Patient: — Final Diagnosis: Diagnosis of secondary microcephaly Symptoms: 23 days after birth revealed that the baby’s head circumference remained at 33 cm (z score=−2.330) Medication: — Clinical Procedure: Analysis of samples by reverse transcriptase – polymerase chain reaction (RT-PCR) revealed the presence of ZIKV only in breast milk Specialty: Pediatrics and Neonatology Objective: Unusual clinical course Background: The Zika virus is an arbovirus that has as main source of transmission the bite of infected insects of the genus Aedes and has been associated with cases of congenital malformation and microcephaly in neonates. However, other sources of transmission have been identified since the emergence of this virus in the world population, such as vertical transmission by semen and possibly other body fluids such as vaginal secretion and breast milk. Case Report: An infant, born to a mother whose previous delivery was a baby with severe microcephaly, was normal and was negative for Zika virus at birth but developed secondary microcephaly 1 month later, that persisted. The baby was exclusively breast-fed and Zika virus was present in the mother’s milk. Conclusions: We report the detection of Zika virus exclusively in the breast milk of a woman after her second delivery of an infant, who later developed microcephaly. This case is consistent with possible vertical transmission.

Recent outbreaks of Zika virus (ZIKV) infection highlight the urgent need to evaluate the efficacy of current public health measures to educate susceptible groups about how to prevent infection, modes of viral transmission, and consequences of infection. We performed a cross-sectional study in the city of Jundiaí, São-Paulo, from March 2016 to August 2017. In 315 high-risk pregnant women we evaluated the rate of ZIKV infection, knowledge of pathways of ZIKV transmission, and the use of protective measures. Data were analyzed and correlated with sociodemographic variables. The rate of ZIKV infection was 10.8%. ZIKV transmission by mosquitoes was the best-known means of virus acquisition, while transmission of ZIKV by sexual intercourse as well as mother–fetus transmission was known by less than half of the women. The use of insect repellent, reported by 53% of participants, was correlated with higher education and personal directives from health professionals. Condom use was reported by 19.5% of subjects. Improved strategies to increase awareness of ZIKV infection and its consequences, designed to appeal to specific, targeted populations, are clearly necessary to more accurately prevent the spread of this infection and diminish adverse consequences in the pregnant population.

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Objective: Evaluate the improvement in recreational inactivity (tv/internet/vieogames) in school age children after a multidisciplinary educational program in cardiovascular prevention (CVP) at school. Methods: Students aging 6 to 10 years old were exposed to two different approaches at two public schools in Sao Paulo, Brazil. For the control school we delivered written educational material (EM) for their parents during the year of 2012 about healthy lifestyle. The intervention school students received the same EM for their parents and the children were exposed to a weekly educational program in CVP with a multidisciplinary heath team during the year 2012. This intervention tried to teach to these children concepts of healthy nutrition, avoidance of tobacco and physical activity. Both at the inclusion in the study and one year later we collect data of parents and their children, including a questionnarie about the time children spent in tv, computes and videogames during the day (recreational inactivity). Results: We studied 262 children. The control group had 136 children (mean age of 8 years) and the intervention group had 126 children (mean age of 8 years). In the intervention group 79.4% of children (100 children) had a reacreational inactivity time (RIT) > 2 hours/day, and in the control group 80.1% of children (109 children) had a RIT > 2 hours/day. After one year of educational intervention 87 children (69.0%) of the intervention group and 107 children (78.6%) of the control group still had a RIT >2 hours/day, p= 0.03923 (Fisher's Exact test Mid p). This represents a 13% reduction in the intervention group and a 1,8% reduction in the control group. Conclusion: An educational program in cardiovascular prevention directed to children at school age can improve recreational inactivity in children contributing for the reduction of obesity and cardiovascular risk.

Paired maternal and newborn urine and amniotic fluid from 138 subjects collected during a Zika virus (ZIKV) outbreak was analyzed for ZIKV by gene amplification (RT-qPCR), and the findings were correlated with clinical symptoms and neurological anomalies in the babies. ZIKV was detected in 1 of 9 symptomatic women (11.1%) and in 19 of 129 asymptomatic women (14.7%). Neurological manifestations were present in 19 babies (13.7%), 10 of 20 (50%) positive and 9 of 119 (7.6%) negative (p < 0.001) for ZIKV. Twelve (8.6%) urines collected during gestation were ZIKV-positive; only 2 remained positive for ZIKV postpartum. Six (4.1%) newborn urines collected within 1 day of delivery were ZIKV-positive cases. In 3 of these cases, ZIKV was detected in mother's urine pre-and postpartum and in both mother's urine and babies' urine. Four of the amniotic fluid samples (2.9%) were ZIKV-positive. Among ZIKV-negative babies with neurological sequel, 87.5% were female; in contrast, 72.7% ZIKV-positive babies with neurological abnormalities were male (p = 0.019). We conclude that during a ZIKVoutbreak, clinical symptoms and ZIKV detection in biological fluids are poor predictors of infection and adverse neurologic sequel in newborns.