Published On: February 9, 2016

Brazil in the Zika Zone

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Rosana Vieira Alves bathes her 4-month-old daughter Luana Vieira, who was born with microcephaly, at their home in Olinda

Nothing is spreading faster than the Zika virus in Latin America and the Caribbean except perhaps the stories about it. Sadly, a public health emergency is exactly what Brazil doesn’t need this week with Carnival celebrations in full blast around the country and the upcoming Olympics in Rio de Janeiro this August. The country is hoping for record numbers of tourists to bolster the economy, as Brazil suffers through its second year of recession and high unemployment.

The World Health Organization (WHO) declared an international public health emergency on February 1, noting that its experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly, a rare condition in which babies are born with unusually small heads, is strongly suspected. The WHO began monitoring Zika infections in Brazil last May; since then the virus has been detected in more than thirty countries around the globe. Epidemiologists estimate that more than 1.5 million Brazilians have been infected with the Zika virus.

Zika is not a new virus and is believed to have entered Brazil during the 2014 World Cup, probably from Africa or Asia. In the past, Zika was not considered a deadly or even dangerous disease. However, in the last few months, Brazil has been grappling with a growing surge in medical reports of microcephaly. According to data released recently by Brazil’s Ministry of Health, there have been 4,783 reported cases of microcephaly in the past year. Before that, Brazil had an average of 150 cases annually.

The Zika virus was discovered in the Zika Forest in Uganda in 1947. The virus has mild effects – red eyes, fever, joint pains and a rash – and nearly 80 percent of people who are infected experience no symptoms at all. With so many cases showing no symptoms, until its possible connection to microcephaly, Zika was considered far less harmful than dengue or yellow fever, which are transmitted by the same species of mosquito. Eight hundred people died in Brazil in 2015 from dengue fever, but there have been no reported deaths from Zika.

Worldwide spread of Zika

Worldwide spread of Zika

In 2014, doctors say, the first patients started trickling into public hospitals in Natal, a city on the northeast coast of Brazil. It was a few weeks after the 2014 World Cup, and Natal had been one of the host cities of the games. Many Zika patients lived on the city’s margins, others in small towns dotted across the sertão, northeast Brazil’s arid hinterland. Almost all of the patients had the same symptoms: a flat pinkish rash, bloodshot eyes, fever, joint pain, and headaches. None were desperately ill, but the similarities in their symptoms were striking. At that time, doctors in Natal tested for dengue, but the tests ruled that out, along with other common viruses. On one day in January 2015, 100 patients showed up at the state’s hospitals with Zika symptoms.

Until that time, Zika was known to exist only in Africa, Asia, and the South Pacific. In 2007, Zika was confirmed in Micronesia, just west of the Philippines and north of Australia. It could have come from anywhere in Asia. In October 2013, the Zika virus raced through the many islands of French Polynesia, including Tahiti and Bora Bora. In early 2014, it bounced to the Cook Islands, just to the west, and New Caledonia, close to Australia. It also leapt to Easter Island, home of the giant stone heads, its official arrival in the Western Hemisphere. It is still island-hopping today. American Samoa and Tonga are having outbreaks now. Scott C. Weaver, a virologist at the University of Texas Medical Branch in Galveston, wrote an article in 2009 warning that Zika was approaching the Americas. Until 2013, there was no evidence Zika had ever hospitalized anyone.

No one is certain how Zika arrived in Brazil. It could have been during the World Cup, but a second theory, proposed by French scientists connected to the Pasteur Institute in Paris, who had investigated the outbreak in Polynesia, was that it arrived a few weeks later, during the Va’a World Sprint, a canoe race in Rio that attracted teams from several Polynesian islands.

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Unfortunately today, more questions than answers surround Zika. For example, now that international attention is focused on Zika, medical researchers in Brazil are re-examining all the reported cases of microcephaly. Thus far, researchers have definitely confirmed only 404 cases of microcephaly. Of the 1,313 cases the government has investigated so far, only 404 were confirmed. The diagnosis was rejected in the remaining cases.

