Brazil - Ministry of Health confirms relationship between Zika virus and microcephaly - November 12, 2015

[Gert van der Hoek]

NOVEMBER 12, 2015

RIO DE JANEIRO, Brazil .- Brazilian authorities on Thursday announced tougher measures to register virus infections zika to the possibility that they may be related to increased cases of microcephaly that forced the country to declare a health emergency, they reported today official sources.

Regional health departments of some of the Brazilian states that already have been cases of fever zika reported that registration take further steps to give special monitoring to pregnant women.

The Minister of Health of Brazil, Marcelo Castro, said Wednesday the government's decision to declare a health emergency with the sharp increase in the state of Pernambuco (northeast) cases of microcephaly, insufficient development of the skull of the newborn, which They reach 141 since last July.

Castro said that "it is not a new disease," but said the average case of microcephaly in Pernambuco was ten per year, so the 141 notifications in four months sow "alarm" and require a thorough investigation.

Ministry specialists have admitted that one of the hypotheses under investigation to explain the jump in the number of cases of microcephaly is its possible relationship with the zika because the increase occurred in coincidence with the appearance of the virus in the northeast region Brazil.

The Ministry of Health supports the coincidence between the appearance of Zika , registered for the first time in Brazil in April, and the increase of babies born with microcephaly, but considers any hasty conclusion about it.

"All hypotheses are investigated," said the minister when asked about the relationship of microcephaly with zika .

The State Health Secretariat of Rio de Janeiro reported that as of Monday the reporting of cases of zika laboratory confirmed include an alteration to special monitoring of pregnant women.

 

[Pathfinder]

Translation Google

Registration Date: 11/11/2015 18:11:45 changed the 11/11/2015 in the 18:11:45
PRESS RELEASE

Ministry of Health investigates increase in cases of microcephaly in Pernambuco

The Ministry of Health says it is monitoring the reporting and investigation of cases of microcephaly in Pernambuco since October 22, when it was notified. A team of Rapid Response to Emergencies in Public Health from the Ministry of Health - initially formed by six professional epidemiologists - traveled immediately to Recife to support the Health Departments of the State and municipalities in field investigations. The fact was also reported to the World Health Organization and the Pan American Health Organization, according to international protocols disease notifications.

Until 09/11 were reported 141 suspected cases of microcephaly in Pernambuco, in 44 municipalities in the state. On average per year, the state recorded around ten cases. In children and pregnant women, clinical trials are being conducted, imaging and laboratory, according to the protocol defined by the Health Ministry and Pernambuco Health Department. It is important to clarify that investigations are ongoing and, to date, there is no definition of the cause of the injury, whether infectious or not.

Questions and answers microcephaly

The Ministry of Health also received reports of the states of Para?ba and Rio Grande do Norte on the same subject. All these suspicions are being investigated and have the monitoring of the Ministry of Health teams.

Given the situation, the Ministry of Health declared on Wednesday (11), Emergency Public Health of National Importance to give greater flexibility to the investigations. It is a mechanism established by law for cases of public health emergencies that require the urgent job of prevention, control and risk containment, damage and harm to public health.

The Ministry of Health also activated, on Tuesday (10), the Emergency Operations Center for Global Health (COES) in Brasilia. It is a crisis management mechanism, which brings together the various areas which can contribute to response to this event so that it be treated as a priority.

The microcephaly is not a new grievance. It is a congenital malformation, in which the brain does not develop properly. In the current situation, the investigation of the cause is that has worried health authorities. In this case, babies are born with head circumference (HC) lower than normal and is usually exceeding 33 cm. This defect can be congenital effect of a number of factors from different sources, such as chemicals, biological agents (infectious) such as bacteria, viruses, and radiation.

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http://portalsaude.saude.gov.br/ind...umento-de-casos-de-microcefalia-em-pernambuco

 

[Gert van der Hoek]

Tuesday, 11/17/2015

Government confirms presence of the Zika virus in fetuses with microcephaly


The Ministry of Health confirmed on Tuesday afternoon, 17, have identified the presence of zika virus in amniotic fluid samples collected in two fetuses with microcephaly of Paraiba.

