreak. For the past 30 days, hundreds were treated at municipal First Aid post with similar symptoms. "An average 250 to 300 visits a day, most with joint pain, pain behind the eyes, fever, and itching, a rash on the body," explained Dr Erica Quintal Teixeira Fernandes [at present, dengue would be the most likely case. - Mod.RNA]

It happened with a merchant who 3 weeks ago began to feel discomfort [what type of discomfort? - Mod.RNA], followed by itching in the legs. Small bubbles and then spots began to appear [on his body], and the malaise worsened. After consulting the medical unit, he was treated for allergy and the itching decreased, but the marks on the body continued. Days later, his sons also went through the same problem. "We had headache, dizziness, shortness of breath, and vomiting," they said.

According to Health Surveillance, the prime suspect is that this is a new mutation of the dengue virus [based on what evidence? - Mod.RNA]. "With the investigations which the surveillance performs in relation to the symptoms, we can guarantee that 70 percent of these cases are dengue [confirmed by laboratory testing? And the other 30 percent? - Mod.RNA]," said Adriane Garcia da Rosa.

--
Communicated by:
ProMED-PORT


[These are, at the very least, worrying statements/speculations like "a new mutation of the dengue virus," used to attribute to dengue events/cases that perhaps are not even being investigated and (laboratory confirmed or discounted) systematically.

Investigations conducted by the Departments of Health of the states and the Ministry of Health are essential for elucidating and understanding the outbreaks that have been described.

Use of case definitions and research protocols (sample collection and laboratory analysis) is mandatory, especially now [29 Apr 2015] that Zika virus was announced as having been confirmed by a research laboratory ( see below).

Question: the Zika virus would be the only agent to be prosecuted in the cases/outbreaks that have been reported in the Northeast? Would it be circulating in (and infecting) other states? Let's keep our eyes open. - Mod.RNA

Since 8 Feb 2015 ProMED-PORT has posted reports in Portuguese of hundreds of cases of fever with rash and joint pains in several northeastern states of Brazil: Bahia, Maranhao, Paraiba, Pernambuco and Piaui (see map at
http://viajerobrasil.com/wp-content/...-2-839x735.jpg

Now a Brazilian research group has reported identifying the cause as the mosquito-borne Zika virus:
Source: Globo (in Portuguese)
http://g1.globo.com/bahia/noticia/20...dor-e-rms.html.

Other mosquito-borne viruses with similar symptoms such as dengue and chikungunya were excluded previously. They identified the virus by the PCR test, which detects signature portions of viral RNA. But Zika virus belongs to the group known as flaviviruses, which are notorious among virologists for their cross-reactions in lab tests. Until the actual virus is isolated, we cannot be certain it is not a totally new agent of the flavivirus group.

Zika seems unlikely, because it up to now it has only been detected in Africa, Asia, and the Pacific. One suggestion is that it was imported by a football fan incubating it who was visiting Brazil for the World Cup. But the cup final was in mid-July 2014 -- where could the virus have been hiding since then? Until its identity is confirmed, this is all speculation. - Mod.JW

[alert]

Translated from ProMED Portuguese:

Published Date: 05/04/2015 22:51:03
Subject: PRO / PORT> Disease unidentified - Brazil (11) (PI) outbreak update
Archive Number: 20150504.3341440

DISEASE UNIDENTIFIED - BRAZIL (11) (PIAU?), OUTBREAK, UPDATE
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Date: Monday, May 4, 2015
Source: cidadeverde.com [05/01/2015] [edit]

http://cidadeverde.com/saude-confirma-que-circula-em-teresina-novo-virus-o-zika-veja-os-sintomas-191634

Health confirms that circulates in Teresina new virus, Zika; see symptoms
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It circulates in Teresina identified as a new virus that Zika has symptoms similar to dengue and chikungunya. The information was confirmed [??? !!! - Mod. RNA] by epidemiology manager of the Municipal Health Foundation (FMS), amariles Borba [based on what ??? Very worrying statement, hasty and, for now, little consistent, especially when issued by a medical authority - Mod RNA]..