As a result, it is believed many cases of microcephaly were falsely reported, partially in response to the heightened media coverage of the health crisis. The reporting numbers were based solely on measuring the size of an infant’s head, and some infants simply have smaller heads and never have microcephaly. As Brazil’s health professionals continue to re-examine all 5,000 or so cases, it’s possible a majority of those are false positives because all babies with a head circumference of less than 32 centimeters are flagged as a suspected case, but many infants are born with small heads for other reasons.

Several independent experts say that many of the false positives were the result of an appropriate amount of caution and care by the Brazilian authorities. The government began requiring local health officials to report suspected cases of microcephaly in October 2015. It did so after doctors in Zika-stricken areas began seeing an alarming increase in babies being born with unusually small heads and the brain damage that often comes with it. Brazilian researchers then linked the condition to the Zika virus.

The government originally told health professionals to report suspected microcephaly cases when a baby’s head at birth was 33 centimeters (13 inches) or less. At that time, very little was known about the Zika virus and its possible effects on pregnancy, so officials here did what is common in public health surveillance cases: “They set broad criteria to make sure they were catching as many cases as possible. But that standard also meant that there were many false positives of babies being reported who were actually healthy,” said Claudio Maierovitch, director of the department of surveillance of communicable diseases at Brazil’s health ministry.

Aedes aegypti mosquito

Aedes aegypti mosquito

Even more perplexing and critical, it is still unclear whether this alarming rise in cases of microcephaly is in fact caused by the Zika virus. While some scientists believe there is a direct link, others are warning against a jump to judgement. Thus far, the connection between the two may only be coincidental; a direct causal relationship has yet to be proven.

Additionally, there is a proven connection between excessive alcohol consumption by pregnant women and microcephaly. Thus even with confirmed cases of microcephaly, there may be other causes besides Zika, such as fetal malnutrition, genetic factors, exposure to toxic chemicals, and viruses passed from the mother to the fetus such as rubella.

Researchers in the state of Pernambuco, home to a third of Brazil’s suspected cases of microcephaly, said last week that they have identified some of the clearest evidence yet of a direct link between the debilitating birth defect and the Zika virus. Researchers here tested the spinal fluid of 12 babies with microcephaly, all of whom were born to mothers who reported having symptoms of Zika early in their pregnancies. In all 12 cases, the researchers found evidence of Zika — results they described as stunning.

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

“We used to have 10 cases a year in Pernambuco. Then in August of 2015 we started having 10 cases a week,” said Dr. Angela Rocha, a pediatric infectious disease specialist at Recife’s largest public hospital.

Dr. Angela Rocha, Oswaldo Cruz Hospital in Recife

Dr. Angela Rocha (l.), Oswaldo Cruz Hospital in Recife

Currently, there are 33 countries and territories with active Zika transmissions. The world’s attention may be focused on the Zika outbreak in Brazil, but there’s a chance the spread of the disease could be even more intense in neighboring Venezuela. That is the conclusion of some doctors there, whose response to the virus has been hampered by the government’s failure to release reliable numbers about the spread of the mosquito-borne disease. Last week, Venezuela’s Health Minister Luisana Melo said the country had 4,700 suspected cases of Zika. But independent experts in Venezuela believe that Melo’s figures are an underestimate by two orders of magnitude, and blame the government for covering up the true extent of Zika.

Further questions remain regarding the sudden spread of Zika cases. Climate change may have fueled the outbreak of the mosquito-born Zika virus in Latin American and make it harder for developing countries to manage future epidemics, researchers said. Record-high temperatures last year in Brazil, Ecuador, and other South American countries created ideal conditions for the mosquito that transmits Zika. Rising temperatures and increased rainfall can extend the geographic range and enrich breeding areas of mosquitoes, ticks, fleas, and other insects that transmit diseases, scientists said. The pathogens they carry tend to become more resilient at higher temperatures and go through their life cycles faster.

