Showing posts with label Zika Virus facts. Show all posts
Showing posts with label Zika Virus facts. Show all posts

Monday, April 11, 2016

'Scarier Than We Initially Thought:' CDC Sounds Warning On Zika Virus



Dr. Anne Schuchat, Principal Deputy Director of the Centers for Disease Control and Prevention (CDC), and Dr. Anthony Fauci, Director of National Institutes of Health (NIH), speak about the Zika virus during a press briefing in the Brady Press Briefing Room at the White House Monday.(Photo: SAUL LOEB, AFP/Getty Images)

WASHINGTON — Public health officials said Monday they've learned a lot more about Zika since the White House asked Congress for  $1.9 billion to combat the mosquito-borne virus, and are increasingly concerned about its potential impact on the United States.
"Most of what we've learned is not reassuring," said Dr. Anne Schuchat, the principal deputy director of the Centers for Disease Control and Prevention. "Everything we look at with this virus seems to be a bit scarier than we initially thought."
She said the virus has been linked to a broader array of birth defects throughout a longer period of pregnancy, including premature birth and blindness in addition to the smaller brain size caused by microcephaly. The potential geographic range of the mosquitoes transmitting the virus also reaches farther northward, with the Aedes aegypti species present in all or part of 30 states, not just 12. And it can be spread sexually, causing the CDC to update its guidance to couples.
And researchers still don't know how many babies of women infected with Zika will end up with birth defects, or what drugs and vaccines may be effective.
"This is a very unusual virus that we can't pretend to know everything about it that we need to know," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
The assessment, delivered to reporters at the White House Monday, comes the week after the White House informed Congress it was moving more than $510 million previously earmarked for Ebola prevention toward Zika prevention efforts.

Congressional Republicans accused the White House of trying to "politicize" Zika. "We’re glad the administration has agreed to our request to use existing Ebola funds to address the Zika epidemic," said Doug Andes, a spokesman for House Speaker Paul Ryan, R-Wis. "If additional Zika resources are needed those funds could and should be addressed through the regular appropriations process."
"We can't just stop and wait for the money. If we don't get the money the president has asked for, we're not going to take it to the point we need," Fauci said. "When the president asked for $1.9 billion, we needed $1.9 billion."
The Centers for Disease Control announced Monday it was providing $3.9 million in emergency Zika funding to Puerto Rico. saying the number of cases there is doubling every week and could reach into the hundreds of thousands. The money will go to increased laboratory capacity.
"We are quite concerned about Puerto Rico, where the virus is spreading throughout the island," Schuchat said. "We think there could be hundreds of thousands of cases of Zika virus in Puerto Rico and perhaps hundreds of affected babies."

Source:  , USA TODAY
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Friday, February 12, 2016

What Travelers Need To Know About Zika And Dengue


In Transit
By SHIVANI VORA, www.nytimes.com FEB. 11, 2016
Mosquito repellent is the most effective way to protect from the Zika virus.Mark Graham for The New York Times
Outbreaks of the mosquito-borne diseases Zika and dengue aren’t slowing down: The Zika virus continues to spread throughout theCaribbean and Brazil, and the mayor of Hawaii County, Billy Kenoi,declared a state of emergency on the Big Island on Monday in response to the increasing number of dengue cases there. Here is what you need to know if you are contemplating or already have plans to travel to a destination affected by either disease.
Is it safe to travel to a destination affected by Zika or dengue?
Dr. Ian Lipkin, an epidemiology professor at the Columbia University Mailman School of Public Health, says that traveling to a Zika-infected destination is safe for the average traveler. Pregnant women, however, should avoid such travel; also, they shouldn’t have unprotected sex for the duration of their pregnancy with men who have traveled to Zika-infected areas because of the potential risk of brain damage to their unborn babies that may be transmitted through sperm.
Dengue, on the other hand, can affect any traveler, but that doesn’t mean that it is unsafe to travel to a destination where it is present.
Are there any vaccines you can take to protect yourself if you are traveling to places where there have been cases of these diseases?
Dr. Lipkin says that there are no vaccines you can take to protect yourself from dengue or Zika. “There are vaccinations that are in the process of being developed but nothing out yet,” he said.