"This disease, Zika, has the same symptoms of dengue and chikungunya [in terms Some signs / symptoms, but are similar, but not everyone, including chronic evolution of Chikungunya and the risk of complications / death in dengue - Mod .. RNA] The virus circulates in Teresina [as well ??? Who confirmed the virus circulation in the state of Piau? ??? -. Mod RNA] has some suspicious notifications, but only in two months [-?! Mod . RNA] know when the Bethlehem laboratory release the results [whether they are suspects, awaiting the laboratory results, as announced / confirmed virus circulation in Piau? - Mod RNA]..

Amariles Borba emphasizes that prevention is combating the mosquito. "The higher the income, the greater the number of mosquitoes [????. - Mod RNA]. The aegypti_ _Aedes not look against the check and not the level of education," said Amarilis.

The doctor reported that were sent to the Evandro Chagas Institute 209 surveys collected in Teresina patients. Eleven of them have already been returned with negative results for chikungunya. And the Infectious Disease Hospital Natan Portela is collecting suspected cases of Zyca where were collected 25 suspect.

[alert]

And now things get weird....

Published Date: 05/08/2015 11:49:51
Subject: PRO / ESP> Virus Zika - Brazil: (BAH) (02) questioning of initial diagnostic results
Archive Number: 20150508.3350229

VIRUS ZIKA - BRAZIL: (BAH) (02) QUESTIONING OF INITIAL DIAGNOSTICS RESULTS
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Date: May 8, 2015
Source: Portal News, Brazil

http://www.portaldenoticias.net/zika-virus-diagnosticos-de-casos-na-bahia-podem-estar-errados/

[Edited by Jaime Torres]


Preliminary studies by experts in surveillance of the Ministry of Health of Bahia (SESAB) said the probability of error in the analysis that identified cases of Zika virus in Bahia, conducted by researchers at the UFBA.

During the investigations, technicians SESAB found that the biological material used in the investigation referred to colloquially as a probe, which acts as a magnet to attract and identify organisms causing infectious diseases - was imported from the United States without authorization National Agency of Health Surveillance (Anvisa), contrary to the legal regulations.

According to an infectious disease of the same institution as the Zika it is part of the same family of viruses chikungunya, dengue and yellow fever, is suspected of possible flaws in the handling of the probe that could lead to diagnostic errors.

"Depending on the extracted part (probe), it is possible that it reacts in the presence of a virus" brother "he said. The SESAB has collected the samples analyzed by researchers to be reevaluated accredited by the Ministry health laboratories

Reported by: Jaime R. Torres

- ProMED-ESP


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................. Jt


[The research of any kind, including epidemiological, is subject to constant disputes and questions. However, in the press release outlined in the current report, only reference is made to the fact that the diagnostic kits used were imported without being subject in the form prior to the assessment of the relevant local regulatory agency, which does not necessarily invalidate the initially announced results. It will be of great national and regional interest to know as soon as possible the results of the reassessment of the original samples whose findings suggest the existence of a new flavivirus in our continent, capable of generating large epidemics in the same areas already affected by dengue and chikungunya . Moderator Jaime R. Torres]

[alert]

Published Date: 05/09/2015 12:15:43
Subject: PRO / ESP> Virus Zika - Brazil: (BAH) (03) comment
Archive Number: 20150509.3352126

VIRUS ZIKA - BRAZIL: (BAH) (03) COMMENTARY
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I appreciate the enormous work in presenting information Promed-esp. However, in relation to the recent report on the possible occurrence of an outbreak of the Zika virus in the state of Bahia (Brazil), it is necessary to clarify that the Chikungunya virus belongs to a completely different family (_Togaviridae_) of Dengue Virus and Zika Virus (_Flaviviridae_), so these should not be considered as viruses all "brothers", as it is suggested in that report.

