Singapore has so far detected more than 280 Zika infections since reporting its first case on Aug. 27.

Zika infections in pregnant women have been shown to cause microcephaly - a severe birth defect in which the head and brain are undersized - as well as other brain abnormalities. The connection between Zika and microcephaly first came to light last fall in Brazil, which has since confirmed more than 1,800 cases of the birth defect.

In adults, Zika infections have also been linked to a rare neurological syndrome known as Guillain-Barre, as well as other neurological disorders.

An analysis of two locally infected patients showed the Zika strain in Singapore likely evolved from a strain already circulating in Southeast Asia since the 1960s, the Straits Times newspaper said on its website.

The analysis will be made available for the benefit of the global scientific community, including the World Health Organization (WHO), the newspaper said.

On Wednesday, the WHO updated its assessment of the Zika virus as a cause of congenital brain abnormalities in babies and the Guillian-Barre syndrome, after considering months of research into the mosquito-borne disease. </s> Zika infections are expected to continue rising in the Asia-Pacific region, where authorities are increasing surveillance, preparing responses to complications and collaborating on information about the disease, the World Health Organization said Monday.

Complicating the fight against the virus, spread by mosquitoes, is the lack of a "foolproof" approach to mosquito control, as shown by decades of efforts to contain dengue virus, WHO Director General Margaret Chan said in her address to a Western Pacific regional meeting of the world health body.

She said other questions included why the first signs of the virus's existence in the Asia-Pacific region came from travelers whose infections were confirmed once they returned home.

"Is this weak surveillance an indication of population-wide immunity, or proof that the virus has somehow acquired greater epidemic potential?" she asked.

Zika symptoms are mild and no deaths have been reported globally, said Dr. Li Ailan, director for health security and emergencies at WHO's Western Pacific regional office. But she said based on WHO's risk assessment, Zika viral infection will continue to spread in the region and authorities are preparing for complications.

The complications include like microcephaly and Guillain-Barre syndrome. Babies born to Zika-infected mothers have been found to have microcephaly, or a birth defect where the head is abnormally small and brains might not have developed properly. Guillain-Barre syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system.

The Western Pacific region is the second most Zika-affected region in the world, Li said. Nineteen of its 27 countries have reported Zika cases since 2007 and 13 of them this year.

Dr. Shin Young-soo, WHO's Western Pacific regional head, said they are working very hard to increase surveillance and detection of Zika, and long-term response to the disease are among the topics to be discussed at the five-day conference. Those include detecting cases and reducing mosquito density, especially in high-risk locations, Dr. Li said. </s> Zika: Vietnamese authorities report first microcephaly case likely linked to mosquito-borne virus

Updated

Vietnam's Health Ministry has reported a microcephaly case that it says is likely to be the country's first linked to the mosquito-borne Zika virus.

The case, a four-month old baby whose mother was diagnosed with Zika when she was pregnant, was found in the central province of Dak Lak.

"This is a microcephaly case with a high probability of being related to the Zika virus and also the first such case in Vietnam," the General Department of Preventive Medicine, a department of the nation's health ministry, said in a statement posted on its official website.

Vietnam so far has reported a total of nine cases of Zika infection, with more cases expected to be confirmed in the next few days, the department's director Tran Dac Phu said.

If the microcephaly case is confirmed to be linked to Zika, Vietnam would become the second South-East Asian country after Thailand to report such a case.

Vietnam earlier this month raised the threat level for Zika and stepped up monitoring of pregnant women in the country after detecting more cases and amid growing outbreaks in the region.

Zika infections in pregnant women have been shown to cause microcephaly — a severe birth defect in which the head and brain are undersized — as well as other brain abnormalities.

The connection between Zika and microcephaly first came to light in Brazil, which has confirmed more than 1,800 cases of microcephaly.

In adults, Zika infections have also been linked to a rare neurological syndrome known as Guillain-Barre, as well as other neurological disorders.

Reuters

Topics: infectious-diseases-other, diseases-and-disorders, vietnam, asia

First posted </s> (CNN) The pictures from Brazil are heartbreaking: baby after baby born with a small head and damaged brain after an attack by the Zika virus during pregnancy. The official numbers are equally disturbing: The rate of birth defects involving the nervous system nearly doubled across Brazil after Zika arrived.

This stark statistical reality was discovered by a team of researchers from Brazil's Oswaldo Cruz Foundation, which analyzed hospital records across Brazil from 2008, well before Zika arrived, until the end of February 2016.

The researchers also looked for data on rare, potentially deadly inflammations of the brain and spinal cord such as encephalitis, myelitis, and encephalomyelitis, as well as Guillain-Barré syndrome , a disorder where the body's immune system attacks its own nerve cells, causing pain, paralysis and even death.