I have a trip booked to a Zika- or dengue-affected destination and want to cancel my plans. How flexible are hotels being with their cancellation policies in light of the disease?
Most of the large hotel brands like Hilton Worldwide, Hyatt hotels, Four Seasons Hotels and Resorts, Starwood Hotels & Resorts and the Ritz-Carlton Hotel Company don’t have any official cancellation policies and are reviewing requests for cancellations on a case-by-case basis. Jack Ezon, the president of the New York travel company Ovation Vacations who has had more than 80 trip cancellations because of Zika, says that hotels in Zika-affected areas are starting to become more amenable to refunds or giving guests credit for a future stay as the virus continues to spread.
The stickiness, he says, comes in areas that don’t have reported cases of Zika but are near a region that does. One example: Anguilla and St. Bart’s don’t have any reported Zika cases yet, but getting to either island usually requires connecting through St. Martin or San Juan, Puerto Rico, both of which are Zika-affected destinations. “If you have to travel through an affected destination to get to one that isn’t, the hotels in the latter aren’t as forgiving about refunds or credits,” Mr. Ezon said.
What about air carriers?
Domestic airlines have introduced policies when it comes to refunds, and almost all address Zika-affected destinations.
Delta Air Lines said that travelers with tickets to Zika-affected areas may qualify for a change to alternative destinations, travel dates or a refund. Also, they may make fee-waived changes to future reservations/tickets, but these changes need to be made by Feb. 29.
United Airlines said that customers who hold tickets to regions that the Centers for Disease Control and Prevention says are affected by the virus can postpone their trips or receive full refunds.
American Airlines said that pregnant travelers, along with their companions, who are concerned about traveling to a destination outside the United States that is affected by Zika, can request a refund. In order to receive a refund, they must provide a doctor’s note confirming their pregnancy, and stating that they are unable to travel because of the virus.
JetBlue will allow customers who have concerns about traveling to Zika-affected areas a refund or rebooking, a spokeswoman said.
Virgin America will let travelers who have tickets to any Mexican destinations — Cancún, Puerto Vallarta and Los Cabos — get a refund or change their flight free of charge, a spokesman said.
What’s the best way to protect yourself from taking a financial hit if you want to change your travel plans because of Zika or dengue?
Buy travel insurance, but the right kind. Stan Sandberg, a founder ofTravelInsurance.com, says that travelers heading to a Zika- or dengue-affected area should purchase a plan with a Cancel for Any Reason (CFAR) option; RoamRight and Travel Insured International are two companies that offer such plans.
What can we do to minimize the chance of contracting Zika or dengue?
The single best way to protect yourself is to use mosquito repellent. Each brand has different directions for frequency of application, but Dr. Lipkin says to use double of that recommendation. If your bottle suggests reapplying every four hours, for example, you should reapply every two hours. “If you’re outside in a warm climate, the repellent will evaporate faster because you’re likely perspiring,” he said.
Also, if you’re in a room that doesn’t have air-conditioning, he says that using a window, standing or table fan keeps mosquitoes at bay because the insects don’t have wings strong enough to fly against the current of the fan.
How would you know if you’ve contracted either Zika or dengue?
With both, you may have mild flu-like symptoms, a fever, a headache or severe joint pain. These usually appear within a week or 10 days of having been bitten by a mosquito carrying either virus. But you may have no symptoms at all, which means that you didn’t contract the virus. (Symptoms of severe dengue, which the C.D.C. says mostly affects children, are persistent vomiting, bleeding and difficulty breathing.)
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Friday, February 5, 2016