Best regards

Julian RUIZ-SAENZ, PhD.
Red Colombiana de Virology


[Thank the relevant comment of Dr. Ruiz-Saenz, who points out taxonomic differences between the Chikungunya virus on one side and Dengue and Zika virus on the other properly. However, it should be noted that the three viruses, as well as being transmitted by similar vectors, have as a common characteristic an RNA genome of positive sense, nonsegmented, and a lipid envelope glycoprotein is present on the surface. In fact, the current Family _Flaviviridae_, formerly part of the _Togaviridae_ Family. Moderator Jaime R. Torres]

[alert]

I am not a researcher, so this is a bit beyond my pay grade. I know from previous outbreaks that there is a high degree of cross-reactivity among the various flaviviruses. I know that there are multiple circulating strains of dengue in the area, which is a flavivirus, as above. Could all this be a laboratory artifact, perhaps due to samples containing one or more dengue strains? The report of Zika is almost certainly wrong. Such a detection would be huge news. Given how fast chikungunya spread in the Americas, the last thing we would want is Zika as well.

Could we be dealing with a novel strain of dengue?

The other option, of course is a novel flavivirus, cross-reactive with Zika. and possibly dengue as well.

To further complicate issues, if something novel is going on, the patients could just as easily be co-infected with dengue, and we might be missing the novel virus, even if there is one.

We await further tests.

[Gert van der Hoek]

computertranslation

Ministry confirmed 16 cases of Zika virus in the country



05/14/2015 12h45 Bras?lia

Paula Laboissi?re - Reporter Agency Brazil Edition: Denise Griesinger

The Ministry of Health confirmed today (14) a total of 16 cases of zika virus in the country - eight in Bahia and eight in Rio Grande do Norte. The disease is transmitted by the bite of Aedes aegypti, the same mosquito that transmits dengue.

The samples were sent to reference laboratories of the Instituto Evandro Chagas and Control and the US Disease Prevention Center for evaluation. Analyzes made by the Federal University of Bahia Health Sciences Institute have already indicated preliminary result for the presence of the virus.

The Zika virus was first isolated in 1947 from samples of monkeys used as sentinels for detecting yellow fever, in Zika Forest, Uganda. It is considered endemic in eastern and western Africa and there is sporadic circulation record also in Asia and Oceania.

In the Americas, he had already been identified in Easter Island, Chile's territory in the Pacific Ocean in 2014. imported cases were reported in Canada, Germany, Italy, Japan, the United States and Australia.

[Gert van der Hoek]

computertranslation - Press release MOH

Registration Date: 14/05/2015 12:05:47 changed in the 14.5.2015 the 12:05:00

PRESS RELEASE

Confirmation of Zika virus in Brazil

The Ministry of Health confirmed on Thursday (15) the Zika virus circulation in the country. The Instituto Evandro Chagas positive attested to the examination of 16 people who presented preliminary results for the virus. There were eight samples of Bahia and eight Rio Grande do Norte. The Ministry monitors the situation and participate in the investigation of other suspected cases of rash to set the causative agents and adopt the surveillance, prevention and complementary control in the country.

Q & A about the Zika virus

Seconds studies, only 18% of people with Zika virus present clinical manifestations of the disease. Its evolution is benign with an incubation period of approximately four days. The disease is characterized by low-grade fever, conjunctival hyperemia (red eyes), without secretion and no itching, arthralgia (pain in joint) and maculopapular rash (rash with white or red dots), muscle aches, headache and pain back. Signs and symptoms can last up to seven days.

Most cases have no signs and symptoms and there is no record associated death. The virus is transmitted by the Aedes aegypti mosquito bite, the same transmitting dengue. For this reason, measures of prevention and control are the same as adopted for dengue and chikungunya.

Treatment is symptomatic and based on the use of acetaminophen (paracetamol) for fever and pain as medical advice. There is indicated the use of aspirin and anti-inflammatory drugs because of the increased risk of bleeding complications, as with dengue. Guided seek health care for proper conduct.

Independent confirmation of other samples Zika virus, it is important that health professionals remain attentive front of suspected dengue cases in health facilities and to adopt the recommendations for clinical management as recommended in the current protocol.