The results, advanced by the newspaper "O Estado de S. Paulo", indicate a close relationship between the sudden increase in cases and the virus, which entered the country earlier this year, caused epidemic in the Northeast and is already present in 14 states, including Rio and Sao Paulo.


"We can not be dogmatic. But the presence of the virus is not just a coincidence," said the director of Department of the Ministry of Health Diseases, Claudio Maierovitch. "We are being extremely cautious in this respect, because the situation is new in the world. So far, there were no reports of the virus zika with congenital malformation. Therefore we talk about a possible relationship," said the director.

The World Health Organization was informed about the test results released on Tuesday. In making the announcement, the director invited scientists from all over Brazil and the world to help prove the cause and effect - a possible link between infection zika and the increase in cases.

 

[Pathfinder]

Translation Google

Registration Date: 11/17/2015 17:11:59 changed the 11/17/2015 in the 18:11:38
MICROCEPHALY

Ministry of Health disseminates epidemiological bulletin

The Ministry of Health publishes on Tuesday (17) the first epidemiological bulletin on microcephaly, which increased the number of cases in the country has been monitored and investigated by folder. To date, it was reported 399 cases of the disease in newborns of seven states in the Northeast.

The largest number of cases was registered in Pernambuco (268), first state to identify increase of microcephaly in your area and which has the follow-Ministry of Health team since October 22. Next are the states of Sergipe (44), Rio Grande do Norte (39), Para?ba (21), Piau? (10), Cear? (9) and Bahia (8).

The investigation of these cases is being conducted by the Ministry of Health seamlessly with state and local health departments, with the support of national and international institutions. Expert committees support the Ministry of Health in epidemiological and laboratory analyzes and monitoring of cases.

In addition to this support, on Tuesday (17), the Ministry of Health sends to all state health departments guidance on the notification process, surveillance and assistance to pregnant women and infants affected by microcephaly. This information is constantly updated.

Can not even be sure about the cause for the increase of microcephaly that has been registered in seven states. All hypotheses are being thoroughly analyzed by the Ministry of Health and any conclusion at this point is precipitated. The analyzes were not completed and, therefore, still in progress.

Fiocruz, which participates in investigations, notified on Tuesday (17) that the Flavivirus Laboratory of the Instituto Oswaldo Cruz concluded diagnoses that established the presence of the Zika virus genome in samples from two pregnant women from Para?ba, whose fetuses were confirmed with microcephaly by ultrasound exams. The genetic material (RNA) virus was detected in amniotic fluid samples using RT-PCR in real time.

Despite being an important scientific finding for understanding the Zika virus infection in humans, the current data do not allow correlating unequivocally causally, infection Zika with microcephaly. Such clarification will be given by studies coordinated by the Ministry and other institutions involved in research into the causes of microcephaly in the country.

The Ministry of Health is addressing this issue with priority and responsibility that the subject demands, giving transparency to data and information, with weekly disclosure forecast epidemiological bulletin of the disease.

Last week was declared Emergency Public Health of National Importance to give greater flexibility to the investigations. It is a mechanism provided for in cases of public health emergencies that require the urgent job of prevention, control and risk containment, damage and harm to public health.

It is also in operation since the 10th of November, the Emergency Operations Center for Global Health (COES), a crisis management mechanism that brings together the various areas to respond to this event. The fact has been reported to the World Health Organization and the Pan American Health Organization, according to international protocols disease notifications.

Managers and health professionals, the Ministry of Health advises that all cases of microcephaly are reported immediately via an online form that, from this Wednesday (18), will be available to all health departments.

On pregnant women, it is important that they maintain the monitoring and prenatal consultations, with the completion of all tests recommended by your doctor. The Ministry of Health reinforces the guidance of not consume alcohol or any other drugs, not use drugs without medical prescription and avoid contact with people with fever or infection.