Some scientists have said the Zika outbreak is associated with El Nino-related heavy rains in parts of Latin and Central America. But two researchers from the European Center for Disease Prevention and Control in Stockholm believe that the outbreak is due to the record-high temperatures and severe drought that occurred in northeast Brazil in the latter half of 2015, which were caused by a combination of El Niño and global climate change.

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Brazil says it is sending a set of samples related to the Zika outbreak to the US Centers for Disease Control and Prevention, an announcement on February 5 that follows criticism over the country’s hoarding of disease data and biological material. The Associated Press had reported just two days earlier that researchers across the world were being starved of access to Zika virus samples and information, with many countries relying on older strains from outbreaks in the Pacific and Africa for tests and research. The World Health Organization and Brazilian health officials said legal issues were complicating the sharing of data. Brazil’s health ministry said it had just wrapped up Zika field work with an American team and would be shipping two thirds of the material gathered to the United States.

Last May, as the first cases of Zika in Brazil were emerging, President Dilma Rousseff signed a new law to regulate how researchers use the country’s genetic resources. But the regulatory framework hadn’t yet been drafted, leaving scientists in legal limbo. “Until the law is implemented, we’re legally prohibited from sending samples abroad,” said Paulo Gadelha, president of the Oswaldo Cruz Foundation, Brazil’s premier state-run research institute for tropical diseases. “Even if we wanted to send this material abroad, we can’t because it’s considered a crime.”

With so many unanswered questions, the Zika emergency is posing major challenges on several fronts: how to best educate the public, how to best eliminate the virus’s spread, and can a vaccine be developed?

Gleyse Kelly da Silva with her baby who has microcephaly in Recife

Gleyse Kelly da Silva with her baby who has microcephaly in Recife

Leading researchers in Brazil are now borrowing techniques used to accelerate the fight against Ebola in the hope of developing a Zika virus treatment that could be tested in humans in a year. Professor Jorge Kalil, head of the state-run Butantan Institute, told Reuters this week that scientists in Brazil plan to use animals to produce antibodies to tackle the virus. A similar research path was used in the hunt for an Ebola treatment. There is no cure or vaccine for the Zika virus yet.

Hampering its research, Butantan has been hard-hit by two years of budget cuts. But Kalil voiced hope that Dilma Rousseff would make good on a pledge to prioritize resources for Zika. “All the projects I have requested so far have been approved, and I hope that resources will be disbursed very quickly,” he said. However, even with sufficient funding, it would be three years, Dr. Kalil thinks, before a vaccine could be tested on humans.

Indian pharmaceutical company Bharat Biotech said last week it was developing two candidate vaccines, one of which is already in pre-clinical testing in animals, to fight the Zika virus. “We believe we have an early-mover advantage in developing the Zikavac and we are probably the first in the world to file for a global patent for Zika vaccine candidates,” the company said in a statement.

Dr. Stanley Plotkin, a leading vaccine inventor, said a Zika vaccine “should not be extremely difficult to make” because the disease is closely related to yellow fever and Japanese encephalitis, for which there are effective vaccines.

Eradication efforts in Recife

Eradication efforts in Recife

Brazil’s health minister, Marcelo Castro, has urged Latin American countries to work together in the fight against the Zika virus and said US experts would arrive to begin work on finding a vaccine. “On February 11, US technical experts will arrive in Brazil to hold a high-level meeting where they will determine the first steps and timetable for developing this vaccine,” Castro said from a meeting of regional health ministers in Montevideo, Uruguay. On February 5, Dilma discussed the Zika epidemic with President Barack Obama by telephone. The two leaders talked about how to accelerate the development of a vaccine as well as other control measures.

Dilma’s office said a high-level bilateral group would “develop a partnership in the production of vaccines and therapeutics.” It will be based on an existing cooperation agreement between Brazil’s Butantan Institute of biomedical research and the US National Institutes of Health to develop a vaccine against dengue. But no matter how fast they are able to act, scientists have warned that it could take years for a Zika vaccine to become available. There is currently no specific treatment for Zika, and no way to prevent it other than to avoid mosquito bites. The Entomological Society of America and its Brazilian counterpart have organized a one-day summit in Brazil on March 13 aimed at prompting fresh international action on the “grand challenge” of defeating this mosquito species.