[alert]

Published Date: 2015-05-15 16:53:35
Subject: PRO/AH/EDR> Undiagnosed illness - Brazil (02): Zika virus conf
Archive Number: 20150515.3364149
UNDIAGNOSED ILLNESS - BRAZIL (02): ZIKA VIRUS CONFIRMED
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Date: Thu 14 May 2015
Source: O Globo [in Portuguese, trans. Mod.TY, edited]
http://oglobo.globo.com/sociedade/sa...-zika-16151785


Fiocruz [Oswaldo Cruz Foundation] in Bahia state confirms new Zika virus cases
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A new virus known as Zika, transmitted by the same mosquitoes as dengue and chikungunya [viruses], has begun to circulate in Brazil. The 1st cases were confirmed this month [May 2015] in Bahia and now scientists confirmed the presence of the virus in Rio Grande do Norte as well. There are also reports, unconfirmed, of patients in northeastern states of Maranhao, Pernambuco, Sergipe, and Paraiba, as well as suspected ones in Rio de Janeiro. The symptoms of these 3 illnesses [dengue, chikungunya, and Zika] are similar, but worrisome for researchers and, especially, for the eventual occurrence of simultaneous outbreaks [of the 3 diseases], that could cause more serious complications.

Samples from 21 patients in Natal were tested by Fiocruz scientists along with collaboration from the Universidade Federal do Rio Grande Norte. They used molecular tests that were developed in countries with greater incidence of [Zika virus] disease and showed that genetic material of 8 of the samples were of the new virus. For the rest [of the 21], they guaranteed that they are not dealing with dengue or chikungunya [viruses]. "Possibly they are also Zika virus but we are not able to get proof because the viruses circulate in the individual's blood for 2-3 days, and the tests are not sensitive enough to detect it after this period," explained virologist Claudia Nunes Duarte dos Santos, Research Coordinator and head of the Molecular Virology Laboratory of the Instituto Carlos Chagas/Fiocruz Parana. "The data show that, in fact, the disease is spreading in the country."

In addition to symptoms similar to those of dengue and chikungunya -- pain in the joints and body, headache, fever, nausea diarrhea, and malaise -- Zika virus [infections] can cause photophobia, conjunctivitis, and rash over the whole body, including the palms of the hands and soles of the feet, accompanied by itching. After the mosquito bite, symptoms appear between 3-12 days and last for 4 days to a week. Specialists say that the symptoms are milder than for the other 2 illnesses [dengue and chikungunya], and no deaths have been registered. The concern, really, is about co-infections.

"[Zika virus infection] is less serious, but it is possible to acquire the 3 viruses simultaneously, and we do not know what the clinical course would be of these co-infections with Zika virus, for which there is no [pre-existing] immunity," Claudia speculated. "There is need for thorough research to clarify this [possibility] and develop treatment [approaches].

In Rio de Janeiro, the symptoms of some patients have confused Fiocruz researchers who, after testing [samples from] a series of [patients with] diseases, decided to send samples from these individuals for evaluation in Parana. The unit had been working with other viruses, and was responsible for the isolation of chikungunya [virus] in Feira de Santana, in Bahia, a city that is living through an outbreak of the disease.

"Since last year [2014] in Brazil there is an increasing number of patients who have shown symptoms of the disease. We have reports from the northern region," said Claudia.

There are 2 types of Zika virus strains [subtypes]: an Asian one and an African one. Research that was done with genetic sequencing of the material from Natal gave data that "indicated strongly" that we are dealing with the Asia strain, said Claudia. The next step of the research will be to identify how and where the virus was introduced into Brazil. The most likely hypothesis is that the virus had arrived in the country via visiting foreigners during the World Cup games [in Brazil in 2014].

In the case of Bahia, 12 samples of Zika virus were confirmed on 29 Apr 2015 from patients of the Camacari municipality. According to the Federal University of Bahia (UFBA), responsible for the discovery, the disease has also affected individuals of Salvador, Feira de Santana and other municipalities in Bahia.

The results from Bahia as well as those of Rio Grande do Norte were sent to the Ministry of Health, which stated that the samples will be tested by the Instituto Evandro Chagas in Belem [a national reference laboratory] and/or the US CDC. According to the Ministry, confirmation will occur only after the report is issued from a reference laboratory.