It is also important that pregnant women adopt measures to reduce the presence of disease-transmitting mosquitoes by eliminating breeding sites, and protect themselves from mosquito exposure, keeping doors and windows closed or screened, wear pants and long-sleeved shirt and use repellents allowed for pregnant women.

The microcephaly is not a new grievance. It is a congenital malformation, in which the brain does not develop properly. In the current situation, the investigation of the cause is that has worried health authorities. In this case, babies are born with head circumference (HC) lower than normal and is usually exceeding 33 cm. This defect can be congenital effect of a number of factors from different sources, such as chemicals, biological agents (infectious) such as bacteria, viruses, and radiation.

CASOS EM INVESTIGA??O NOS SETE ESTADOS QUE TIVERAM AUMENTO INUSITADO DE MICROCEFALIA
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[TD="width: 204"] ESTADO
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[TD="width: 166"] N? DE CASOS/2015
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[TD="width: 204"] PERNAMBUCO
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268​

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[TD="width: 204"] SERGIPE
[/TD]
[TD="width: 166"]

44​

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[TD="width: 204"] RIO GRANDE DO NORTE
[/TD]
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39​

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[TD="width: 204"] PARA?BA
[/TD]
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21​

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[TD="width: 204"] CEAR?
[/TD]
[TD="width: 166"]

9​

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[TD="width: 204"] PIAU?
[/TD]
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10​

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[/TD]
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8​

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CASOS DE MICROCEFALIA NOTIFICADOS NOS ANOS ANTERIORES NOS SETE ESTADOS
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[TD="width: 64"] 4
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[/TD]
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[/TD]
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[/TD]
[TD="width: 64"] 9
[/TD]
[TD="width: 64"] 5
[/TD]
[TD="width: 64"] 7
[/TD]
[/TR]
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[TD="width: 188"] Rio Grande do Norte
[/TD]
[TD="width: 64"] 2
[/TD]
[TD="width: 64"] 2
[/TD]
[TD="width: 64"] 4
[/TD]
[TD="width: 64"] [/TD]
[TD="width: 64"] 1
[/TD]
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[/TD]
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[/TD]
[TD="width: 64"] 2
[/TD]
[TD="width: 64"] 3
[/TD]
[TD="width: 64"] 5
[/TD]
[TD="width: 64"] 5
[/TD]
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[TD="width: 188"] Pernambuco
[/TD]
[TD="width: 64"] 7
[/TD]
[TD="width: 64"] 5
[/TD]
[TD="width: 64"] 9
[/TD]
[TD="width: 64"] 10
[/TD]
[TD="width: 64"] 12
[/TD]
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[TD="width: 188"] Sergipe
[/TD]
[TD="width: 64"] 3
[/TD]
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[/TD]
[TD="width: 64"] 2
[/TD]
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[/TD]
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[TD="width: 188"] Bahia
[/TD]
[TD="width: 64"] 12
[/TD]
[TD="width: 64"] 13
[/TD]
[TD="width: 64"] 7
[/TD]
[TD="width: 64"] 14
[/TD]
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CASOS DE MICROCEFALIA NOTIFICADOS NOS ANOS ANTERIORES NO BRASIL
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[TD="width: 64"] 139
[/TD]
[TD="width: 64"] 175
[/TD]
[TD="width: 64"] 167
[/TD]
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[/TD]
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http://portalsaude.saude.gov.br/ind...terio-da-saude-divulga-boletim-epidemiologico

 

[Pathfinder]

Fears that Zika virus is causing deformities in babies as it spreads across South America

By Donna Bowater, Rio de Janeiro1:55PM GMT 18 Nov 2015

Health authorities across South America and the Caribbean are on alert over the increasing spread of a mosquito-borne disease, Zika virus, which may be linked to congenital brain deformity.
...
While the cause of the increase has not yet been established, Fiocruz, a Brazilian scientific institute, said that the Zika virus had been found in the amniotic fluid of two pregnant women whose foetuses had been diagnosed with microcephaly.