In Montevideo last week, the health ministers of 14 Latin American countries agreed on a roadmap to fight the Zika virus. After meeting all day in the Uruguayan capital, the ministers approved a 16-point declaration to fight the region’s “serious epidemiological situation” due to the Aedes aegypti mosquito, which also carries dengue fever, yellow fever, and chikungunya. Uruguayan Health Minister Jorge Basso said “the challenge” is to resolve the questions where scientific evidence is not yet definitive, remarking on the WHO’s commitment to determine the relationship between Zika and microcephaly. Participating in the meeting were the health ministers from Argentina, Brazil, Uruguay, Venezuela, Paraguay, Bolivia, Costa Rica, Mexico, the Dominican Republic, Colombia, Suriname, Peru, Chile, and Ecuador.

Although the WHO has not established a direct link between microcephaly and neurological disorders with Zika, Health Minister Marcelo Castro says that scientific studies here in Brazil have established an “unquestionable” causal connection.

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Another mystery the Latin American health ministers meeting in Uruguay are trying to solve is why Zika has been linked to birth defects in Brazil but not in other countries where the virus has been detected. Colombian Health Minister Alejandro Gaviria told the Associated Press that researchers need to look at what may be fueling the differences in manifestations. He gave the example of Colombia, where 20,000 cases of Zika have been confirmed but not a single case of microcephaly.

Colombia announced that over 2,000 pregnant women had contracted the Zika virus. The National Health Institute said that Colombian authorities had recorded 20,297 cases of Zika, with about 10 per cent occurring in pregnant women. The latest figures make Colombia the second most affected country after Brazil.

With so much attention focused on Zika, speculations are rampant as to the connection of Zika with the apparent epidemic of microcephaly. International health experts are convening in Geneva, Switzerland to discuss the mystery of the sudden increase in microcephaly.

Municipal worker sprays Receife

One theory denies that the Zika virus is the direct cause of microcephaly. It holds that genetically modified mosquitoes (GMM) are to blame. In mid-2012, British biotech company Oxitec began releasing GMMs with the aim of reducing the overall mosquito population that spreads dengue fever, the Zika virus, and chikungunya in northeast Brazil.

Oxitec continues its work today. Every weekday, a van drives slowly through the Brazilian city of Piracicaba in São Paulo state carrying a cargo of mosquitoes. More than 100,000 of them are dumped from plastic containers out the van’s window, and they fly off to find mates. They have been genetically engineered to pass a lethal gene to their offspring, which die before they can reach adulthood. In small tests, this approach has lowered mosquito populations by 80 percent or more. Oxitec believes that their approach is Brazil’s best hope at fighting Zika, at least until a vaccine is developed, which will take years.

One researcher in Brazil has a completely different theory. He also believes there is no causal connection between Zika and microcephaly and thinks the rise in microcephaly is being caused by the MMR vaccine being given to women who are pregnant. The vaccine is a standard vaccination given to school children in Brazil and the US to prevent measles, mumps, and rubella.

However, there is no hard data to back up this theory, nor the one concerning GMMs. The MMR theory arose from a comparison to the US in the 1960s when an outbreak of rubella was tied to microcephaly and other birth defects in newborns. The concerns at that time over rubella, also called German measles, paved the way in the 1970s for states like California to allow abortions when a fetus is substantially damaged.

Oxitec Laboratory

Oxitec Laboratory

A pediatric cardiologist from the state of Paraíba in Brazil says she has data proving the severity of microcephaly is getting worse, but that the actual number of cases is not increasing. In fact, in her state where she collected data on head sizes from 100,000 newborns over the past five years, there has been an increase in the number of cases, but 2015 was not the worst year. She states that if Zika is the cause of the increase in microcephaly cases, then Zika has been in Brazil for longer than first assumed. She also believes there is a definite possibility that Zika is not the direct cause of microcephaly.