Zika Virus And Travel Insurance: What You Need To Know

Zika Virus and Travel Insurance: What You Need to Know
TravelPulse file photo
With news of the Zika virus dominating current news cycles, it’s not surprising that top travel insurance providers are fielding a high volume of calls from policyholders concerned about the virus’ potential to impact their upcoming travel.
“We have seen an astronomical increase in the number of policyholders calling our 24/7 Assistance team asking about their plans’ coverage and how the benefits apply to the Zika virus,” said Jason Schreier, CEO April Travel Protection.
“We’ve received about 300 calls from customers who are concerned about Zika and want to know how travel insurance can help,” added Dan Durazo, director of communications for Allianz Global Assistance.
Generally, travelers who purchased “cancel for any reason” policies prior to the virus’ outbreak may cancel their travel plans over concerns regarding potential infection. But providers say to date there’s been no noteworthy increase in this area. Durazo said Allianz has received about 100 claims related to Zika.
Beyond cancel-for-any-reason policies, the Zika virus outbreak is not covered under most “trip cancellation” plans sold by travel insurance providers. “The Zika virus outbreak doesn’t alter policy guidelines for trip cancellation, said Schreier. “Per the Centers for Disease Control, the virus alert is set at level 2, which means policyholders can still travel to the affected destinations and practice enhanced precautions.”
The Zika virus’ risks are most serious for pregnant women, as the birth defect microcephaly, which health officials have linked to Zika, was recently declared a public health emergency by the World Health Organization.  Durazo notes that “Some Allianz travel insurance products do allow customers to cancel their trip if a member of their party becomes pregnant after the insurance is purchased.” 
He added, “Customers who do have cancellation coverage could receive a refund for the pre-paid, non-refundable travel payments that they might otherwise lose.” Durazo advised Allianz policyholders with additional questions to contact the company.
Schreier said pregnancy “is not a covered reason for trip cancellation,” even if a physician statement preventing travel is submitted. However cancellation of travel to a Zika-affected destination due to pregnancy would be covered under an optional “Enhanced Unforeseen Events” upgrade to the April’s “Choice” policy package.
To date, neither official has observed a surge of policy purchases in connection with travel to Zika-impacted regions. Schreier has noticed only a “slight increase in the number of trip cancellation and Choice policies booked through our aggregator partners."
In addition, The Caribbean Tourism Organization issuing a statement Wednesday saying its 28 member destination report “very few cancellations as a result of Zika.”  
Both Allianz Global Assistance and April Travel Protection are advising policyholders to monitor Centers for Disease Control notices and contact their hotlines should they become ill during their travels. “Allianz customers who become ill with the Zika virus may also be covered for emergency medical treatment,” said Durazo. “Customers who are traveling and need help should call our Travel Assistance department.” 
Schreier added, “If a traveler contracts the virus while traveling, April would cover and coordinate all assistance for emergency medical, medical evacuation, and trip interruption.”  
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Thursday, February 4, 2016

Travelore Update: Short Answers To Hard Questions About Zika Virus


By ,  and NICHOLAS ST. FLEUR RELATED ARTICLE




PLAY VIDEO 2:05

The World Health Organization has declared the Zika virus an international public health emergency, prompted by growing concern that it could cause birth defects. As many as four million people could be infected by the end of the year. Officials at the Centers for Disease Control and Prevention have urged pregnant women against travel to about two dozen countries, mostly in the Caribbean and Latin America, where the outbreak is growing.
The infection appears to be linked to the development of unusually small heads andbrain damage in newborns. Some pregnant women who have been to these regions should be tested for the infection, the agency said. Here are some answers and advice about the outbreak.