Dr Kleber Luz, an infectologist at the Federal University of Rio Grande do Norte, said around 80 per cent of the mothers whose babies had microcephaly in Rio Grande do Norte also had symptoms compatible with Zika in their first trimester.
...

The Pan American Health Organisation (PAHO), part of the World Health Organisation, issued an epidemiological alert on Tuesday for other member states to report any similar increase.


?Any increase of microcephaly or other neurological congenital disorder must be assessed and investigated,? it said.
...
http://www.telegraph.co.uk/news/wor...abies-as-it-spreads-across-South-America.html

 

[Gert van der Hoek]

Conclusions on zika in babies will take at least six months

11 25 2015

"A nightmare." This is how virologist and professor at USP Paolo Zanotto defines the situation of Brazil regarding the increase in cases of microcephaly, supposedly because of zika virus.

That's because ever, anywhere in the world, there have been studies on the ability of the virus to cause such malformations. More than that: there was no suspicion that this could happen.

Experts say it will take six months to a year to work on the topic find results. In other words, it needs to change the tire while the car runs.

What is speculated so far is this:

1) The mechanism by which zika affect the fetus is similar to other known viruses such as rubella, HIV, herpes, and cytomegalovirus can cause defects -all.
Furthermore, the relationship between the microcephaly and Zika virus would be unprecedented -those between arbovirus transmitted by arthropods (such as mosquitoes).

2) The previous lack of detection of the relationship between zika microcephaly and should be a lack of previous epidemics range of the virus.
This effect was not observed in other affected places like the island of Yap, Micronesia in 2007, or on Easter Island between 2013 and 2014. The hypothesis is that these locations was not the scale factor. "For the first time the virus has found a group of millions of people likely on their way," says Professor of Virology, Faculty of Medicine of Sao Jose do Rio Preto Mauricio Nogueira.

3) zika would be transmitted vertically (ie, the pregnant to the fetus) via placenta after an infection in the first trimester of pregnancy, when the fetal nervous system is still developing.

Probably the future nerve cell has on its surface receptors that favor the infection, which is housed there and and multiply, usurping the cellular machinery and curbing growth and connection between the cells.

As a result, the brain would end up small, reflecting on a smaller skull and complications such as limited mobility, reasoning, speech, learning, among others.

MORE:

 

[Gert van der Hoek]

Within a week, cases of microcephaly in newborns grow 85%


Brasilia - Brazil already adds 739 reported cases of babies with suspected microcephaly, skull malformation that can bring serious consequences to development.

In just one week, the number of registrations increased 85% and has reached at least 160 municipalities in nine states ...

 

[Gert van der Hoek]

Epidemiological update: Complications potentially linked to the Zika virus outbreak, Brazil and French Polynesia


27 Nov 2015

Zika epidemic

Zika virus infections are still spreading in previously unaffected areas of the world. Since 2014, indigenous circulation of Zika virus (ZIKV) has been detected in the Americas. As of week 47, November 2015, autochthonous cases have been reported by WHO in Brazil, Colombia, Suriname, El Salvador and Guatemala [1]. According to media quoting the national authorities, on 26 November, the first two indigenous cases of ZIKV infection were confirmed in Mexico, one in Chiapas and the second in Nuevo Leon [2]. Autochthonous cases have also been reported from Cape Verde, the Republic of Fiji, the Republic of Vanuatu, Samoa, the French territory of New Caledonia, the Solomon Islands and Indonesia in 2015 [3-5].