Similarly, the Zika crisis is having political ramifications in Brazil. The apparent relationship between the Zika virus pandemic and the country’s rise in cases of the birth defect microcephaly is pushing Brazilian women to resort to abortions — a procedure that is illegal in Brazil except in cases of rape, anencephaly, or risk to the mother’s life.

Folha de S.Paulo reported that ever since the confirmation of the Zika outbreak, women have been increasingly resorting to Misoprostol, or Cytotec, a drug that induces labor and may cause abortions. Pregnant women fear that their babies may be born with microcephaly. The issue of abortion rights in Brazil has received international attention in the past because of Brazil’s highly restrictive laws, and the issue is again in the spotlight because of the microcephaly outbreak.

Rash caused by Zika

Rash caused by Zika

Debora Diniz, the co-founder of Anis, a nonprofit women’s organization in Brazil, was invited to write an article expressing her views for The New York Times. In her article she articulates that the microcephaly epidemic “mirrors the social inequality of Brazilian society. It is concentrated among young, poor, black and brown women, a vast majority of them living in the country’s least-developed regions.” She continues: “In 2010, I conducted a national survey that found that by age 40, one in five Brazilian women had had at least one abortion. The overwhelming majority of these abortions were illegal and performed in unsafe conditions.”

Anis: Institute of Bioethics, Human Rights and Gender is one of several groups collaborating on a petition to Brazil’s Supreme Court to loosen restrictions on abortion. Ms. Diniz, who is a law professor says: “We’re petitioning the government for a bundle of broad public policy actions related to reproductive health; access to contraceptive methods; early, safe diagnoses for microcephaly; improved prenatal care; and the right to an abortion in the event of a positive diagnosis. The issue here is not about the fetus. We have an epidemic on our hands, and we are not forcing women to choose an abortion. But we want the state to recognize that women should have that choice.”

A judge in Brazil has taken the rare step of publicly proclaiming that he will allow women to have legal abortions in cases of microcephaly, preparing the way for a fight over the issue in the legal/political corridors in Brasília.

A major question lawmakers will need to tackle is, as 80 percent of those infected with Zika show no symptoms, a pregnant woman can have the virus and not know it. Hence a critical step for scientists will be to determine if a fetus is at risk if the mother experiences no symptoms.

Elimination and then return of the Zika mosquito

Elimination and then return of the Zika mosquito. Credit: Japanese Society of Tropical Medicine

 

The Zika mosquito has been around for eons but was eliminated. Then it returned to Brazil 40 years ago. An eradication effort in the 1950s eliminated the mosquito from Brazil, but the effort was abandoned after its apparent success. Dengue-carrying mosquitoes were eradicated in 18 Latin American countries from 1947 to 1962. However, the primary chemical being used to eradicate the mosquitoes, DDT, was pulled from the market for its connection to cancer. In the decades since then, the mosquito has returned. Some public health experts believe DDT should be used again with better safeguards in place to protect people, plants, and animals. A determined American doctor, Fred L. Soper, eradicated a malaria-carrying mosquito in Brazil in the 1930s, even before the widespread use of DDT.

Hopefully, the panic now ensuing over Zika, which some officials are already labeling a pandemic, will help to raise awareness of the problems caused by mosquito-borne diseases and inspire politicians to provide the massive government funding necessary to help stop these diseases. For example, a different species of mosquito infects humans with malaria and half a billion people in the world contract malaria annually, and 2.7 million of them die, according to the WHO. Some 22,000 people die each year from dengue fever, which is caused by the same species that causes Zika. “When it comes to killing humans, no other animal even comes close,” Bill Gates, whose foundation fights disease globally, has written about mosquitoes.

