Tuesday, March 1, 2016

Zika virus and microcephaly 2

A small case study released today by the Centers for Disease Control and Prevention (CDC) supports the agency's suspicion that when pregnant women contract the Zika virus there is higher risk for adverse outcomes for the fetus, including microcephaly.

That risk appears especially associated with a Zika infection in the first trimester of pregnancy. 

The discouraging news came on the same day that the CDC issued a new travel alert recommending that pregnant women not go to the Summer Olympics in Brazil, which is experiencing surges in both Zika infections and infants with microcephaly. The agency also announced that it is establishing a special registry for pregnant women in the United States who contract the virus to better understand this public health threat.

In the latest edition of the agency's Morbidity and Mortality Weekly Report (MMWR), CDC investigators outline the cases of nine pregnant women who became infected with the Zika virus after traveling to an area of active transmission. None of them died or were hospitalized. One woman who experienced Zika symptoms in her third trimester delivered a healthy infant, as did a woman whose symptoms appeared in the second trimester. The pregnancy of another woman with second-trimester symptoms is continuing.

For six women who reported Zika symptoms in their first trimester, the outcomes were mostly grim. Two of them miscarried, two aborted their pregnancies, and another delivered an infant with microcephaly. The sixth woman has yet to deliver her child.

One woman chose to end her pregnancy after an ultrasound suggested the absence of the corpus callosum, ventriculomegaly, and brain atrophy at the 20-week mark. A follow-up fetal MRI revealed severe brain atrophy. Reverse transcription polymerase chain reaction testing detected the RNA of Zika virus in the woman's amniotic fluid.

The MMWR article did not provide details about the other woman who had an abortion, or the health status of her fetus. Denise Jamieson, MD, MPH, a member of the agency's Zika response team, said at a news conference today that there was no additional information on the second terminated pregnancy. Dr Jamieson coleads a section of the team focused on pregnancy and birth defects.

The results of the case study, small as it was, were surprising, she said. 
"We did not expect to see these brain abnormalities in this small case series of US pregnant travellers," Dr Jamieson said. "It is…greater than what we would have expected."



  1. Several South and Central American governments made headlines—and stunned healthcare providers around the world—when they issued public health recommendations asking women to avoid pregnancy for the foreseeable future.

    Brazil, Colombia, Ecuador, Honduras, and Jamaica have asked women to delay pregnancy for at least the next few months to a year; El Salvador has asked women to not get pregnant until 2018.

    These remarkable recommendations were fueled by international concern over possible links between Zika virus infection and serious birth defects, specifically microcephaly. And while there's no disagreement that the recent apparent epidemic of microcephaly cases in South and Central America is a public health crisis, the recommendations themselves have spurred a lot of debate and discussion.

    Here in the United States, some healthcare professionals are openly doubtful that the recommendations will have any meaningful impact on Zika-linked health outcomes.

    "When a government comes out and says, 'Don't get pregnant for 2 years,' that's the clearest indication of their desperation," said K. C. Rondello, MD, a disaster epidemiologist with the US Department of Health and Human Services' National Disaster Medical System….

    Simply telling women to avoid pregnancy is unlikely to make a dent in possible Zika-linked birth defects, said Carol Hayes, CNM, MN, MPH, immunization adviser and a consultant for women's health and health policy at the American College of Nurse Midwives. According to the Guttmacher Institute, 51% of pregnancies in the United States are unintended, "and this is in a country where we have decent access to healthcare for the most part," Hayes said.
    In contrast, throughout much of the countries affected by Zika, access to healthcare is limited, health education is minimal, and access to contraception is virtually nonexistent. Furthermore, the most vulnerable residents appear to be those living in poverty, and research published in JAMA shows that adverse childhood experiences, including poverty and abuse, increase the risk for unintended pregnancy…

    The affected countries are predominantly Roman Catholic, and birth control is not easily available.

    "Telling someone not to get pregnant means, in some interpretation, don't have sex," said Georges Benjamin, MD, executive director of the American Public Health Association. And while natural family planning—timing intercourse to avoid conception—is accepted by the Catholic Church, it also has a failure rate of nearly 25%, according to the Association of Reproductive Health Professionals….

    The lack of concrete knowledge about the natural history of Zika infection makes public health efforts challenging. And some experts hope that the feared future won't be as bad as imagined.