The mosquitoes that transmit the disease [virus] are those known as _Aedes aegypti_ and _Aedes albopictus_, present in the American Continent [in localities] that suffer outbreaks of dengue and chikungunya. So while as of now there have been no recent confirmed cases on the mainland -- just one recorded in February 2014, on Easter Island, Chile -- there is the possibility that the disease is spreading silently, according to Claudia [dos Santos]. "It is likely that [disease from] Zika virus is going unnoticed. "

Because of this, the Pan American Health Organization (PAHO), linked to the World Health Organization (WHO), has warned of the risk of outbreaks. "The wide distribution of vectors in the Americas, combined with the high degree of mobility of people in the region and in the world, represent a risk of dissemination of Zika virus in the American Continent, according to a statement published on 7 May 2015.

The agency recommends that surveillance for this pathogen must be organized based on the same system that exists for dengue and chikungunya, taking into account the clinical differences. "Mosquito control is the only way that virus transmission by the vectors can be interrupted, " it adds. [What differences? There is no single symptom that is unique to Zika virus disease. - Mod.JW]

New to the American Continent, the disease was described for the 1st time in 1947 in the Zika Forest in Uganda. About 20 years later, it was confirmed in humans in Nigeria. And, from there, it spread to regions of Africa (in countries like Tanzania, Egypt, Sierra Leone, and Gabon) and Asia (India, Malaysia, Philippines, Thailand, Viet Nam, and Indonesia), then reaching Oceania. In 2007, there was an outbreak in Yap Island in Micronesia, where 185 cases were recorded.

In 2013, there was an outbreak in French Polynesia. On that occasion, there were no deaths. However, of the 10 000 registered cases, 70 were considered serious, presenting with neurological complications -- Guillain Barre syndrome and meningoencephalitis -- and thrombocytopenic purpura and leucopenia. Studies are being conducted to investigate whether [these serious cases] occurred due to co-infection with other viruses, since there was a concurrent outbreak of dengue [going on].

There is no vaccine for any of these [3] diseases. The current treatment is just symptomatic. The use of paracetamol [acetaminophen] is recommended to relieve fever and antihistamines against itching. As with dengue, aspirin (acetylsalicylic acid) and anti-inflammatory drugs are not recommended due to the risk of bleeding. Patients should also drink plenty of fluids.

[Byline: Flavia Milhorance]

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[The arrival of Zika virus in Brazil is not good news. Vector mosquitoes are abundant and there is a large population of susceptible people, not just in Brazil, but, as the cited WHO report indicates, throughout the Americas where outbreaks of dengue and chikungunya virus infections occur (see http://www.paho.org/HQ/index.php?opt...&Itemid=999999). Although the Zika virus isolates have not yet been confirmed by the national or international reference laboratories, the Parana laboratory has sequenced the virus and identified it as Zika virus. Assuming that the reference laboratories confirm the identity of the virus as Zika, diagnostic laboratories throughout the Americas will need to include Zika virus diagnostic tests in their battery of tests.

Maps of Brazil showing the location of the states mentioned can be accessed at http://www.lib.utexas.edu/maps/americas/brazil.jpg . - Mod.TY]

[Nobody can say I brought it to Brazil (I live in Rio de Janeiro) because I worked only with the African serotype -- see a paper I co-authored in 1964 in the Bulletin of WHO: Twelve isolations of Zika virus from Aedes (Stegomyia) africanus (Theobald) taken in and above a Uganda forest
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2555143 and they say this is the Asian one. - Mod. JW]

[Gert van der Hoek]

02/06/2015

Rio de Janeiro officially registered the first case of local transmission of the zika virus

The first case of zika - the new disease transmitted by the mosquito Aedes aegypti - was recorded this weekend in the state of Rio de Janeiro. Symptoms of dengue and zika are very similar: fever, body aches, joint pain, red spots, but the zika virus also causes redness in the eyes.

According to the State Secretary of Health, Alexandre Chieppe the like symptoms hinder the proper diagnosis of the doctors. "This is a concern for us not neglect those cases of dengue to occur with greater lethality. It is important to have clarity in diagnosis and, if in doubt, comes as dengue, "said the undersecretary.

The case identified over the weekend was diagnosed by laboratory testing. "The confirmation came on Sunday (31) night confirmed the first of zika with transmission here in the state of Rio de Janeiro. There was no history of travel and evolved clinically well, "said Chieppe.

