Emergence of Congenital Zika Syndrome: Viewpoint From the Front Lines
Authors: Federico Costa, Manoel Sarno, Ricardo Khouri, Bruno de Paula Freitas, Isadora Siqueira, Guilherme S. Ribeiro, Hugo C. Ribeiro, Gubio S. Campos, Luiz C. Alcântara, Mitermayer G. Reis, Scott C. Weaver, Nikos Vasilakis, Albert I. Ko, Antonio Raimundo Almeida
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions17 May 2016Emergence of Congenital Zika Syndrome: Viewpoint From the Front LinesFederico Costa, PhD, Manoel Sarno, MD, PhD, Ricardo Khouri, PhD, Bruno de Paula Freitas, MD, Isadora Siqueira, MD, PhD, Guilherme S. Ribeiro, MD, PhD, Hugo C. Ribeiro, MD, Gubio S. Campos, PhD, Luiz C. Alcântara, PhD, Mitermayer G. Reis, MD, PhD, Scott C. Weaver, PhD, Nikos Vasilakis, PhD, Albert I. Ko, MD, and Antonio Raimundo Almeida, MD, PhDFederico Costa, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Manoel Sarno, MD, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Ricardo Khouri, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Bruno de Paula Freitas, MDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Isadora Siqueira, MD, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Guilherme S. Ribeiro, MD, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Hugo C. Ribeiro, MDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Gubio S. Campos, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Luiz C. Alcântara, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Mitermayer G. Reis, MD, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Scott C. Weaver, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Nikos Vasilakis, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., Albert I. Ko, MDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut., and Antonio Raimundo Almeida, MD, PhDFrom Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0332 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Zika, a mosquito-borne flavivirus discovered in Uganda in 1947, remained obscure until its emergence in Micronesia in 2007. Six years later, it arrived in French Polynesia and other islands in the South Pacific (1). The virus was first detected in Brazil in early 2015 and has now spread throughout South and Central America and the Caribbean (2). Infection often remains unrecognized because it either is asymptomatic (75% to 80%) or has a nonspecific presentation of rash and fever. The first suggestion that Zika virus causes more than a self-limited illness was during the French Polynesian outbreak, when incidence of Guillain-Barré ...References1. Musso D, Cao-Lormeau VM, Gubler DJ. Zika virus: following the path of dengue and chikungunya? [Letter]. Lancet. 2015;386:243-4. [PMID: 26194519] doi:10.1016/S0140-6736(15)61273-9 CrossrefMedlineGoogle Scholar2. Fauci AS, Morens DM. Zika virus in the Americas—yet another arbovirus threat. N Engl J Med. 2016;374:601-4. [PMID: 26761185] doi:10.1056/NEJMp1600297 CrossrefMedlineGoogle Scholar3. Oehler E, Watrin L, Larre P, Leparc-Goffart I, Lastere S, Valour F, et al. Zika virus infection complicated by Guillain-Barre syndrome—case report, French Polynesia, December 2013. Euro Surveill. 2014:19. [PMID: 24626205] MedlineGoogle Scholar4. Cardoso CW, Paploski IA, Kikuti M, Rodrigues MS, Silva MM, Campos GS, et al. Outbreak of exanthematous illness associated with Zika, chikungunya, and dengue viruses, Salvador, Brazil [Letter]. Emerg Infect Dis. 2015;21:2274-6. [PMID: 26584464] doi:10.3201/eid2112.151167 CrossrefMedlineGoogle Scholar5. Victora C, Schuler-Faccini L, Matijasevich A, Ribeiro E, Pessoa A, Barros F. Microcephaly in Brazil: how to interpret reported numbers? Lancet. 2016;387:621-4. [PMID: 2686496] doi:10.1016/S0140-6736(16)00273-7 CrossrefMedlineGoogle Scholar6. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol. 2016 Jan;47 1 6-7. doi:10.1002/uog.15831. [PMID: 26731034] CrossrefMedlineGoogle Scholar7. Mlakar J, Korva M, Tul N, Popovic M, Poljšak-Prijatelj M, Mraz J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016. [PMID: 26862926] CrossrefMedlineGoogle Scholar8. Martines R, Bhatnagar J, Keating M. Notes from the field: evidence of Zika virus infection in brain and placental tissues from two congenitally infected newborns and two fetal losses—Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65:159-60. [PMID: 26890059] doi:10.15585/mmwr.mm6506e1 CrossrefMedlineGoogle Scholar9. de Paula Freitas B, de Oliveira Dias J, Prazeres J, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. AMA Ophthalmol. . [PMID: 26865554] doi:10.1001/jamaophthalmol.2016.0267 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas;and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0332.Corresponding Author: Federico Costa, PhD, Instituto de Saúde Coletiva, Rua Basílio da Gama S/N, Canela, Salvador, Bahia 40110-040, Brazil; e-mail, [email protected]com.Current Author Addresses: Dr. Costa: Instituto de Saúde Coletiva, Rua Basílio da Gama S/N, Canela, Salvador, Bahia 40110-040, Brazil.Dr. Sarno: Hospital Geral Roberto Santos, Secretaria da Saúde do Estado da Bahia and Maternidade Climerio de Oliveira, Universidade Federal da Bahia, Rua do Limoeiro, 137, Nazaré, Salvador, Bahia 41055-150, Brazil.Dr. Khouri: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia 40296-710, Brazil.Dr. de Paula Frietas: Hospital Geral Roberto Santos, Secretaria da Saúde do Estado da Bahia, Av Paulo VI, 2240, Apt. 1004, Pituba, Salvador, Bahia 41810-001, Brazil.Dr. Siqueira: Centro de Pesquisas Gonçalo Moniz, Funda, R. Waldemar Falcao, 121, Salvador, Bahia 40296-710, Brazil.Dr. G. Ribeiro: Instituto da Saúde Coletiva, Universidade Federal da Bahia and Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia 40296-710, Brazil.Dr. H. Ribeiro: Hospital Geral Roberto Santos, Secretaria da Saúde do Estado da Bahia, Salvador, Bahia, Brazil.Dr. Campos: Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil.Dr. Alcântara: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Rua Waldemar Falcão, 121, Candeal, Salvador, Bahia 40296-710, Brazil.Dr. Reis: Centro de Pesquisas Gonçalo Moniz, Funda, Rua Waldemar Falcão, 121, Salvador, Bahia 40296-710, Brazil.Drs. Weaver and Vasilakis: Institute for Human Infections and Immunity, University of Texas, 301 University Boulevard, Galveston, TX 77555.Dr. Ko: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034.Dr. Almeida: Hospital Geral Roberto Santos, Secretaria da Saúde do Estado da Bahia and Faculdade da Medicina, Universidade Federal da Bahia, Av Santa Luzia, 149/302, Ed Bosque Italia, Salvador, Bahia 40295050, Brazil.Author Contributions: Conception and design: F. Costa, M. Sarno, M.G. Reis, N. Vasilakis, A.I. Ko, A.R. Almeida.Analysis and interpretation of data: F. Costa, M. Sarno, B. de Paula Freitas, G.S. Ribeiro, H. Ribeiro, S.C. Weaver, N. Vasilakis, A.I. Ko.Drafting of the article: F. Costa, M. Sarno, R. Khouri, B. de Paula Freitas, G.S. Ribeiro, N. Vasilakis, A.I. Ko.Critical revision of the article for important intellectual content: F. Costa, M. Sarno, B. de Paula Freitas, I. Siqueira, G.S. Ribeiro, L.C. Alcântara, S.C. Weaver, N. Vasilakis, A.I. Ko.Final approval of the article: F. Costa, M. Sarno, B. de Paula Freitas, I. Siqueira, G.S. Ribeiro, M.G. Reis, S.C. Weaver, N. Vasilakis, A.I. Ko, A.R. Almeida.Provision of study materials or patients: M. Sarno, B. de Paula Freitas, I. Siqueira, H.C. Ribeiro, M.G. Reis, A.R. Almeida.Obtaining of funding: M.G. Reis, A.I. Ko.Administrative, technical, or logistic support: B. de Paula Freitas, H.C. Ribeiro, M.G. Reis, S.C. Weaver, A.R. Almeida.Collection and assembly of data: F. Costa, M. Sarno, B. de Paula Freitas, H.C. Ribeiro, L.C. Alcântara, A.I. Ko, A.R. Almeida, G.S. Campos.This article was published at www.annals.org on 24 February 2016. 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