    "Think about SARS and H1N1. We thought the mortality for those diseases would be much higher than they ultimately were because we saw the deaths and focused on that," Dr Benjamin said. "Well, it turns out that the diseases had been around for a while and that many people contract and survive mild infections. I hope it's similar in this case. We don't know yet how many women get pregnant, get infected, and don't have a poor outcome."
    It's possible that the recommendations will have some impact on birth rates. But the experts interviewed for this article say it's unlikely that they'll halt or slow the spread of possible Zika-linked birth defects.

    "Can a Hail Mary pass score a touchdown?" Dr Rondello asked, comparing the recommendations with a desperate football play. "Theoretically, yes. But the chances of that happening aren't great."


  2. Few women have competed in the Olympics while pregnant, but the suspicion that the Zika virus in mothers is causing birth defects is central to calculations by athletes and others planning travel to Brazil in August for the summer games.

    Chief among their concerns is whether Zika, unlike similar mosquito-borne viruses, can be transmitted sexually, or remain latent in the body - possibly presenting a risk for women who become pregnant after the Olympics have ended.

    More than a dozen disease experts, in interviews with Reuters, said there is no evidence at this point of long-term risk for future pregnancies. But, given the surprises seen with the virus so far, they said people should remain cautious until studies give scientists a better picture of how the virus works. They said it would take months or even years of study for definitive answers to questions about Zika's risks.

    Public health agencies have urged pregnant women to avoid travel to Zika outbreak areas but have given little guidance for couples planning to start a family.

    Dr. Claire Panosian, of the University of California, Los Angeles, division of infectious diseases, said that for years she has advised couples to wait several months after traveling to exotic locales before trying to conceive because of the risk of birth defects from diseases like toxoplasmosis.

    Zika should be no different, she said: "Women of child-bearing age should be very scrupulous - wait several months."...

    The U.S. Centers for Disease Control and Prevention says pregnant women should consider skipping the 2016 Olympics because of the risk of Zika infection. For women who are considering becoming pregnant - and their male partners - the agency recommends consulting their physicians in deciding whether to go to the Games.

    The U.S. Food and Drug Administration, however, has suggested a more detailed time frame. It called this week for a six-month delay in all human cell or tissue donations, including of semen and eggs, from people who have had Zika infections or traveled to an outbreak area.

    Canada's national health agency on Wednesday advised women who want to get pregnant to wait at least two months after traveling to countries affected by the Zika outbreak...

    Some current Olympic hopefuls say they might think twice about the Rio Games if Zika could threaten future pregnancies, and they are hoping for some better answers before the competition begins.

    "If things stood as they are right now, I probably would not go," renowned U.S. soccer goalkeeper Hope Solo told CBS last week. "At some point I do want to start a family, and I don't want to be worried."

    Solo has spoken out about feeling conflicted over her two great ambitions – winning Olympic gold and becoming a mother in the future. "It's scary, and I have a lot of reservations about going to the Olympics," she said...

    The U.S. Olympic Committee has told athletes that babies may be at risk if the mother is infected with Zika while pregnant, or if she becomes pregnant within an unknown time frame after being infected.

    Whether the virus can remain in the body and cause a recurrence also is not known. In one case, Zika virus was detected in semen 62 days after the man was infected, but it was not clear whether it was capable of infecting someone else.

    Separately, the CDC is investigating at least 14 cases of possible sexual transmission.


  3. There’s a “Prevent Zika Virus Kit” for sale on eBay for $59.99 – but the listing says the merchandise is worth $110.18. The kit includes insect repellent spray, lotion, wipes, and access to “expert” Zika alerts and prevention measures. So, basically, for three Jacksons you can get several varieties of insect repellents and Zika news.

    Rainbow Technology Corporation, a company that markets specialty products, is featuring insect repellent for skin ($3.84) and clothing ($9.71) to fight Zika. The Miami-based men’s sportswear company, Hook & Tackle, teamed up with Insect Shield to develop permethrin-treated clothing to combat the spread of the virus. The fishing publication Coastal Angler Magazine featured an ad for it in its March 2016 issue.

    But possibly the most interesting of them all is the BugsAway Leilani Multi-Way Dress. It’s essentially a calf-length sleeveless dress with permethrin in the fabric. But with a $25.99 price tag, one can’t help but to think, “What if an infected mosquito lands on your arms… or chest… or ankles…?” Notably, the company makes a range of clothing to repel the disease-carrying mosquitos.

    So, are all of these products simply insect repellents that are being marketed using the word “Zika”?

