Patrícia Brasil; Guilherme Amaral Calvet; André Machado Siqueira; Mayumi Wakimoto; Patrícia Carvalho de Sequeira; Aline Nobre; Marcel de Souza Borges Quintana; Marco Cesar Lima de Mendonça; Otilia Lupi; Rogerio Valls de Souza; Carolina Romero; Heruza Zogbi; Clarisse da Silveira Bressan; Simone Sampaio Alves; Ricardo Lourenço-de-Oliveira; Rita Maria Ribeiro Nogueira; Marilia Sá Carvalho; Ana Maria Bispo de Filippis; Thomas Jaenisch

“ Further studies need to be carried out to address this question in more detail, with important implications on epidemiology and disease control of ZIKV.
The age distribution with a bias towards adults is consistent with the overall age profile of the clinic. Female patients were overrepresented with regard to males, which might be due to differences in health care–seeking behavior.
An epidemic of microcephaly in newborns in Northeast Brazil has been the focus of attention by public health authorities in Brazil and worldwide. ”

“ Patients with acute febrile disease seen at this outpatient clinic are either referred from other health units in Rio de Janeiro, or are spontaneously seeking care as they live in the nearby district of ‘Manguinhos’—an impoverished neighborhood close to the FIOCRUZ research center with a human development index of 0.726, a population of 36,160 persons in an area of 261 square kilometres, and an estimated number of 10,816 households. ”

“ After the identification of ZIKV infection in a patient with no travel history outside Rio de Janeiro in May 201 [19] , additional prospective surveillance at the outpatients' clinic was initiated in order to specifically identify patients with suspected ZIKV disease. Patients with acute onset of generalized macular or papular rash were considered suspected cases of ZIKV. We interviewed patients using a standard case report form (CRF) to collect information about demographic features, clinical signs and symptoms, and the severity of the disease (S1 File) . ”

“ In January 2015, an increase of cases with exanthematic disease was observed. Trained physicians evaluated the patients using a detailed case report form that included clinical assessment and laboratory investigations. The laboratory diagnostic algorithm included assays for detection of ZIKV, CHIKV and DENV. 364 suspected cases of Zika virus disease were identified based on clinical criteria between January and July 2015. ”

“ More recently, the state of Rio de Janeiro has reported a tenfold increase in microcephaly cases in 2015 compared to previous years [30] and, due to the long-lasting medical and economic consequences, it is of high importance that multidisciplinary studies are conducted to determine the incidence and the phenotypic variability of congenital abnormalities related to ZIKV infection during pregnancy. ”

“ Both ZIKV as well as DENV are members of the family Flaviviridae, whereas CHIKV is an alphavirus of the Togaviridae family. ZIKV was first described in humans in Africa in 1952 [10] and has recently caused epidemics in the Pacific region. ”

“ Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis. 2008;14 (8) :1232–9 . doi: 10.3201/eid1408.080287 ; PubMed Central PMCID: PMC2600394. pmid:18680646↑ Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. Journal of clinical microbiology. ”

“ Available at: http://www.inmet.gov.br/sonabra/pg_iframe.php?codEst=A652&mesAno=2015. Accessed 16.12.2015.↑ Schatzmayr HG, Nogueira RM, Travassos da Rosa AP. An outbreak of dengue virus at Rio de Janeiro—1986. Mem Inst Oswaldo Cruz. 1986. Apr-Jun;81 (2) :245–6 . pmid:3587006↑ Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis. ”