Increase in notification of microcephaly in Brazil and Zika virus (ZIKV) infection

Background

On 11 November 2015, the Brazilian Ministry of Health declared a public health emergency in relation to an unusual increase in the number of children born with microcephaly in Pernambuco state during 2015 [6]. An increase of microcephaly was also reported in the states of Para?ba and Rio Grande do Norte. On 17 November 2015, the Brazilian Ministry of Health reported the confirmation by RT-PCR of the presence of ZIKV RNA in amniotic fluid samples collected from two pregnant women with foetal microcephaly from the state of Para?ba [7]. Both pregnant women presented compatible symptoms of ZIKV infection during their pregnancy. The significance of this finding is still under investigation. On 17 November 2015, the Pan American Health Organization/World Health Organization (PAHO/WHO) issued an epidemiological alert regarding the increase in microcephaly in the north east of Brazil. WHO Member States were requested to remain alert to the occurrence of similar events in their territories and to notify any occurrences through the channels established under the International Health Regulations (IHR) [8].

As of 21 November 2015, 739 suspected cases of microcephaly have been identified in 160 municipalities across nine states of Brazil. Pernambuco state has reported the highest number of cases (487) followed by the states of Para?ba (96), Sergipe (54), Rio Grande do Norte (47), Piau? (27), Alagoas (10), Cear? (9), Bahia (8) and Goi?s (1) [9].



Guillain–Barr? syndrome in Brazil

On 25 November 2015, media quoting the Flavivirus Laboratory at the Oswaldo Cruz Institute reported that seven cases of Guillain–Barr? syndrome (GBS) had been linked to ZIKV cases in Pernambuco state [10]. The number of cases of GBS increased significantly in the north east of the country between April and June 2015, shortly after the ZIKV epidemic started. According to media, an increase in GBS has been observed in several states across Brazil, with 24 cases in Rio Grande do Norte state between April and June 2015, four times more than the historical average [11]. There have also been increases in Pernambuco (130 cases), Bahia (55 cases), Maranh?o (14 cases) and Para?ba (6 cases) states [11]. Investigations are on-going regarding a possible association with ZIKV infection.

MORE:

 

[Shiloh]

Source: http://www.who.int/csr/don/27-november-2015-microcephaly/en/
[h=1]Microcephaly ? Brazil[/h] Disease Outbreak News
27 November 2015

The Ministry of Health (MoH) of Brazil has provided PAHO/WHO with an update regarding the unusual increase in the number of cases of microcephaly among newborns in the northeast of Brazil.
As of 21 November, a total of 739 cases of microcephaly were being investigated in nine states in the northeast of Brazil. The distribution of the cases was as follows: Pernambuco (487 cases), Para?ba (96 cases), Sergipe (54 cases), Rio Grande do Norte (47 cases), Piau? (27 cases), Alagoas (10 cases), Cear? (9 cases), Bahia (8 cases) and Goi?s (1 case). One fatal case was reported in the state of Rio Grande do Norte.
[h=3]Public health response[/h] In response to the situation, the MoH has taken the following actions:

• disseminating information to health professionals on measures to be taken.
• disseminating information to the population, especially pregnant women, to receive prenatal care and complete all tests recommended by their doctors.
• disseminating information about established reference healthcare services and patient care flow in each Federation Unit.
• strengthening vector prevention and control in urban and peri-urban areas, in accordance with the National Guidelines of the National Program for Dengue Control.

PAHO/WHO and the Global Outbreak Alert and Response Network (GOARN) is deploying technical experts to assist the MoH in various areas, including arbovirus virology, epidemiology and disease surveillance.
[h=3]WHO advice[/h] Although the cause of this event is yet to be determined, information is being shared with Member States to raise awareness of the situation and to alert countries for similar events in their territories. For these reasons and to further the understanding of the etiology of this event, PAHO/WHO urges Member States to report any increase of microcephaly or other neurological disorders in newborns that cannot be explained by known causes. Recommendations by PAHO/WHO are available in the Epidemiological Alert (see related links).

 

[Gert van der Hoek]

Registration Date: 11/28/2015 18:11:32 changed the 11/28/2015 in the 18:11:11

PRESS RELEASE

Ministry of Health confirms relationship between Zika virus and microcephaly

The finding reinforces the call for a national mobilization to contain the mosquito, Aedes aegypti, which is responsible for spreading disease


The Health Ministry confirmed on Saturday (28) the relationship between the Zika virus and microcephaly outbreak in the Northeast. The Evandro Chagas Institute, Ministry of the organ in Bethlehem (PA), forwarded the results of tests carried out on a baby, born in Cear?, with microcephaly and other congenital malformations. In blood and tissues was identified the presence of Zika virus.

