MEM INST OSWALDO CRUZ, RIO DE JANEIRO, Vol. 112 | 2017
PAGES: DOI: 10.1590/0074-02760160510 Review
Zika puzzle in Brazil: peculiar conditions of viral introduction and dissemination - A Review

Cristina Possas1,+, Patricia Brasil2, Mauro CA Marzochi3, Amilcar Tanuri4, Reinaldo M Martins1, Ernesto TA Marques5,6, Myrna C Bonaldo7, Antonio GP Ferreira8, Ricardo Lourenço-de-Oliveira9, Rita Maria R Nogueira10, Patricia C Sequeira10, Keyla BF Marzochi3, Akira Homma1

1Fundação Oswaldo Cruz-Fiocruz, Bio-Manguinhos, Assessoria Científica Sênior, Rio de Janeiro, RJ, Brasil
2Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Doenças Febris Agudas, Rio de Janeiro, RJ, Brasil
3Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
4Universidade Federal do Rio de Janeiro, Instituto de Biologia, Departamento de Genética, Rio de Janeiro, RJ, Brasil
5Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas Aggeu Magalhães, Departamento de Virologia, Recife, PE, Brasil
6University of Pittsburgh, Center for Vaccine Research, Pittsburgh, PA, United States
7Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular de Flavivírus, Rio de Janeiro, RJ, Brasil
8Fundação Oswaldo Cruz-Fiocruz, Bio-Manguinhos, Departamento de Reativos para Diagnóstico, Rio de Janeiro, RJ, Brasil
9Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Mosquitos Transmissores de Hematozoários, Rio de Janeiro, RJ, Brasil
10Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Flavivírus, Rio de Janeiro, RJ, Brasil

Abstract

This article discusses the peculiar conditions that favoured the unexpected introduction of Zika virus into the poorest northeastern region of Brazil in 2015, its speed of transmission to other Brazilian states, other Latin American countries and other regions, and the severity of related neurological disorders in newborns and adults. Contrasting with evidence that Zika had so far caused only mild cases in humans in the last six decades, the epidemiological scenario of this outbreak in Brazil indicates dramatic health effects: in 2015, an increase of 20-fold in notified cases of microcephaly and/or central nervous system (CNS) alterations suggestive of Zika congenital infection, followed by an exponential increase in 2016, with 2366 cumulative cases confirmed in the country by the end of December 2016. A significant increase in Guillain-Barré syndrome in adults has also been reported. Factors involved in viral dissemination, neural pathogenesis and routes of transmission in Brazil are examined, such as the role of social and environmental factors and the controversies involved in the hypothesis of antibody-dependent enhancement, to explain the incidence of congenital Zika syndrome in Brazil. Responses to the Zika outbreak and the development of new products are also discussed.

Financial support: CNPq, FAPERJ, FIOCRUZ
(Zika Working Group at Bio-Manguinhos).
+ Corresponding author: This e-mail address is being protected from spambots. You need JavaScript enabled to view it. /
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Received 24 November 2016
Accepted 20 February 2017

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