  1. United
    States
    ZIKA VIRUS
    Egypt
    Mexico
    India
    Kenya
    Indonesia
    Brazil
    Areas with current or past evidence of Zika
    Angola
    Easter
    Island
    By The New York Times | Sources: Centers for Disease Control and Prevention; Pan American Health Organization
    1.What is the Zika virus?
    A tropical infection new to the Western Hemisphere.
    The Zika virus is a mosquito-transmitted infection related to dengue, yellow fever and West Nile virus. Although it was discovered in the Zika forest in Uganda in 1947 and is common in Africa and Asia, it did not begin spreading widely in the Western Hemisphere until last May, when an outbreak occurred in Brazil.
    Until now, almost no one on this side of the world had been infected. Few of us have immune defenses against the virus, so it is spreading rapidly. Millions of people in tropical regions of the Americas may now have been infected.
    Yet for most, the infection causes no symptoms and leads to no lasting harm. Scientific concern is focused on women who become infected while pregnant and those who develop a temporary form of paralysis after exposure to the Zika virus. 

  2. UNITED
    STATES
    ATLANTIC
    OCEAN
    MEXICO
    VENEZUELA
    PANAMA
    COLOMBIA
    PACIFIC
    OCEAN
    ECUADOR
    BRAZIL
    PERU
    BOLIVIA
    100%
    Probable range
    of the yellow
    fever mosquito,
    Aedes aegypti
    PARAGUAY
    50%
    0%
    ARGENTINA
    By The New York Times | Source: Moritz U. G. Kraemer et al., eLife Sciences; Simon Hay, University of Oxford
    2.How is the virus spread?
    Mosquitoes, but not every species.
    Zika is spread by mosquitoes of the Aedes genus, which can breed in a pool of water as small as a bottle cap and usually bite during the day. The aggressive yellow fever mosquito, Aedes aegypti, has spread most Zika cases, but that mosquito is common in the United States only in Florida, along the Gulf Coast, and in Hawaii – although it has been found as far north as Washington, D.C., in hot weather.
    The Asian tiger mosquito, Aedes albopictus, is also known to transmit the virus, but it is not clear how efficiently. That mosquito ranges as far north as New York and Chicago in summer.
  3. 3.Can the Zika virus be sexually transmitted?
    Yes, but experts suspect that it rarely happens.
    Experts believe that the vast majority of all Zika infections are transmitted by mosquitoes, not sex. As of Feb. 2, there have only been three reports suggesting sexual transmission.
    • In 2008, a scientist studying malaria in Africa returned to Colorado and apparently infected his wife before developing symptoms himself. Both had fever, rash and headaches. A year later, tests on their blood, which had been frozen, revealed that both had had Zika.
    • In 2013, live virus was found in the semen of a 44-year-old Tahitian man; whether he infected anyone is unknown.
    • In early February, health officials in Texas announced that a traveler who had returned to Dallas from Venezuela apparently had infected a sexual partner.
    In the first two cases, the men had genital pain and blood in their semen, suggesting that their testes or prostates had been infected. Details regarding the third case were not released.
    Based on these reports, the C.D.C. issued tentative new guidelines suggesting that pregnant women avoid contact with semen from men who have recently returned from areas with Zika transmission. Men returning from these regions should consider using condoms, the agency said.
    Officials did not provide guidance on how long to do so. British health authorities have suggested using condoms for at least 28 days.
    There are still many unknowns, including:
    • Can a woman pass the virus to a man through sex? Can it be passed through anal, oral or any other form of sex?
    • Does a man have to have blood in his semen to be infectious? Is he infectious before the blood appears?
    • If there is no blood, does he have to have had Zika symptoms like fever and rash to transmit the virus? How long does a man remain infectious?

    1. 4.How might Zika cause brain damage in infants?
      Experts aren’t certain how it happens, or even whether the virus is to blame.
      The possibility that the Zika virus causes microcephaly – unusually small heads and damaged brains – emerged only in October, when doctors in northern Brazil noticed a surge in babies with the condition.
      It may be that other factors, such as simultaneous infection with other viruses, are contributing to the rise; investigators may even find that Zika virus is not the main cause, although right now circumstantial evidence suggests that it is. 
      It is not known how common microcephaly has become in Brazil’s outbreak. About three million babies are born in Brazil each year. Normally, about 150 cases of microcephaly are reported, and Brazil says it is investigating nearly 4,000 cases. Yet reported cases usually increase when people are alerted to a potential health crisis.