    - See more at: http://www.hcplive.com/medical-news/cashing-in-on-zika-one-insect-repellent-at-a-time?utm_source=Informz&utm_medium=HCPLive&utm_campaign=Trending_News_3-4-16#sthash.LlwpBudT.dpuf

  4. In a case report published online in the journal PLOS Neglected Tropical Diseases, a team of researchers working at the frontlines of the epidemic document the case of a 20-year-old pregnant woman referred to their clinic following the outbreak of Zika in her home city of Salvador, Brazil. Zika, a mosquito-borne flavivirus, was first identified in Brazil in early 2015, and an increase in the number of newborns with microcephaly (incomplete brain development) was first observed in November of last year.

    The authors report that the pregnant patient presented to their clinic with an uneventful course of pregnancy and normal ultrasound findings at the 14th gestational week. The patient reported no Zika symptoms and had received no diagnosis for Zika, dengue fever, or chikungunya.

    Ultrasound examination of the patient’s fetus at the 18th gestational week, however, revealed intrauterine growth retardation. Further ultrasound examinations in the second and third trimesters revealed severe microcephaly as well as hydranencephaly, intracranial calcifications, destructive lesions of the posterior fossa, hydrothorax, ascites and subcutaneous edema. Due to fetal demise, the authors induced labor at the 32nd gestational week and obtained Zika virus real-time PCR amplification samples from the female fetus’ cerebral cortex, medulla oblongata, and cerebrospinal and amniotic fluid.

    As the authors are still working to combat the Zika virus and its effects, they were unable to comment on their case report to Contagion® at press time. However, in their concluding remarks, they write that because the Zika virus is asymptomatic, “it is likely that exposures in pregnant women... often go unnoticed.” They believe that the explanation for fetal demise in their case is due to “asymptomatic exposure of the mother… likely in the first trimester, [causing] an intrauterine infection which in turn, resulted in hydranencephaly and hydrops fetalis in the fetus.”

    The authors add that the finding of an association between Zika and hydrops fetalis suggests that the virus may cause damage to tissues in addition to the fetal central nervous system, writing that, “We cannot extrapolate from this single case the overall risk for developing hydrops fetalis and fetal demise among pregnant women exposed to the virus. The strain detected in this case… appears to be the same as the epidemic strain that has spread across the Americas and Caribbean.


  5. See http://childnervoussystem.blogspot.com/2016/02/gwen-hartleys-19-week-sonogram-was.html?showComment=1457237907422#c4074479610334910301
    (also see the post itself)

  6. Zika’s US footprint is getting bigger. In a report released today the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Review, researchers found that at least 116 US residents have laboratory-confirmed Zika infections, based on CDC testing. All the cases are related to travel outside the continental US. Cases confirmed at state laboratories were not included in the total, so there could be others, the CDC said. More than 90% of patients who sought testing had symptoms such as aches, fever, and a rash. Since many people get Zika and never feel sick, it is also likely that cases go undiagnosed or reported. “Before 2015 Zika virus disease among US Travelers was uncommon,” Paige Armstrong, MD and colleagues noted in the report. But with outbreaks in the Pacific Islands, the Caribbean, and Central and South America, there is an increasing risk of infection in returning travelers. So far there have been no cases acquired in the US, but there are concerns that since the virus is spread by mosquitos, there is a potential for it to become endemic in areas like Florida where mosquitos live year round. Of the CDC-confirmed cases, most came as result of travel to Haiti (27 cases) El Salvador (16), Colombia (11), Honduras (11) and Guatemala (10). One case involved a pregnant woman who contracted Zika during a visit to Brazil. Her baby was born with “severe congenital microcephaly,” believed to be due to the infection, the authors said. Most (96%) of the cases were in women who had traveled to Zika zones, but 4% involved sexual transmission from people who had returned from such areas. The CDC keeps revising its travel warnings and recommendations. Among the latest changes, the CDC says pregnant women are relatively safe in Zika regions if they stay at an altitude of at least 6,560 feet above sea level—no-fly zones for Aedes aegytpti the mosquito that transmits the virus. There are 37 countries and US territories where Zika is a problem.

    - See more at: http://www.hcplive.com/medical-news/dozens-in-us-confirmed-with-travel-related-zika?utm_source=Informz&utm_medium=HCPLive&utm_campaign=Trending_News_PM_3-20-16#sthash.x2R6dccX.dpuf

  7. On April 1, 2016, the Centers for Disease Control and Prevention (CDC) held a Zika Action Plan Summit in Atlanta, Georgia with the aims of preparing health officials of the possibility of local Zika transmission. The Summit reiterated the importance of acting on Zika now, before it reaches the continental US...