“After 30 years of this kind of fight, we had more than two million cases of dengue last year in Brazil,” said Dr. Artur Timerman, an infectious disease expert in São Paulo. “New approaches are critically necessary.” In response to the Zika crisis, President Obama asked Congress on February 8 to approve 1.8 billion dollars in emergency funds to help American scientists learn more about the virus and how to vaccinate against it. The following day, February 9, government health officials in the US reported 57 confirmed cases of Zika in the US.

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The striking deformity at the center of the epidemic, microcephaly, is not new: It has pained families across the globe and mystified experts for decades. The cause may never be determined. Zika virus is only suspected in the Brazilian cases, while many other factors are well documented. And no one can say what the future might hold for a particular child with microcephaly.

An estimated 25,000 babies receive a microcephaly diagnosis each year in the United States. Microcephaly means that the baby’s head is abnormally small, sometimes just because the parents themselves have small heads. “By itself, it doesn’t necessarily mean you have a neurological problem,” said Dr. Marc C. Patterson, a pediatric neurologist at the Mayo Clinic Children’s Center in Rochester, Minnesota.

However, microcephaly can portend significant brain damage. The most severe cases can be detected before birth with ultrasound scans, but usually only toward the end of the second trimester, at about 24 weeks. Most expectant mothers have ultrasound exams at about 20 weeks, however, so the condition can be missed. Many parents learn their child is microcephalic only after birth, when the newborn’s head is measured.

Abortion is generally legal in the United States only until the fetus is viable outside the womb, which can range from 24 to 26 weeks. That leaves parents little time for an enormously difficult decision, complicated by doctors’ inability to say what the effects of microcephaly might be. Prognoses for these children vary widely. At least 10 percent have no mental deficits at all. Others are highly functional, albeit with intellectual disabilities. Still others are profoundly disabled, in wheelchairs with limited ability to communicate and fed through a gastric tube.

Brazilian journalist Ana Carolina Caceres, 24, was born with microcephaly. Dismayed by recent comments about microcephaly, Ana Carolina stated: “On the day I was born, the doctor said I had no chance of survival. But he – like many others – was wrong. I grew up, went to school, went to university. Today I am a journalist.”

Recife

Recife

In perhaps the most troubling new development, Brazilian scientists said on February 5 that they had detected the presence of the Zika virus in samples of human saliva and urine, a first for Brazil. The Brazilian researchers warned that the virus might have the potential to spread through kissing or urine, but they were quick to point out that this still remains to be proven. Nonetheless, the announcement amplified concern in Brazil with many people pointing out the possible impact to the annual Carnival celebration, which began on the same day.

“It is something we have to further investigate,” said Dr. Myrna Bonaldo, the head of the Flavivirus Molecular Biology Laboratory at Fiocruz, a prominent research institute here. “We are not yet sure if Zika can be transmitted to others through saliva or urine,” she said.

French scientists had already published research last year in the Journal of Clinical Virology that located the Zika virus in human saliva following an outbreak of the virus in 2013 and 2014 in French Polynesia.

“The significance of the results is unclear,” said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. “We know, for example, that dengue is only transmitted via Aedes mosquito bites, and yet we can find the dengue genome in urine and saliva. So more research would need to be done to determine if Zika can be transmitted via kissing. For now,” Dr. Hotez added, “it still seems highly likely that the overwhelming number of cases of Zika are transmitted through mosquito bites.”

Dr. Rocha with 3-month-old with microcephaly

Dr. Rocha with 3-month-old with microcephaly

US health officials say a person in Dallas became infected with Zika through sex with a partner who had travelled to Venezuela, in the first case of the illness being transmitted within the United States. Thus far, there are no reports of Zika cases in the US being caused by mosquitoes. “This opens up a whole new range of prevention issues,” said Dr. William Schaffner, chief of preventive medicine at Vanderbilt University Medical School. Still, he cautioned that sexual transmission is probably rare compared with the viral spread by mosquitoes. “Business travelers to Latin America and the Caribbean now must worry about passing it to their partners,” he said. “There’s a lot of concern out there, but just no data to address it.”