    2. ATLANTIC
      OCEAN
      VENEZUELA
      PANAMA
      PACIFIC
      OCEAN
      COLOMBIA
      ECUADOR
      BRAZIL
      PERU
      Recife
      BOLIVIA
      Microcephaly cases in Brazil
      By state, as of Jan. 30
      Rio de Janeiro
      ARGENTINA
      10
      100
      1,000
      10
      100
      Possible cases
      under investigation
      Confirmed
      cases
      By The New York Times | Source: Brazil’s Ministry of Health
      5.What is microcephaly?
      Babies with microcephaly have unusually small heads. In roughly 15 percent of cases, a small head is just a small head, and there is no effect on the infant, according to Dr. Constantine Stratakis, a pediatric geneticist and a scientific director at the National Institute of Child Health and Human Development.
      But in the remainder of cases, the infant’s brain may not have developed properly during pregnancy or may have stopped growing in the first years of life. These children may experience a range of problems, like developmental delays, intellectual deficits or hearing loss.
      The consequences can vary widely from child to child. Pinpointing an underlying cause helps clinicians to advise parents about their newborn’s prognosis.
      Genetic abnormalities are a common cause. Microcephaly can also be triggered by infections of the fetus, including German measles (also known as rubella), toxoplasmosis (a disease caused by a parasite found in undercooked contaminated meat and cat feces) and cytomegalovirus. 
      Microcephaly may also result if a pregnant woman consumes alcohol, is severely malnourished or has diabetes. If the defect occurs in a child’s first years, it may be a result of a brain injury during labor.
      There is no treatment for an unusually small head.
      “There is no way to fix the problem, just therapies to deal with the downstream consequences,” said Dr. Hannah M. Tully, a neurologist at Seattle Children’s Hospital who specializes in brain malformations.

    3. United States
      Haiti
      Dominican Republic
      Puerto Rico
      Guadeloupe
      St. Martin
      Martinique
      Barbados
      U.S. Virgin Islands
      Curaçao
      ATLANTIC
      OCEAN
      Mexico
      Cuba
      Jamaica
      Guatemala
      Honduras
      El Salvador
      Nicaragua
      Costa Rica
      Guyana
      Suriname
      French Guiana
      Venezuela
      Panama
      Colombia
      Ecuador
      Brazil
      PACIFIC
      OCEAN
      Peru
      Bolivia
      Areas
      pregnant women
      should avoid
      Paraguay
      Argentina
      Note: American Samoa, Cape Verde and Tonga should also be avoided.
      By The New York Times | Sources: Centers for Disease Control and Prevention; Pan American Health Organization
      6.What countries should pregnant women avoid?
      About two dozen destinations mostly in the Caribbean, Central America and South America.
      The Pan American Health Organization believes that the virus will spread locally in every country in the Americas except Canada and Chile. Here is the C.D.C.’s current list of countries and territories in which Zika virus is circulating. The latest updates are here.

    4. 7.How do I know if I’ve been infected? Is there a test?
      It’s often a silent infection, and hard to diagnose.
      Until recently, Zika was not considered a major threat because its symptoms are relatively mild. Only one of five people infected with the virus develop symptoms, which can include fever, rash, joint pain and red eyes. Those infected usually do not have to be hospitalized.
      There is no widely available test for Zika infection. Because it is closely related to dengue and yellow fever, it may cross-react with antibody tests for those viruses. To detect Zika, a blood or tissue sample from the first week in the infection must be sent to an advanced laboratory so the virus can be detected through sophisticated molecular testing.