    Commenting on the effects of the Zika virus, Dr. Frieden stated that this is the first time in 50 years that a mosquito-borne pathogen has been linked to birth defects as well as pregnancy complications. It comes as no surprise that the CDC’s priority is protecting pregnant women and women of child-bearing age against contracting the virus, however, speakers at the Summit reiterated the importance of protecting men from the virus as well. Unlike other viruses spread by Aedes aegypti mosquitos (such as Chikungunya and Dengue), the Zika virus can be spread from one infected individual to another through sexual intercourse.

    An attendee of the Summit questioned the CDC’s interpretation of who an “infected individual” is, noting that a pregnant woman whose child is born with a birth defect is not officially deemed infected. Dr. Jamieson addressed this comment, stating that “case definitions were developed before we learned the link between infection and birth defects," further noting the need to redefine infection classification. As a result, future Zika efforts focus on combating the virus altogether, rather than focusing on one single aspect of the virus...

    The Summit also discussed vector surveillance and control, noting that there are currently 30 US states at high risk of Zika transmission. Since the Ae. aegypti mosquito eggs need water in order to hatch, it is important to eliminate unnecessary water containers that may harbor mosquito eggs, and completely cover containers that are needed.

    With a new FDA-approved investigational test now availale for blood screening, Dr. Frieden reassured his audience that there is nothing to worry about. He stated, “Even if we were to have local [Zika virus] transmission, we don’t expect it to be persistent.” This is due to the high usage of window screens and air conditions (which hinder the entrance of mosquitos) in American homes. However, it was further suggested that individuals are reminded to use mosquito repellants when venturing outdoors.


  8. Weather, travel, and poverty may be among the factors that could potentially contribute to Zika virus outbreaks in US cities during peak summer months, according to an analysis based on several computer simulation models published in PLOS Currents Outbreaks on March 16.

    Using meteorologically-driven models for 2005-2015 to simulate the potential seasonal abundance of the Aedes aegypti mosquito vector in 50 US cities, researchers at the National Center for Atmospheric Research projected that conditions for the mosquito populations would be largely unsuitable in most cities in the US during winter months (December-March), except in southern Florida and south Texas, where relatively warm weather could sustain low-to-moderate potential mosquito populations. But they projected that as the weather warms, conditions could be ripe for Aedes aegypti mosquito populations along the East Coast, across the southern tier of the country, and as far west as Phoenix and Los Angeles.The researchers analyzed and factored into their analysis past travel patterns from countries and territories with Zika outbreaks, and projected that cities in southern Florida and impoverished areas in southern Texas could be particularly vulnerable to local viral transmission. Poverty could play a role in greater exposure to mosquitoes and the virus, the researchers wrote, explaining that poorer populations might have less access to air conditioning, house screens, as well as clean water.While the simulation models offer a realistic assessment of where mosquito vector may be found, they do not fully account for all the areas that may be impacted by imported Zika cases, said Kenneth L. Tyler, MD, FAAN, professor and chair of neurology at the University of Colorado Anschutz Medical Campus in Denver. And, he noted, the models do not factor in the potential for sexual transmission of the virus, which researchers are still trying to understand.


  9. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age With Possible Zika Virus Exposure — United States, 2016. Emily E. Petersen, MD; Kara N.D. Polen, MPH; Dana Meaney-Delman, MD; Sascha R. Ellington, MSPH; Titilope Oduyebo, MD; Amanda Cohn, MD; Alexandra M. Oster, MD; Kate Russell, MD; Jennifer F. Kawwass, MD; Mateusz P. Karwowski, MD; Ann M. Powers, PhD; Jeanne Bertolli, PhD; John T. Brooks, MD; Dmitry Kissin, MD; Julie Villanueva, PhD; Jorge Muñoz-Jordan, PhD; Matthew Kuehnert, MD; Christine K. Olson, MD; Margaret A. Honein, PhD; Maria Rivera, MPH; Denise J. Jamieson, MD; Sonja A. Rasmussen, MD

    Morbidity and Mortality Weekly Report. 2016;65(12):315-322.

    Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception. Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission (http://www.cdc.gov/zika/geo/active-countries.html), or sex (vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who traveled to or resided in an area of active transmission…

    In a recent study from Brazil, among 42 women with laboratory-confirmed Zika virus infection at any time during pregnancy who underwent prenatal ultrasonographic studies, 12 (29%) had abnormal findings; these included microcephaly, intracranial calcifications, other brain abnormalities, abnormal cerebral artery flow, intrauterine growth restriction, and fetal death. Further studies are underway to better estimate this risk but it is important to recognize that microcephaly caused by viral destruction of brain tissue is likely to be part of a spectrum of neurological damage; the percentages in both studies may substantially underestimate the proportion of infants affected…

    The risk for adverse pregnancy outcomes associated with maternal Zika virus infection around the time of conception is currently unknown. However, early reports suggest there might be adverse outcomes associated with Zika virus infection in early pregnancy: two women with Zika virus disease at <7 weeks’ gestation both had pregnancy losses, with Zika virus RNA detected in products of conception, and another woman with clinical illness consistent with Zika virus disease at 7–8 weeks’ gestation delivered a full-term infant with severe microcephaly.(continued)

  10. (continued)There is no evidence that Zika virus will cause congenital infection in pregnancies conceived after the resolution of maternal Zika viremia. Data on the incubation period for Zika virus disease and the duration of Zika viremia are limited. Evidence from case reports and experience from related flavivirus infections indicate that the incubation period for Zika virus disease is likely 3–14 days After symptom onset, the duration of Zika viremia may range from a few days to 1 week; the longest duration of viremia in the published literature was 11 days.

    Women with Zika virus disease should wait until at least 8 weeks after symptom onset before attempting conception. No data are available regarding the risk for congenital infection among pregnant women with asymptomatic infection. Based on the estimated upper limit of the incubation period for Zika virus disease (14 days) and approximate tripling of the longest published period of viremia after symptom onset (11 days), and given the limited data on duration of Zika viremia and the potential for individual immune system variability, asymptomatic women with possible Zika virus exposure should be advised to wait at least 8 weeks after the last date of exposure before attempting conception…

    Infectious Zika virus has been isolated from the semen of two men (one with hematospermia) at least 2 weeks after symptom onset and possibly up to 10 weeks after symptom onset. A third report documented Zika virus RNA in semen 62 days after symptom onset. The duration and pattern of Zika virus persistence in semen is not known; further testing was not performed to document when replicative Zika virus or Zika virus RNA were no longer present in the men’s semen…

    It is not known whether a positive serologic test result in an asymptomatic man would indicate possible presence of Zika virus in semen, or if a negative serologic test result would preclude the presence of the virus in semen.


  11. Tang H, Hammack C, Ogden SC, Wen Z, Qian X, Li Y, Yao B, Shin J, Zhang F, Lee EM, Christian KM, Didier RA, Jin P, Song H, Ming GL. Zika Virus Infects Human Cortical Neural Progenitors and Attenuates Their Growth. Cell Stem Cell. 2016 Mar 4. pii: S1934-5909(16)00106-5. doi: 10.1016/j.stem.2016.02.016. [Epub ahead of print]

    The suspected link between infection by Zika virus (ZIKV), a re-emerging flavivirus, and microcephaly is an urgent global health concern. The direct target cells of ZIKV in the developing human fetus are not clear. Here we show that a strain of the ZIKV, MR766, serially passaged in monkey and mosquito cells efficiently infects human neural progenitor cells (hNPCs) derived from induced pluripotent stem cells. Infected hNPCs further release infectious ZIKV particles. Importantly, ZIKV infection increases cell death and dysregulates cell-cycle progression, resulting in attenuated hNPC growth. Global gene expression analysis of infected hNPCs reveals transcriptional dysregulation, notably of cell-cycle-related pathways. Our results identify hNPCs as a direct ZIKV target. In addition, we establish a tractable experimental model system to investigate the impact and mechanism of ZIKV on human brain development and provide a platform to screen therapeutic compounds.

  12. The Centers for Disease Control and Prevention (CDC) recently reported that the Zika virus can be transmitted from an infected man to a sex partner though anal sex. Other case reports have confirmed that the Zika virus can be transmitted sexually from an infected male to female sex partners through vaginal sex, but this is the first report confirming the transmission of the virus through anal sex.

    The Zika virus causes microcephaly and other birth defects in infants, and has been linked to other outcomes such as Guillain-Barré syndrome. The known modes of transmission are from mother to child and from an infected male to a female sex partner through vaginal sex. In January 2016, the Dallas County Health and Human Services (DCHHS) investigated a reported case of transmission from a male who had travelled to an area of active Zika virus transmission, to his noninfected male partner, who had remained in the United States.