Ireland has reported its first two cases of the mosquito-borne Zika virus but says both patients are in good condition and neither is pregnant. In the US cases in Texas and Florida, as well as Ireland, the virus appeared in individuals who had recently traveled to Latin America or the Caribbean.

Dr. Kristy Murray, an infectious disease specialist at Texas Children’s Hospital, said there had been seven confirmed Zika cases in Houston, where she is based, all in travelers back from Zika-infested areas. Experts in mosquito-borne diseases expect some local transmission of the Zika virus through mosquitoes in Florida and along the Gulf Coast once the weather warms up. How far it spreads will depend on how aggressive mosquito control is.

Zika vaccine testing

Zika vaccine testing in Germany

Brazilian authorities suspect the virus can also be transmitted through blood transfusions. With the possibility that the Zika virus may be spread through saliva, urine, blood, or semen, a new dimension of the epidemic is entered. Until this week, officials believed the virus could only be contacted through a mosquito bite. Some health officials in Brazil are suggesting that women considering having children delay their pregnancies.

Additionally, Polynesian and French doctors are now investigating a possible connection between Zika and Guillain-Barré syndrome, a form of temporary paralysis that starts in the hands and feet. Along with infant microcephaly, the syndrome has turned out to be one of the Zika epidemic’s chief fears. It is an autoimmune attack on nerve cells that can be triggered by several viruses or bacteria. It is usually temporary, though it can last for weeks; however, if the paralysis reaches the muscles powering the lungs, and the patient is not quickly put on a respirator, it can kill.

In Maceió, Recife, and other cities, cases of Guillain-Barré are beginning to spike. Dr. María Lúcia Brito, a neurologist in Recife, saw 50 patients with it in 2015, up from 14 the year before. Colombia, Venezuela, Suriname, and El Salvador, where mosquitoes thrive year-round, all have reported Guillain-Barré cases. Colombia has “an explosion” of them, its health minister said, with three deaths.

 

 

Zika fact card from Canada

Zika fact card from Canada

 

Historically, humans have been struggling with mosquito-borne diseases like malaria going back half a million years. History also shows us that diseases can spread bigotry. Threats to our health can bring subconscious anxieties about outsiders. Often, in the case of diseases, that means issues of race or immigration, and those insecurities can result in support for policies that institutionalize discrimination by banning flights from certain countries or instituting additional screening protocols for certain populations — both of which were suggested when Ebola was ravaging Western Africa. Similarly, diseases can be ignored when they affect only a certain portion of the population, such as gays in the case of AIDS, or poor people. Thus far, the majority of confirmed cases of microcephaly in Brazil have been among those families living in poverty.

Luckily, there’s some good news to report as well. In Recife, and Pernambuco state around it, microcephaly cases have been declining for about three weeks. It is unclear exactly why, but researchers are starting to wonder if the epidemic has peaked, at least in Recife. Dr. Turchi, who has been working with Zika patients in Recife, was hopeful. “I’m more comfortable now,” she said. “I see so many people working as a team and so much international concern. Now it has become clear to the whole world.”

In conclusion, there remain far more questions than answers regarding the spread of Zika, and further research must be done. While it seems certain that there has been an increase in the appearance of microcephaly cases in Brazil, no one yet knows the cause or can definitely link it to Zika. Also, after the reported cases are re-examined by public health officials, there may turn out to be only one or two thousand cases of microcephaly. While this is a tragedy, when put into the larger perspective – the 25,000 cases reported regularly each year in the US – the situation in Brazil no longer looks like an epidemic. However, should the increase in microcephaly cases be definitively linked to Zika as the cause, the prospects of finding a solution become increasingly difficult, and the increase in microcephaly is likely to continue. The predominantly poor families who will shoulder the burden of these babies with birth defects will need government assistance. Only time and additional funding for research can address this mystery.

 

 

 

 

[Research for this article comes from The New York Times, GlobalPost, Associated Press, Bloomberg News, Reuters, The Telegraph, Latin American Herald Tribune, Huffpost Brasil, Pacific Standard Magazine, and HealthDay.]

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