      1. The C.D.C. testing algorithm for pregnant women who have visited countries in which the Zika virus is spreading. Centers for Disease Control and Prevention
        8.I’m pregnant and I recently visited a country with Zika virus. What do I do?
        Some women should get blood tests, and just about all should get ultrasound scans.
        On Jan. 19, the C.D.C. issued interim guidelines for women in that situation and for their doctors. The guidelines are complex — and may change.
        In general, they say that pregnant women who have visited any area with Zika transmission should consult a doctor. Those who have had symptoms of infection like fever, rash, joint pain and bloodshot eyes during their trip or within two weeks of returning should have a blood test for the virus. 
        That recommendation is controversial, because even women with no symptoms may have been infected — 80 percent of those who get the virus do not feel ill — and there is no evidence that babies are hurt only when the mother has been visibly ill. But at the time the guidelines were issued, the C.D.C. and state health departments simply did not have the laboratory capacity to test every pregnant woman who visited Latin America and the Caribbean in the last nine months, as well as every pregnant woman in Puerto Rico.
        Even for women who get blood tests, the news is not entirely reassuring. Tests for the virus itself only work in the first week or so after infection. Tests for antibodies can be done later, but they may yield false positives if the woman has had dengue, yellow fever or even a yellow fever vaccine.
        Under the C.D.C’s testing algorithm, pregnant women who have been to affected regions – whether they have symptoms or not, and whether they have negative or positive blood tests – should eventually have an ultrasound scan to see if their fetuses are developing microcephaly or calcification of the skull.
        Unfortunately, an ultrasound usually cannot detect microcephaly before the end of the second trimester.
        Some women also should have amniocentesis to test the fluid around the fetus for Zika virus. But amniocentesis involves piercing the amniotic sac with a long needle through the abdomen; it is slightly risky for the fetus and is not recommended before 15 weeks gestation.
        Several companies are working on rapid tests for Zika infection. The C.D.C. also usually distributes test kits and training materials to state health departments during outbreaks, which should increase testing capacity.
      2. 9.I’m of childbearing age, but not pregnant and not planning to get pregnant. Should I go to an affected country?
        Only if you use birth control religiously.
        Half of pregnancies are unintended. If you want to visit a country where Zika transmission has been reported, Dr. Laura E. Riley, a specialist who works with high-risk pregnancies and infectious disease at Massachusetts General Hospital, advises strict use of birth control to ensure you don’t get pregnant.
        Women who become unexpectedly pregnant while traveling or shortly afterward will face blood tests, monthly ultrasounds and a great deal of anxiety.
        “Why would you ever sign yourself up for that?” said Dr. Riley. “There’s enough in life to worry about. I wouldn’t add that to my list.”
      3. 10.I’m pregnant now, but wasn’t when I visited one of the affected countries. What’s the risk?
        Very low, experts say.
        With rare exceptions, the virus does not appear to linger in the body, and people who recover from the infection are immune.
        “Our understanding, thus far, is that the risk is very, very low if you were in that place prior to conception,” said Dr. Laura E. Riley of Massachusetts General Hospital.
        “I wouldn’t be worried about if you conceived after you got back to the U.S.”

        1. Gleyse Kelly da Silva holding her daughter, Maria Giovanna, who was born with microcephaly in Recife, Brazil. The birth defect has been linked to the Zika virus. Felipe Dana/Associated Press
          11.Does it matter when in her pregnancy a woman is infected with Zika virus?
          Earlier in pregnancy seems to be more dangerous.
          The most dangerous time is thought to be during the first trimester – when some women do not realize they are pregnant. Experts do not know how the virus enters the placenta and damages the growing brain of the fetus.
          Closely related viruses, including yellow fever, dengue and West Nile, do not normally do so. Viruses from other families, including rubella (German measles) and cytomegalovirus, sometimes do.
        2. 12.Should infants be tested?
          Other birth defects may be linked to the virus.
          Federal health officials say that newborns should be tested for infection with the Zika virus if their mothers have visited or lived in any country experiencing an outbreak and if the mothers’ own tests are positive or inconclusive.
          The reason, officials said in interviews, is that infection with the virus could be linked to defects in vision and hearing, among other abnormalities, even if the child does not suffer microcephaly. The other defects may require further assessments and testing.
          The new guidance applies only to infants of mothers who reported symptoms of Zika virus infection — a rash, joint pain, red eyes or fever — while living abroad in an affected country or within two weeks of travel to such a destination.
          1. 13.Is there a treatment?
            No.
            The C.D.C. does not recommend a particular antiviral medication for people infected with the Zika virus. The symptoms are mild – when they appear at all – and usually require only rest, nourishment and other supportive care. 