The results, published in the Centers for Disease Control and Prevention journal Emerging Infectious Diseases , found "an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis and encephalomyelitis" beginning in mid-2014.

That's more than a year before the world became aware of the outbreak in October 2015, and stories of Zika's terrible consequences began to appear in the news.

The numbers show the northeast region of Brazil, often considered the epicenter of the Zika outbreak, was indeed the hardest hit. Historical averages of congenital malformations were stable at about 40/100,000 live births until November of 2015. Then the number jumped to 170/100,000 births, four times higher.

Then, in the four months between November 2015 and February 2016, "a total of 1,027 hospitalizations for congenital malformations of the nervous system were recorded nationwide," the researchers said. Almost half, 448, occurred in the Northeast.

Rates of Guillain-Barré and encephalitis, myelitis and encephalomyelitis showed a similar increase in the Northeast. Hospitalizations for Guillain-Barré increased by nearly 3% until the outbreak peaked in July of last year, while the Northeast was the only area of the country to see an increase in CNS.

No one really knows why this section of Brazil was so unfortunate.

"It might be the economic environment," one researcher told CNN's Chief Medical correspondent Dr. Sanjay Gupta, during his visit to the northeastern city of Salvador just before the Olympic Games in Rio.

"Because of the poverty, we have a more closely packed population, and sanitary conditions are worse in this part of the country," said Dr. Jamary Oliveira Filho, a Harvard-trained neurologist who is studying the Zika outbreak. "It's the perfect setup for epidemic to occur, where there's already inadequate social conditions."

In their study, researchers from Oswaldo Cruz Foundation mention additional theories. One is that co-infection with dengue or chikungunya, two other viruses passed by the same mosquito that carries Zika, might be contributing to the devastating consequences of the virus. Another is that a drought, malnutrition and contamination of drinking water might be a contributing factor.

"The concentration of neuropathies in the northeast states remains a mystery for researchers and health surveillance services," said the researchers. "New detection tools for outbreaks should be pursued to identify real trends and, at the same time, minimize false alarms and panic that could be provoked in populations potentially affected by the Zika epidemic." </s> A 45-year old woman who lives in Iloilo city in the central Philippines has the virus, Dr Eric Tayag, spokesman at the health ministry, told a media briefing.

The woman is not pregnant, he said, and was recovering at her home. It was considered "highly likely" she had contracted the virus locally as she had no history of travel to any affected country in the past two weeks, Tayag said.

The Philippines reported its first case of Zika in 2012, that of a teenaged boy in Cebu island in the central Philippines. Four subsequent cases were foreigners.

A Zika outbreak is affecting large parts of Latin America and the Caribbean, with Brazil the hardest hit, but cases have been cropping up in Asia.

Singapore has reported more than 240 Zika cases since the first locally infected case was detected on Aug. 27 and neighboring Malaysia has reported one such case.

Zika infections in pregnant women have been shown to cause microcephaly - a severe birth defect in which the head and brain are undersized - as well as other brain abnormalities.

The connection between Zika and microcephaly first came to light last fall in Brazil, which has since confirmed more than 1,800 cases of microcephaly.

In adults, Zika infections have also been linked to a rare neurological syndrome known as Guillain-Barre, as well as other neurological disorders.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes. </s> The Zika virus that has spread to more than 50 countries is no longer considered an international public health emergency, the World Health Organization declared Friday. But the change in designation does not represent a downgrading of Zika's importance, officials said.

The WHO labeled Zika an international emergency in February primarily to understand what was causing the "extraordinary clustering" of microcephaly cases in Brazil, the epicenter of the outbreak, said David Heymann, who chairs the expert panel that made the recommendation. When the emergency was declared, he said, researchers had not yet proven that the mosquito-borne virus causes the severe birth defect characterized by an abnormally small head and underdeveloped brain.

Studies have since established the link between Zika and microcephaly. Now, the best way to tackle the virus and its serious complications is for the WHO to manage "this significant and enduring public health challenge" within the organization, Heymann said. That will allow for a more sustained focus, with more dedicated resources and expertise, he added.

"This represents an escalation into a major activity within WHO," he said at a press conference in Geneva. "If anything, it's escalated in importance."

Peter Salama, a senior WHO official, said Zika represents a set of long-term issues, including neurological complications in children as well as adults, family planning and maternal reproductive health, that will require a comprehensive research agenda and sustained financing over many years.

Yet many public health officials and experts are worried that this technical distinction may be lost and end up sending the wrong message about Zika - even as new cases seem to be emerging in Asia.