    According to the report, after returning home to Dallas, Texas, from a 1-week trip to Venezuela, the male developed a fever, rash on his upper body and face, and conjunctivitis that lasted 3 days. One day before his symptom onset, and one day after, the male had unprotected anal sex with his male partner. One week later, the male partner developed a fever, myalgia, headache lethargy and malaise and subsequently “developed a slightly pruritic rash on his torso and arms, small joint arthritis of his hands and feet, and conjunctivitis.” While the symptoms resolved, both males visited their primary care provider for evaluation. Several days after symptom onset, serum specimens were collected from both patients and Zika virus infection was confirmed.

    Although the Aedes aegypti mosquito is found in Dallas, stateside infection was ruled out since the winter temperatures recorded in the area during the time of infection were not high enough to warrant mosquito activity.

    According to the CDC, there have been at least five other cases of sexually transmitted Zika virus infection: all male-to-female transmission involving vaginal sex. Since sexual transmission through both vaginal and anal sex is an emerging mode of transmission for Zika virus infection, health care practitioners are urged to report any cases of sexual transmission to public health agencies. These emerging modes of transmission might contribute to more infections than was first anticipated and the reporting of cases to public health agencies can help inform recommendations to prevent further infections.

    http://www.contagionlive.com/news/cdc-reports-additional-mode-of-zika-transmission? utm_source=Informz&utm_medium=Contagion+Live&utm_campaign=Contagion_Live_Trending_4-15-16

  13. Garcez PP, Loiola EC, Madeiro da Costa R, Higa LM, Trindade P, Delvecchio R, Nascimento JM, Brindeiro R, Tanuri A, Rehen SK. Zika virus impairs growth in human neurospheres and brain organoids. Science. 2016 Apr 10. pii: aaf6116. [Epub ahead of print]

    Since the emergence of Zika virus (ZIKV), reports of microcephaly have increased significantly in Brazil; however, causality between the viral epidemic and malformations in fetal brains needs further confirmation. Here, we examine the effects of ZIKV infection in human neural stem cells growing as neurospheres and brain organoids. Using immunocytochemistry and electron microscopy, we show that ZIKV targets human brain cells, reducing their viability and growth as neurospheres and brain organoids. These results suggest that ZIKV abrogates neurogenesis during human brain development.

  14. In one of the first studies that sheds light on exactly how Zika attacks, researcher Patricia Garcez of the Federal University of Rio de Janeiro took human neural stem cells and infected them with virus taken from a Brazilian patient. Neural stem cells — which are able to turn into three major cell types that make up the central nervous system — are the key players in embryonic brain formation.

    The outcome, published in Science on Sunday night[see above comment], was unlike that of any other viruses studied by Garcez and her team. Images show a massive die-off of the stem cells, as well as greatly diminished growth for tissue used as part of a second experiment.

    The team concluded that it appears Zika “targets” human brain cells. The cells they examined by electron microscope were misshapen and necrotic.

    The research adds to the understanding of how the virus appears to be linked to the thousands of babies in Brazil who are being born with microcephaly, a condition marked by an abnormally small head and, in many cases, brain defects.

    At the White House on Monday, top federal health officials did not play down the latest developments.

    “Most of what we’ve learned is not reassuring,” said Anne Schuchat, the principal deputy director of the Centers for Disease Control and Prevention. “Everything we look at with this virus seems to be a bit scarier than we initially thought.”

    She said the virus has been linked to a broader set of complications in pregnancy — not just microcephaly, but premature birth and eye problems, among others.

    Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the mounting neurological evidence about possible harm regardless of age “very serious.”

    Courtesy of Doximity

  15. Rita W. Driggers, M.D., Cheng-Ying Ho, M.D., Ph.D., Essi M. Korhonen, M.Sc., Suvi Kuivanen, M.Sc., Anne J. Jääskeläinen, Ph.D., Teemu Smura, Ph.D., Avi Rosenberg, M.D., Ph.D., D. Ashley Hill, M.D., Roberta L. DeBiasi, M.D., Gilbert Vezina, M.D., Julia Timofeev, M.D., Fausto J. Rodriguez, M.D., Lev Levanov, Ph.D., Jennifer Razak, M.G.C., C.G.C, Preetha Iyengar, M.D., Andrew Hennenfent, D.V.M., M.P.H., Richard Kennedy, M.D., Robert Lanciotti, Ph.D., Adre du Plessis, M.B., Ch.B., M.P.H., and Olli Vapalahti, M.D., Ph.D. Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities. NEJM online. March 30, 2016 DOI: 10.1056/NEJMoa1601824

