How a Medical Mystery in Brazil Led Doctors to Zika Virus – NYTimes

Brazilian soldiers took a break after inspecting a backyard in Recife, as part of a joint operation with municipal health officials to combat the mosquitoes that spread the Zika virus. Photo Credit: Mauricio Lima for The New York Times

Brazilian soldiers took a break after inspecting a backyard in Recife, as part of a joint operation with municipal health officials to combat the mosquitoes that spread the Zika virus.
Photo Credit: Mauricio Lima for The New York Times

Something strange was happening last August in the maternity wards of Recife, a seaside city perched on Brazil’s easternmost tip, where the country juts into the Atlantic.

“Doctors, pediatricians, neurologists, they started finding this thing we never had seen,” said Dr. Celina M. Turchi, an infectious diseases researcher at the Oswaldo Cruz Foundation, a prominent scientific institute in Brazil.

“Children with normal faces up to the eyebrows, and then you have no foreheads and very strange heads,” she recalled, referring to the condition known as microcephaly. “The doctors were saying, ‘Well, I saw four today,’ and, ‘Oh that’s strange, because I saw two.’”

Aside from their alarming appearance, many of the babies seemed healthy.

“They cried,” Dr. Turchi said. “They breast-fed well. They just didn’t seem to be ill.”

Doctors Stumped

They did not know it then, but they were seeing the first swell of a horrifying wave. A little-known pathogen — the Zika virus, carried by mosquitoes — had been circulating in Brazil for at least a year. It would later become the chief suspect in the hunt to work out what had happened to those newborns.

Since then, those tiny babies have led the World Health Organization to declare a public health emergency. They have prompted warnings to pregnant women to avoid countries where the virus is circulating, even to refrain from unprotected sex with men who have visited those countries, following a report of sexual transmission of the virus in Dallas last week.

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They have led health ministers of five countries to say something so unthinkable that none had ever uttered it before: Women, please delay having children.

The virus now threatens the economies of fragile nations and the 2016 Summer Olympics in Rio de Janeiro. It has opened a new front in the debate in heavily Roman Catholic countries about a woman’s right to birth control and abortion.

And the children stricken with microcephaly, or abnormally small heads, have doctors everywhere asking: What is this virus? How could it have been around for almost 70 years without us realizing its power? What do we tell our patients about a bug that can hide in a mosquito’s proboscis and a man’s semen, even in human saliva or urine? What do we tell young women who ask if their unborn babies are safe?

“This epidemic is an unfolding story,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “As with Ebola, this virus is something that could exist for years under the radar, and we don’t know until we get thousands of cases what it really does.”

“With Zika, we’re seeing new twists and turns every week.”

To doctors in Recife, whatever was striking the babies seemed to have fallen like a bolt from the blue.

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In reality, it had been building for months. It had even been frequently discussed among clinicians — but no one had realized what was on the horizon.

Seeing the Same Symptoms
A year earlier, doctors say, the first patients had started trickling into public hospitals in Natal, capital of the state of Rio Grande do Norte, about 200 miles up the coast from Recife.

It was a few weeks after the 2014 World Cup, and Natal had been one of the host cities of the soccer championship, which draws fans from all over the world.

Many patients lived on the city’s margins, others in settlements dotted across the sertão, northeast Brazil’s arid hinterland.

Almost all had the same symptoms: a flat pinkish rash, bloodshot eyes, fever, joint pain and headaches. None were desperately ill, but the similarities were striking.

“That scared some patients and doctors, and my team,” said Aline Bezerra, a nurse and the municipal epidemiologist. “We knew nothing other than that it might be some kind of light dengue.”

Tests ruled that out, along with other common viruses, but the patients kept coming. One day in January 2015, 100 showed up at the state’s hospitals.

“We alerted the federal authorities that we were dealing with something urgent and new,” said Dr. Kleber Luz, an infectious diseases specialist at the Federal University of Rio Grande do Norte. “But their reaction was sluggish.”

By last March, the spread of a “doença misteriosa” — the mystery disease — had become impossible to ignore. It appeared in two more states nearby. Then it reached Salvador, a city of 2.5 million.

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Doctors speculated that it was an allergy; that it was roseola, a childhood illness; that it was a new variant of Fifth Disease, a facial rash that gives children a “slapped-cheek” look.

“People were claiming it was polluted water,” said Dr. Gúbio Soares, a virologist at the Federal University of Bahia in Salvador. “I began thinking it was something transmitted by mosquitoes.”

Working in his modest lab with a colleague, Dr. Silvia Sardi, Dr. Soares kept testing blood samples.

Other doctors were doing the same. Over 6,800 samples were tested, according to news reports, from victims ranging from 4 months to 98 years old. Parvovirus, dengue, chikungunya and other suspects were all ruled out.

Finally, in April, Dr. Soares and Dr. Sardi were sure: It was Zika.

“I actually felt a sense of relief,” Dr. Soares said. “The literature said it was much less aggressive than viruses we already deal with in Brazil.”

Source: New York Times


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