The virus, which is primarily transmitted by the Aedes aegypti mosquito, can be passed from a pregnant women to her fetus and cause a host of grave birth defects beyond microcephaly. These problems are collectively known as congenital Zika syndrome. The degree of fetal risk when a pregnant woman has been infected is still unknown.

The Centers for Disease Control and Prevention has been leading the Zika response in the United States and playing a major surveillance and research role in Brazil and other countries. It stressed Friday that despite the "technical declaration" by the WHO, Zika infection continues to be a serious threat to pregnant women, babies born to pregnant women with Zika and their families.

"There is still much to learn about the disease," the CDC statement said. "We need to learn more about Zika and its associated complications of microcephaly and other brain abnormalities, such as when Zika infection poses highest risk to a fetus during pregnancy and the magnitude of that risk. It remains crucially important that pregnant women avoid traveling to areas with local transmission of Zika, because of the devastating complications that can occur in fetuses that become infected during pregnancy."

The CDC said there is also urgent need to develop improved diagnostics and vaccines that can prevent infection and spread of the disease. Public health experts and clinicians need to better understand the risk of neurological complications in affected infants, children and adults, the risks of mosquito-borne and sexual transmission of Zika and how best to prevent Zika infection, the agency said.

The WHO's expert panel extensively discussed how the change in designation would be interpreted and whether that would make it harder to raise money for the international response, Heymann said.

In the end, Salama said, the organization hopes its donors will recognize that Zika is here to stay and that the world will need to deal with it for years to come. Zika and microcephaly will surface wherever there are vectors that can transmit the disease, the experts said.

Asked why the WHO did not drop the emergency designation in April when the CDC concluded that the virus causes microcephaly, Heymann said there were still outstanding worries about the upcoming Summer Olympics in Rio de Janeiro and "understanding what the risks were," he said.

The experts also addressed the continuing mystery about the relatively few cases of microcephaly outside of Brazil. Most of the 2,300 confirmed cases of microcephaly are in that country, with a few dozen also reported in Colombia, where there was a large Zika outbreak.

"The number of confirmed cases [of microcephaly] is less than what we did imagine," Salama said at the press conference. "But we know it's probably not the whole story." He cited biases in how cases were reported that could mean a "significant underestimate" of the toll worldwide.

So far, 28 countries have reported cases of microcephaly. Nineteen have reported adult cases of Guillain-Barré syndrome, which can cause paralysis, "so even though Brazil tops the list, this is not confined to Brazil nor will it be in the future," Salama said.

Researchers have been investigating whether other factors could explain Zika's damage in Brazil's hardest-hit northeast region, including genetic factors, environmental contaminants and co-infections.

A presentation by Brazilian officials to the WHO's Zika expert panel has not yet found a "co-factor" to explain why Zika is causing so much more microcephaly in Brazil, Heymann said. However, "these studies can't be done overnight." </s> (CNN) The Zika virus outbreak and related clusters of microcephaly are no longer a public health emergency of international concern, the World Health Organization said Friday.

This ends the declaration made by the organization in February due to the simultaneous spread of the virus and "extraordinary clusters" of microcephaly among babies born in areas where the virus was spreading.

"We are not downgrading the importance of Zika. By placing this as a long-term program of work, we are saying Zika is here to stay," said Dr. David Heymann, the chairman of the emergency committee on Zika virus and microcephaly, which made the announcement.

In February, it was not known that the virus was the cause of the neurological birth defect. In April, the WHO said the virus definitely causes microcephaly in babies and Guillain-Barré Syndrome in adults.

"The source of the concern was not that there was Zika, it was extraordinary clustering of microcephaly that hadn't been seen before at a time when lots of infection was occurring," Heymann said.

The declaration put into motion research, coordination and funding to answer that and many other questions about the virus, which was initially thought to be a mild mosquito-borne disease. Now it's known that in addition to the devastating neurological complications it can cause, the virus can be sexually transmitted

"There is still a lot of unknowns here, which is why it's so important to have a multiyear plan and program in place," said Dr. Peter Salama, executive director of the WHO's health emergencies program.

Although mosquito season has ended in some areas of the world and transmission of the virus has slowed, it is far from gone. "This disease is like all endemic diseases that have a seasonal appearance," Heymann said.

That is why the WHO's emergency committee recommended the change announced today, emphasizing that Zika is still a high priority. Now, the organization will create a technical committee to handle Zika research, vaccine development and other efforts going forward.

"A robust longer-term technical mechanism was now required to manage the global response," the committee determined.

Calling the WHO's action "a reasonable decision," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, nonetheless said the organization "should be prepared to re-examine the decision if, in fact, we have a resurgence of Zika in South America as we enter into the summer months of January and February in the Southern Hemisphere."