    The current outbreak of Zika virus (ZIKV) infection has been associated with an apparent increased risk of congenital microcephaly. We describe a case of a pregnant woman and her fetus infected with ZIKV during the 11th gestational week. The fetal head circumference decreased from the 47th percentile to the 24th percentile between 16 and 20 weeks of gestation. ZIKV RNA was identified in maternal serum at 16 and 21 weeks of gestation. At 19 and 20 weeks of gestation, substantial brain abnormalities were detected on ultrasonography and magnetic resonance imaging (MRI) without the presence of microcephaly or intracranial calcifications. On postmortem analysis of the fetal brain, diffuse cerebral cortical thinning, high ZIKV RNA loads, and viral particles were detected, and ZIKV was subsequently isolated.

  16. The Ministry of Health (MOH) of Brazil has confirmed 1,271 nationwide cases of microcephaly.

    According to the World Health Organization (WHO), Brazil first confirmed active Zika virus transmission in May 2015. However, a study published in PLOS Neglected Tropical Diseases confirmed that the disease has actually been circulating there since at least January of 2015.

    In April 2016, the Centers for Disease Control and Prevention (CDC) confirmed that Zika infection in a pregnant woman can cause congenital microcephaly. More recently, the CDC published a study which outlined the stages of pregnancy at which Zika is most likely to cause microcephaly and other complications.

    Brazil has been investigating a total of 7,343 possible cases of microcephaly since October 2015. On May 4, 2016, a press release published by the South American country’s MOH stated that there are currently 1,271 lab-confirmed cases of microcephaly and other congenital disorders of the nervous system in 470 municipalities, as of April 30, 2016. Of the confirmed cases, the MOH has identified 203 cases that linked back to a Zika virus infection. There are 3,580 suspected Zika-linked cases that are still under investigation.

    The MOH is currently investigating all reported cases of microcephaly and other nervous system disorders for a possible link to Zika infection. The CDC reports that there is no cure for microcephaly, which can be caused by several complications, including:
    Infections during pregnancy:
    Severe malnutrition
    Alcohol, drug, and toxic chemical exposure
    Interruption of the blood supply to the brain during the developmental stage
    Among other South American countries with active Zika transmission is Panama. On May 4, 2016 the Ministry of Health of Panama stated that there are currently 264 cases of Zika infection, 14 of which are pregnant women. Currently, there are 4 cases of microcephaly in the country.

    The Brazilian MOH reports that there were a total of 57 deaths (including miscarriages, stillbirths, and infant deaths) with a confirmed link to microcephaly or other nervous system complications since the start of the investigation. One hundred and seventy eight deaths are currently being investigated. The MOH advises all pregnant women to practice precautionary safety measures to reduce the Aedes aegypti mosquito (the Zika-causing mosquitos) population around their homes, such as eliminating standing water containers and using recommended insect repellents to protect against mosquito bites.


  17. A Connecticut teenager says she was shocked she tested positive for the Zika virus after learning she was pregnant.

    Sara Mujica, 17, of Danbury, said she found out she was pregnant in March while she was visiting Victor Cruz, her fiance and the baby's father, in Honduras. At the time of the pregnancy test, she said she was getting over an illness that gave her rashes, headaches and neck aches. She thought it was related to fish she had eaten, not Zika.

    She said she returned to Connecticut on March 30 and went to Danbury Hospital to get tested for Zika — just in case. She said she learned of the positive Zika results during a phone call from her crying mother last week, after she had returned to Honduras.

    "I was in a state of shock honestly," Mujica told The Associated Press by phone Monday. "I didn't really know what to say. I didn't know what to do. I just started getting teary eyed and almost crying. I was just trying to stay strong."

    Mosquito-borne Zika has become epidemic in Latin America and the Caribbean. It can cause microcephaly, a severe birth defect in which babies are born with abnormally small heads and brain damage. Researchers don't yet know the rate at which infected women have babies with birth defects.

    Mujica, who is Catholic, said she weighed her risks and decided to keep the baby.

    "This is my blessing. This is my miracle," she said. "I have a cousin who has Down syndrome and he is so smart and l love him so much. I would never give up a Down syndrome child or a child with birth defects."...

    Mujica said she doesn't know at this point if her baby will have birth defects.

    "I'm going to stay positive and hope my baby comes out normal," she said.


  18. A baby girl delivered Tuesday in New Jersey is the first in the continental U.S. to be born with the Zika virus-related brain condition, giving rise to new fears about the spread of the disease.