          2. PLAY VIDEO 00:45
            Health workers sprayed insecticide in the Sambadrome in Rio de Janeiro as part of a campaign to combat mosquitoes, which transmit the Zika virus.
            14.Is there a vaccine? How should people protect themselves?
            Protection is difficult in mosquito-infested regions.
            There is no vaccine against the Zika virus. Efforts to make one have just begun, and creating and testing a vaccine normally takes years and costs hundreds of millions of dollars.
            Because it is impossible to completely prevent mosquito bites, the C.D.C. has advised pregnant women to avoid going to regions where Zika is being transmitted, and has advised women thinking of becoming pregnant to consult doctors before going.
            Travelers to these countries are advised to avoid or minimize mosquito bites by staying in screened or air-conditioned rooms or sleeping under mosquito nets, wearing insect repellent at all times and wearing long pants, long sleeves, shoes and hats.
            1. 15.If Zika virus has been in Africa and Asia for decades, why wasn’t a link to microcephaly detected earlier?
              It may be that the virus never had struck such a large population without immunity.
              Microcephaly is rare, and it has many other causes, including infection of the fetus with rubella (German measles), cytomegalovirus or toxoplasmosis; poisoning of the fetus by alcohol, mercury or radiation; or severe maternal malnutrition and diabetes. It is also caused by several gene mutations, including Down syndrome.
              Until recently, health officials paid little attention to Zika virus. It circulated in the same regions as dengue and chikungunya, and compared to those two painful infections – nicknamed “break-bone fever” and “bending-up fever” – Zika was usually mild.
              The virus is thought to have reached Asia from Africa at least 50 years ago. While it may have caused spikes in microcephaly as it first spread, there was no testing to pin down which of many possible causes was to blame.
              In 2007, a Southeast Asian strain of the Zika virus began leap-frogging the South Pacific, sparking rapid outbreaks on islands where no one had immunity to it. Because island populations are small, rare side effects did not occur often enough to be noticed. But in 2013, during an outbreak in French Polynesia, which has 270,000 residents, doctors confirmed 42 cases of Guillain-Barrê syndrome, which can cause paralysis. That was about eight times the normal number and the first hint that Zika virus can attack the nervous system, which includes the brain.
              Zika was first confirmed in Brazil – a country of 200 million – last May, and it spread like wildfire. The first alarms about microcephaly were raised only in October, when doctors in the northeastern state of Pernambuco reported a surge in babies born with it. Pernambuco has nine million people and 129,000 annual births. In a typical year, nine are microcephalic infants.
              By November 2015, when Brazil declared a health emergency, Pernambuco had had 646 such births.
            2. 16.Outside of Brazil has a Zika outbreak ever been linked to microcephaly?
              Officials in French Polynesia have suspicions about an outbreak two years ago.
              French Polynesia is the only area outside of Brazil to be affected by a Zika outbreak in which public health officials have identified an increase in the number of fetuses and babies with unusually small heads. There is “very high suspicion” of a link between the Zika virus and microcephaly in French Polynesia, said Dr. Didier Musso, an infectious disease specialist at the archipelago’s Institut Louis Malardé – though he said additional research was still needed.
              Last November French Polynesian officials reinvestigated an outbreak of Zika that lasted from October 2013 to April 2014. They reported finding an unusual increase – from around one case annually to 17 cases in 2014-15 – of unborn babies developing “central nervous system malformations,” a classification that includes microcephaly.
              There were no investigations at the time to determine whether the mothers were infected with Zika virus during pregnancy. Four of the mothers were tested later and the results indicated they may have been infected with the virus. Additional research is underway, Dr. Musso said. 
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