One year after the Zika virus outbreak in Brazil: from hypotheses to evidence

Brito, Carlos; Cordeiro, Marli Tenório

doi:10.1590/0037-8682-0328-2016

Cited by 48 publications

(54 citation statements)

References 47 publications

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“…Different case definitions have been published, often based on small case series. Consequently the sensitivity of some case definitions has been questioned by clinicians [11]. For the diagnosis of Zika to be made using clinical and epidemiological criteria in resource-limited areas, or during epidemic periods, it is necessary to establish a sensitive case definition with good specificity.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

et al. 2017

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BackgroundZika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic.MethodologyWe evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features.Results and discussionOur derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096.ConclusionsIn areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.

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Section: Introductionmentioning

confidence: 99%

Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

et al. 2017

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“…More recently, the description of the Zika virus outbreak in Brazil significantly increased awareness of the potential of intrauterine viral infections to lead to severe central nervous system (CNS) damage (3)(4)(5)(6). Fortunately, results from nearly 5 decades of natural history studies of congenital HCMV infections have provided a roadmap for studies of the consequences of Zika virus infections that occur during pregnancy.…”

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confidence: 99%

Congenital Human Cytomegalovirus Infection and the Enigma of Maternal Immunity

Britt

2017

J Virol

155

158

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Human cytomegalovirus (HCMV) is the most common viral infection acquired by the developing human fetus and can result in damage to the developing central nervous system. Although vaccine development to modify this congenital infection is ongoing, the unique epidemiology of maternal HCMV infections appears discordant with strategies for vaccine development. Several characteristics of congenital HCMV infections suggest that the efficacy of vaccines designed to induce responses similar to those that follow natural infection will be limited.

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“…In October 2015 an increase in the number of cases of neonatal microcephaly was observed in the State of Pernambuco (there were 58 cases in a single month, far exceeding the total number of cases registered in previous years) and physicians started to investigate a connection with Zika infection in pregnant woman. The first laboratory confirmation of this came from Paraíba State with RT-PCR positivity in two pregnant women whose foetuses presented with microcephaly (4,7). No cases of microcephaly were described in the French Polynesia outbreak.…”

Section: Symptomatologymentioning

confidence: 92%

Global epidemiology of Zika and Chikungunya virus human infections

et al. 2017

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Zika virus was discovered in 1947. The first reported case of Zika fever was in a sentinel rhesus monkey in Uganda in 1947, while the first human cases were reported in Nigeria in 1954. Since the first evidence of human infection, Zika was active in several countries in Africa and Asia, as sporadic cases and serological evidence of Zika human infections have been demonstrated in several reports. The outbreak of Zika in Yap Island in 2007 is considered the first emergency of this infection. Since then Zika has spread worldwide with a large ongoing epidemic in South and Central America. A huge concern nowadays is about the relationship between Zika infection and microcephaly and about the sexual transmission of the virus. The first identified outbreak of Chikungunya human infection, with an incidence estimated at 23%, was reported from July 1952 to March 1953 in the Southern Province of the current Tanzania. Since then Chikungunya circulated mainly in continental Africa with limited outbreaks. The virus started to spread east bound involving most of the areas surroundings the Indian Ocean. In 2004/2005 a large outbreak developed in La Reunion a French territory in the Indian Ocean: from this point Chikungunya spread to India and from there, due a viraemic traveller returning from Kerala, to Italy where in the summer of 2007 the first outbreak with local viral transmission in a temperate climate zone occurred. In the following years Chikungunya moved to the Caribbean and South America. Recently also the USA experienced the spread of this virus and a limited outbreak based again on local spreading occurred in the French Department of Var, in August 2017.

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One year after the Zika virus outbreak in Brazil: from hypotheses to evidence

Cited by 48 publications

References 47 publications

Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

Congenital Human Cytomegalovirus Infection and the Enigma of Maternal Immunity

Global epidemiology of Zika and Chikungunya virus human infections

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