    Doctors, including Fox News Health Senior Managing Editor Dr. Manny Alvarez, confirmed the birth of a child with Zika virus linked to microcephaly— the first reported case of the birth defect, which is marked by a partially formed brain, in the continental United States.

    The 31-year-old mother, whose name was not disclosed, apparently contracted the Zika virus while in Honduras and was admitted to the emergency room at Hackensack University Medical Center on Friday while vacationing in the U.S. Doctors at Hackensack performed an emergency caesarean section to deliver the baby girl, who was born also with intestinal and visual issues...

    Doctors in Honduras suspected intracranial complications with the child in utero, but it was not until she was admitted to the high-risk unit at Hackensack University Medical Center that doctors confirmed the microcephaly diagnosis. The patient’s aunt told FoxNews.com the mother is not doing well emotionally after the birth of her child...

    While this is the first birth of a child with Zika-linked complications at Hackensack, it is not the first such case in the U.S. In February, the Centers for Disease Control and Prevention (CDC) confirmed that a woman in Hawaii delivered a baby who suffered from severe microcephaly as a result of Zika infection.


  19. Entrepreneurs across the country are rushing to turn fears of the Zika virus into a sales tool, flooding the market with a slew of products, some of them unproven and questionable, that promise to keep consumers safe.

    The products include everything from floppy hats to bed canopies to “anti-Zika” condoms, which offer no discernible protection above any other condom. But most concerning to experts is the promotion of many “natural” mosquito repellents — sprays, wristbands, and patches that are touted as alternatives to the synthetic chemicals known to keep mosquitoes away.

    A STAT review of “natural” products marketed online turned up dozens of efforts to explicitly target consumers concerned about Zika. One company sells wristbands printed with an image of a mosquito and “ZikAway” in big block letters. A brand of stick-on patches for kids features smiley faces and is advertised on Amazon as “high-quality Zika mosquito repellent.”

    Then there’s the pack of wristbands marketed on Amazon with the blaring warning: “PROTECT YOURSELVES FROM ZIKA VIRUS NOW (Before we run out of stock).” Ads for other botanical repellents promise to keep users away from “nasty,” “dangerous,” and “toxic” chemicals.(continued)

  20. (continued)The marketers of many such products “prey on people’s fears” about chemicals, said Walter Leal, a chemical ecologist at the University of California Davis. “The most dangerous outcome is that people become averse to using a good repellent and then contract Zika or dengue.”

    The Centers for Disease Control and Prevention is also concerned about such products, spokeswoman Candice Burns Hoffmann said.

    One reason: Many aren’t effective.

    A study published last fall found that Victoria’s Secret perfume provided better protection from mosquitoes than several natural repellents on the market...

    Regulators at the Environmental Protection Agency have approved about 30 botanical products, most of them made from oil of lemon eucalyptus, as safe and effective to ward off mosquitoes. (By contrast, they have approved hundreds of products made from DEET and Picaridin, the synthetic compounds found in most effective bug sprays.)

    Federal authorities have already cracked down on the marketers of one “natural” repellent.

    Consumer goods maker Viatek recently agreed to pay $300,000 to the Federal Trade Commission to settle charges of deceptive marketing. The company had claimed that its colorful wristbands infused with mint oil created a five-foot shield of protection from mosquitoes that could last for up to 120 hours. (The wristbands, still promoted on Home Depot’s website, were not advertised as a way to ward off Zika specifically.)

    That fine hasn’t deterred the Zika gold rush.

    Entrepreneurs Manny Castro and Ryan Manfred, for instance, had been selling selfie sticks before they spotted a new opportunity — and launched Zika Shield. Since the end of April, they’ve sold thousands of wristbands and sprays made from a formula that contains oil of lemon eucalyptus...

    And the most effective repellent includes synthetic chemicals.

    DEET, developed by the Army, has been used in products marketed to the public since 1957. Experts agree it is safe, including for pregnant women; that conclusion was upheld by a large 2002 study and a 2014 review by the EPA.

    The chemical is not without its drawbacks, though. It’s known to smell bad, though manufacturers have, in recent years, taken steps to make the aroma more pleasant. And there have been reports of adverse effects including neuropathy, or numbness and pain in hands and feet.

    But experts say these side effects are generally the result of misuse. “DEET has been used literally billions of times without adverse effects and protected people from disease,” said Joe Conlon, technical adviser to the American Mosquito Control Association.

    The marketers of ineffective botanical products, Conlon said, are “counting on this chemophobia that seems to have afflicted the citizenry as of late.”