Produção Nacional
Revisado por pares
Congenital Zika syndrome in Brazil
2016; Elsevier BV; Volume: 16; Issue: 7 Linguagem: Inglês
10.1016/s1473-3099(16)30079-2
ISSN1474-4457
AutoresRegina Célia de Souza Campos Fernandes, Thaís Louvain de Souza, Enrique Medina‐Acosta,
Tópico(s)Virology and Viral Diseases
ResumoWe would like to comment on the Lancet Infectious Diseases Editorial entitled Zika virus in the dock.1The Lancet Infectious DZika virus in the dock.Lancet Infect Dis. 2016; 16: 265Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar In Brazil, the diagnosis of microcephaly cases that are linked to congenital Zika virus infection (863 of 5131 suspected cases as of March 12, 2016)2Brazilian Ministry of Health[Microcefalia: 4.268 casos suspeitos continuam em investigação].http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/22649-microcefalia-4-268-casos-suspeitos-continuam-em-investigacaoDate: 2016Google Scholar is based on the clinical and image findings in babies; the exclusion of syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpes simplex; and on maternal manifestations suggestive of Zika virus infection.3Brazilian Ministry of Health[Protocolo de vigilância e resposta à ocorrência de microcefalia].http://www.saude.go.gov.br/public/media/ZgUINSpZiwmbr3/10100011602222060026.pdfDate: 2016Google Scholar In the context of the autochthonous transmission of Zika, dengue, and chikungunya viruses, and in the setting of widespread limitations of laboratory resources, maternal manifestations suggestive of Zika virus infection (low fever and precocious itchy rash associated with one or more symptoms shared with others arboviruses such as conjunctivitis, myalgia, arthralgia, and headache) cannot be deemed nonspecific. Even with universal Zika virus diagnosis by serological tests or molecular assays (eg, RT-PCR), these symptoms will continue to be primary investigative inclusion criteria. It is important to address the Editorial statement regarding the information that 40% of babies in Brazil are born before term. In 2014, despite the high number of elective cesarean deliveries on maternal request, 11% of newborns were preterms,4Brazilian Ministry of Health[SINASC-Sistema de Informações de Nascidos Vivos].http://www2.datasus.gov.br/DATASUS/index.php?area=060702Date: 2016Google Scholar a percentage not different from the numbers in 19 European countries in 2008 (ranging from 5·5% to 11·1%).5Zeitlin J Szamotulska K Drewniak N et al.Preterm birth time trends in Europe: a study of 19 countries.BJOG. 2013; 120: 1356-1365Crossref PubMed Scopus (229) Google Scholar For preterm babies, Brazilian paediatricians are encouraged to use the appropriate head circumference curves. In Brazil, the lower limit to identify the current cases of microcephaly in full-term neonates is 31·9 cm for boys and 31·5 for girls.3Brazilian Ministry of Health[Protocolo de vigilância e resposta à ocorrência de microcefalia].http://www.saude.go.gov.br/public/media/ZgUINSpZiwmbr3/10100011602222060026.pdfDate: 2016Google Scholar Because of the variation in clinical manifestations observed among affected neonates, the association of Zika virus infection during pregnancy and microcephaly is deemed an aspect of a congenital syndrome. The Editorial viewed the causal link between Zika virus and microcephaly as speculative. However, evidence from two studies suggests otherwise. The first detected Zika virus in the amniotic fluid from two women who had Zika virus disease during pregnancy.6Calvet G Aguiar RS Melo AS et al.Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study.Lancet Infect Dis. 2016; 16: 653-660Summary Full Text Full Text PDF PubMed Scopus (813) Google Scholar The second study identified Zika virus in the nervous system of a fetus.7Mlakar J Korva M Tul N et al.Zika virus associated with microcephaly.N Engl J Med. 2016; 374: 951-958Crossref PubMed Scopus (1863) Google Scholar Zika neurotropism was first demonstrated in mice8Bell TM Field EJ Narang HK Zika virus infection of the central nervous system of mice.Arch Gesamte Virusforsch. 1971; 35: 183-193Crossref PubMed Scopus (167) Google Scholar and recently confirmed in an outbreak in French Polynesia.9Cauchemez S Besnard M Bompard P et al.Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study.Lancet. 2016; 387: 2125-2132Summary Full Text Full Text PDF PubMed Scopus (671) Google Scholar Many cases reported in the Brazilian Epidemiology Bulletin are under investigation, and, therefore, the number of publications will rise. Moreover, so-called war-against-Zika initiatives are in place, which include strengthening of preparedness and provision of capability grants for investigation into Zika virus, involving multidisciplinary and interdisciplinary Brazilian research networks. We declare no competing interests Zika virus in the dockIn October, 2015, the Ministry of Health in Brazil reported an unexplained increase in cases of microcephaly, a congenital malformation normally associated with incomplete brain development, in newborn babies (4783 cases vs 150 in the previous year). The reported cases have caused widespread fear among pregnant women all over South and Central America, to the point that some nations such as Ecuador have recommended that their citizens postpone pregnancy to 2018, to give time to investigate the causes of the increase of microcephaly cases. Full-Text PDF
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