[Gert van der Hoek]

Zika Virus - 'cousin' of dengue - already confirmed cases in eight states

NAT?LIA CANCIAN
BRASILIA

06/11/2015

Identified in the country for about a month, the zika virus, new "cousin" of dengue, already totals confirmed cases in at least eight states, according to the Ministry of Health and state departments.

By the 3rd of June, they were confirmed cases of zika virus in Bahia, Rio Grande do Norte, Sao Paulo, Alagoas, Par?, Roraima and Rio de Janeiro. On Wednesday (10), Maranh?o also confirmed the first report of the disease.

The ministry did not say the total cases. Contact the state secretaries, Folha has identified at least 34 records already confirmed after tests.

http://www1.folha.uol.com.br/cotidiano/2015/06/1640752-virus-primo-da-dengue-zika-ja-tem-casos-confirmados-em-oito-estados.shtml

[Gert van der Hoek]

Eurosurveillance, Volume 20, Issue 23, 11 June 2015
Rapid communications
ZIKA VIRUS INFECTION IN A TRAVELLER RETURNING TO EUROPE FROM BRAZIL, MARCH 2015
L Zammarchi¹, D Tappe², C Fortuna³, M E Remoli³, S G?nther², G Venturi³, A Bartoloni ()¹, J Schmidt-Chanasit²

• Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Universit? Degli Studi di Firenze, Florence, Italy
• Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
• Department of Infectious, Parasitic and Immune-Mediate Diseases, Istituto Superiore di Sanit?, Rome, Italy

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Citation style for this article: Zammarchi L, Tappe D, Fortuna C, Remoli ME, G?nther S, Venturi G, Bartoloni A, Schmidt-Chanasit J. Zika virus infection in a traveller returning to Europe from Brazil, March 2015. Euro Surveill. 2015;20(23):pii=21153. Available online: http://www.eurosurveillance.org/View...rticleId=21153
Date of submission: 05 June 2015

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We report a case of laboratory-confirmed Zika virus infection imported into Europe from the Americas. The patient developed fever, rash, and oedema of hands and feet after returning to Italy from Brazil in late March 2015. The case highlights that, together with chikungunya virus and dengue virus, three major arboviruses are now co-circulating in Brazil. These arboviruses represent a burden for the healthcare systems in Brazil and other countries where competent mosquito vectors are present.

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[Gert van der Hoek]

Mem Inst Oswaldo Cruz. 2015 Jun 9:0. [Epub ahead of print]

First report of autochthonous transmission of Zika virus in Brazil.

Zanluca C1, Melo VC2, Mosimann AL1, Santos GI2, Santos CN1, Luz K3.

Abstract

In the early 2015, several cases of patients presenting symptoms of mild fever, rash, conjunctivitis and arthralgia were reported in the northeastern Brazil. Although all patients lived in a dengue endemic area, molecular and serological diagnosis for dengue resulted negative. Chikungunya virus infection was also discarded. Subsequently, Zika virus (ZIKV) was detected by reverse transcription-polymerase chain reaction from the sera of eight patients and the result was confirmed by DNA sequencing. Phylogenetic analysis suggests that the ZIKV identified belongs to the Asian clade. This is the first report of ZIKV infection in Brazil.

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[Gert van der Hoek]

From State Department of Health- Alagoas State

AFTER TESTS RESULTS: Three cases of Zika virus are detected in Alagoas

Transmitted by Aedes aegypti, the disease has symptoms similar to dengue

Mosquito dengue transmitter also transmits the Zika virus

Reporter: Josenildo Torres
Source: Ascom / Health

Upon completion of the tests sent by the State Department of Health (Sesau) to the Instituto Evandro Chagas, Par?, it was confirmed three cases of Zika virus in Alagoas. The patients were seen earlier this year in the municipality of Mata Grande, which borders Alagoas cities that are located near the border of Bahia, where they were already reported nearly 10 cases.

The Zika virus is of the genus Flavivirus, from Uganda, Africa, and is also present in Asia, Oceania and South America and is transmitted by the Aedes aegypti mosquito, which also transmits dengue fever and chikungunya. The first notifications of the disease occurred in 2014 in Rio Grande do Norte and this year also there have been cases in Maranh?o, Para?ba, Bahia, S?o Paulo and Par?.

Registration date: 06/08/2015