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In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival. We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams. Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores −1·54 vs −3·13, difference 1·58 [95% CI 1·45–1·72]); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0·28 [95% CI 0·14–0·56]); and were less likely to have a history of rash during pregnancy (20·7% vs 61·4%, ratio 0·34 [95% CI 0·27–0·42]). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above −2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015. Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies. Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.

In this population-based cohort study that included data on all live births in Brazil from 2015 to 2018, infants with congenital Zika syndrome had substantially higher mortality over the first 3 years of life than those without the syndrome.

Objective This study aims to describe clinical findings and determine the medium-term survival of congenital zika syndrome (CZS) suspected cases. Methods A retrospective cohort study using routine register-based linked data. It included all suspected cases of CZS born in Brazil from January 1, 2015, to December 31, 2018, and followed up from birth until death, 36 months, or December 31, 2018, whichever came first. Latent class analysis was used to cluster unconfirmed cases into classes with similar combinations of anthropometry at birth, imaging findings, maternally reported rash, region, and year of birth. Kaplan–Meier curves were plotted, and Cox proportional hazards models were fitted to determine mortality up to 36 months. Results We followed 11,850 suspected cases of CZS, of which 28.3% were confirmed, 9.3% inconclusive and 62.4% unconfirmed. Confirmed cases had almost two times higher mortality when compared with unconfirmed cases. Among unconfirmed cases, we identified three distinct clusters with different mortality trajectories. The highest mortality risk was observed in those with abnormal imaging findings compatible with congenital infections (HR = 12.6; IC95%8.8–18.0) and other abnormalities (HR = 11.6; IC95%8.6–15.6) compared with those with normal imaging findings. The risk was high in those with severe microcephaly (HR = 8.2; IC95%6.4–10.6) and macrocephaly (HR = 6.6; IC95%4.5–9.7) compared with normal head size. Conclusion Abnormal imaging and head circumference appear to be the main drivers of the increased mortality among suspected cases of CZS. We suggest identifying children who are more likely to die and have a greater need to optimise interventions and resource allocation regardless of the final diagnoses.

Zika virus (ZIKV) became a worldwide public health emergency after its introduction in the Americas. Brazil was implicated as central in the ZIKV dispersion, however, a better understanding of the pathways the virus took to arrive in Brazil and the dispersion within the country is needed. An updated genome dataset was assembled with publicly available data. Bayesian phylogeography methods were applied to reconstruct the spatiotemporal history of ZIKV in the Americas and with more detail inside Brazil. Our analyses reconstructed the Brazilian state of Pernambuco as the likely point of introduction of ZIKV in Brazil, possibly during the 2013 Confederations Cup. Pernambuco played an important role in spreading the virus to other Brazilian states. Our results also underscore the long cryptic circulation of ZIKV in all analyzed locations in Brazil. Conclusions: This study brings new insights about the early moments of ZIKV in the Americas, especially regarding the Brazil-Haiti cluster at the base of the American clade and describing for the first time migration patterns within Brazil.

Zika virus has spread rapidly throughout the Americas and has been associated with fetal abnormalities and a variety of neurologic disorders. This report updates the epidemiologic findings over the past 2 years. To the Editor: The first cases of a new illness involving fever and rash that was deemed to have been caused by Zika virus (ZIKV) infection in Brazil were reported in 2014, and the presence of the virus was confirmed in April 2015. In October 2015, an unusual increase in the number of cases of microcephaly among newborn infants was reported in Brazil; this disorder was apparently linked to ZIKV infection. From the first investigations of microcephaly, and from subsequent studies in Brazil and elsewhere, it is now clear that ZIKV is a cause of a range of neurologic disorders, . . .

In April/2004, a group of people traveled to a farm in a town in the south of Bahia and afterwards, three teenagers from the same family developed symptoms of severe septicemia and two died. The Health Department carried out an epidemiologic, clinical, laboratory and environmental investigation that resulted in the identification of Chromobacterium violaceum, in biological material from one of them, water and soil. This is the first report of the disease in Bahia State.

Em abril/2004, um grupo de pessoas realizou passeio a um sítio em cidade no baixo sul da Bahia e em seguida três adolescentes de uma mesma família apresentaram septicemia grave com óbito de dois destes. Objetivando identificar o evento, o Serviço de Vigilância procedeu à investigação epidemiológica, clínica, laboratorial e ambiental, identificando a Chromobacterium violaceum em material biológico de um dos pacientes que evoluíram para óbito e na água e solo do local do passeio. Esta é o primeira descrição desta doença na Bahia.In April/2004, a group of people traveled to a farm in a town in the south of Bahia and afterwards, three teenagers from the same family developed symptoms of severe septicemia and two died. The Health Department carried out an epidemiologic, clinical, laboratory and environmental investigation that resulted in the identification of Chromobacterium violaceum, in biological material from one of them, water and soil. This is the first report of the disease in Bahia State.

Em abril/2004, um grupo de pessoas realizou passeio a um sítio em cidade no baixo sul da Bahia e em seguida três adolescentes de uma mesma família apresentaram septicemia grave com óbito de dois destes. Objetivando identificar o evento, o Serviço de Vigilância procedeu à investigação epidemiológica, clínica, laboratorial e ambiental, identificando a Chromobacterium violaceum em material biológico de um dos pacientes que evoluíram para óbito e na água e solo do local do passeio. Esta é o primeira descrição desta doença na Bahia. In April/2004, a group of people traveled to a farm in a town in the south of Bahia and afterwards, three teenagers from the same family developed symptoms of severe septicemia and two died. The Health Department carried out an epidemiologic, clinical, laboratory and environmental investigation that resulted in the identification of Chromobacterium violaceum, in biological material from one of them, water and soil. This is the first report of the disease in Bahia State.