Heymann said the WHO was prepared to do so.

The US Centers for Disease Control and Prevention said in a statement that the move does not change the need to continue efforts to combat the virus and its effects.

"Zika infection continues to be a serious threat to pregnant women, babies born to pregnant women with Zika, and their families. There is still much to learn about the disease. We need to learn more about Zika and its associated complications of microcephaly and other brain abnormalities, such as when Zika infection poses highest risk to a fetus during pregnancy, and the magnitude of that risk," the statement said.

As anticipated, the virus is continuing to spread around the world and is circulating in more than 60 countries and territories. Microcephaly and other neurological complications linked to the virus have been reported in at least 28 countries. Of the 2,300 confirmed cases of microcephaly, the majority have been in Brazil, where an increase in babies born with the condition was first seen last year . It's believed that this is only a portion of the actual number of such cases.

Thus, the CDC said, "It remains crucially important that pregnant women avoid traveling to areas with local transmission of Zika, because of the devastating complications that can occur in fetuses that become infected during pregnancy." </s> The case, a four-month old baby whose mother was diagnosed with Zika when she was pregnant, was found in the central province of Dak Lak.

"This is a microcephaly case with a high probability of being related to the Zika virus and also the first such case in Vietnam," the General Department of Preventive Medicine, a department of the nation's health ministry, said in a statement posted on its official website.

Vietnam so far has reported a total nine cases of Zika infection, with more cases expected to be confirmed in the next few days, the department's director Tran Dac Phu told Reuters on Sunday.

If the microcephaly case is confirmed to be linked to Zika, Vietnam would become the second Southeast Asian country after Thailand to report such a case.

Vietnam earlier this month raised the threat level for Zika and stepped up monitoring of pregnant women in the country after detecting more cases and amid growing outbreaks in the region.

Zika infections in pregnant women have been shown to cause microcephaly - a severe birth defect in which the head and brain are undersized - as well as other brain abnormalities.

The connection between Zika and microcephaly first came to light in Brazil, which has confirmed more than 1,800 cases of microcephaly.

In adults, Zika infections have also been linked to a rare neurological syndrome known as Guillain-Barre, as well as other neurological disorders. </s> The Florida Department of Agriculture and Consumer Services announced Friday that it has detected Zika in another mosquito sample from the same small area in Miami Beach where it was announced on Sept. 1 that three other samples had tested positive for Zika.

All samples have consisted of Aedes aeqypti mosquitoes and are from an area where increased trapping and intensified mosquito control measures have already been underway since the Florida Department of Health determined local transmission had occurred.

There have been 571 reported cases of travel-acquired Zika cases in Florida so far. There have been 43 cases of locally-acquired infection in the Miami area.

For almost six months the U.S. Congress has failed to pass a funding bill needed to speed up research and control of the Zika virus, which causes a severe brain defect in unborn children called microcephaly or “tiny head” syndrome and causes Guillain-Barré syndrome in adults, which can be crippling as well as deadly.

There is no vaccine for Zika and no cure.

Mosquitoes, sexual contact with someone infected and contact with infected blood can transmit the virus to humans.

Some emergency funds from the Department of Health and Human Services and the Centers for Disease Control and Prevention have been released, but the amount needed is not enough and not soon enough to stop the spread so far.

There have been 24 sexually transmitted cases reported in the U.S. so far.

“The fact that we have identified a fourth Zika-positive mosquito pool in Miami Beach serves as further confirmation that we must continue our proactive and aggressive approach to controlling the mosquito population, including our recent decision to begin aerial spraying in combination with larvicide treatment by truck,” said Miami-Dade County Mayor Carlos A. Gimenez. “We will continue to work in close collaboration with the health and environmental experts and the City of Miami Beach to keep our community safe from the Zika virus.”

On Friday the US Department of Health and Human Services issued the following update to national Zika statistics:

Zika Case Count: As of September 7, there were more than 18,800 confirmed cases of Zika virus in U.S. states and territories.
•2,964 confirmed cases of Zika in U.S. States and District of Columbia.
•15,869 confirmed cases of Zika in U.S. territories.

Pregnant women with evidence of Zika virus: As of September 1, there were more than 1,750 pregnant women with evidence of Zika virus.
•671 pregnant women in U.S. states and District of Columbia.

In addition, there have been 38 cases of Guillain-Barré syndrome in the U.S. and U.S. territories.

For a state-by-state table of Zika cases in the U.S. visit: http://www.cdc.gov/zika/geo/united-states.html
The Ministry of Health of Peru reports that so far this year, 548 people have contracted Guillain–Barré syndrome in an outbreak in the country. It also clarified that in the five cases in which patients died, death was caused by complications with other serious diseases.