From this finding baby who came to death, the Ministry of Health considers confirmed the relationship between the virus and the occurrence of microcephaly. This is an unprecedented situation in world scientific research. The research on the subject should continue to clarify issues such as the transmission of the agent, its role in the human body, the infection of the fetus and period of increased vulnerability for pregnant women. On initial analysis, the risk is associated with the first three months of pregnancy.

The finding supports the call of the Ministry of Health for a national mobilization to contain the mosquito, Aedes aegypti, responsible for the spread of dengue, chikungunya and zika. The success of this measure requires national actions involving the Federal Government, states, municipalities and all of Brazilian society. The time is now to unite efforts to further intensify actions and mobilization.

The campaign launched this week warned that the dengue mosquito kills and therefore can not be born. The idea is that all days are used for cleaning and inspection points which can be mosquito breeding. The result Contents of Rapid Assessment for Aedes aegypti (LIRAa) indicates 199 municipalities in dengue outbreak risk, chikungunya and zika, requiring a mobilization of all, immediate.

DEATHS

The Ministry of Health was also notified on Friday (27), the Evandro Chagas Institute on two other deaths related to Zika virus. The analyzes indicate that this agent may have contributed to worsening of cases and deaths. This is the first binding Zika virus-related death in the world, which demonstrates a resemblance to dengue.

The first case was confirmed by the Evandro Chagas Institute in Bel?m (BA), this is a man with lupus history and chronic use of corticosteroids drugs, a resident of S?o Lu?s, Maranh?o. With suspected dengue, was held sample collection of blood and viscera fragments (brain, liver, spleen, kidney, lung and heart) and sent to the IEC. The laboratory tests showed negative for dengue. With RT-PCR, it was detected Zika virus genome in the blood and viscera.

Confirmed on Friday (27), the second case is a 16-year-old city of Benevides, Par?, who came to death in late October. With initial suspicion of dengue, notified on 6 October, she had headache, nausea and petechiae (red spots on the skin and mucous membranes). Blood collection was performed seven days after the onset of symptoms on 29 September. The test was positive for Zika, confirmed and repeated.

All findings are being released as they are known. The goal is to give transparency on the current status, as well as issuing guidelines for population and public network. This is an important finding and deserves attention. The Ministry of Health is deepening the analysis of cases and accompany other analyzes that have been conducted by its research institutions and laboratories. The initial protocol for the care of possible worsening of Zika will be the same used for more severe cases of dengue.

Ongoing investigations

The Ministry of Health keeps the surveys of the presence of microcephaly in babies, as well as the evaluation of severe cases in adults, the clinical manifestation and the spread of disease. This week, the federal government's invitation, representatives of the CDC (Centre for Disease Prevention and Control, in English), the United States will join the efforts of national authorities and partners in these analyzes. The CDC is a reference to the World Health Organization (WHO) in communicable diseases.

WHO and its representation in the Americas, PAHO, have been updated on the progress of actions, the results and conclusions of the Ministry of Health.

Activities

The Ministry of Health has intensified the monitoring of the situation, as a priority, and disseminate guidelines for public and for the population, according to the results of the investigations. It also maintains contact with state and municipal departments to coordinate a joint response and, in particular, to mobilize action against the mosquito Aedes aegypti.

The Ministry of Health also reports that the Presidency decided to convene the GEI (Interministerial Executive Group), involving 17 ministries to the national plan for the formulation of combating transmission vector, the Aedes aegypti. They are also being stimulated research into the diagnosis and mobilization fronts in the most critical areas. There are plenty of financial resources to support the actions.

The measures involve, finally, communication actions and support care, such as prenatal care, psychosocial care, physical therapy, support examinations and early stimulation of babies.