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... The two quantitative studies used surveys to collect data. 10 22 Study participants included medical doctors, 8 11 30 31 33 35 medical residents, 9 25 36 medical students, 12 emergency crisis management teams, 40 patients 10 13 22 27 38 39 41 42 and parents of patients. 29 43 Details of data extracted from included studies are provided in online supplemental file 4. ...
... An example from the primary studies is the global uncertainty created by the Zika virus pandemic. 40 "Uncertainty, in sum, was crucial in categorizing the Zika crisis as an international emergency. This was a particular form of unknowing, however, understood by key global health institutions, most notably the WHO, as the confusion created by the absence of a scientific consensus on the nature of the association between ZIKV infection and microcephaly". ...
... This was a particular form of unknowing, however, understood by key global health institutions, most notably the WHO, as the confusion created by the absence of a scientific consensus on the nature of the association between ZIKV infection and microcephaly". 40 Theme: public health uncertainty Uncertainty regarding issues that affect the health of the population of a particular country or community or society, which are within the realms of national boundaries. ...
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Introduction Uncertainty is an inevitable part of healthcare and a source of confusion and challenge to decision-making. Several taxonomies of uncertainty have been developed, but mainly focus on decisions in clinical settings. Our goal was to develop a holistic model of uncertainty that can be applied to both clinical as well as public and global health scenarios. Methods We searched Medline, Embase, CINAHL, Scopus and Google scholar in March 2021 for literature reviews, qualitative studies and case studies related to classifications or models of uncertainty in healthcare. Empirical articles were assessed for study limitations using the Critical Appraisal Skills Programme (CASP) checklist. We synthesised the literature using a thematic analysis and developed a dynamic multilevel model of uncertainty. We sought patient input to assess relatability of the model and applied it to two case examples. Results We screened 4125 studies and included 15 empirical studies, 13 literature reviews and 5 case studies. We identified 77 codes and organised these into 26 descriptive and 11 analytical themes of uncertainty. The themes identified are global, public health, healthcare system, clinical, ethical, relational, personal, knowledge exchange, epistemic, aleatoric and parameter uncertainty. The themes were included in a model, which captures the macro, meso and microlevels and the inter-relatedness of uncertainty. We successfully piloted the model on one public health example and an environmental topic. The main limitations are that the research input into our model predominantly came from North America and Europe, and that we have not yet tested the model in a real-life setting. Conclusion We developed a model that can comprehensively capture uncertainty in public and global health scenarios. It builds on models that focus solely on clinical settings by including social and political contexts and emphasising the dynamic interplay between different areas of uncertainty.
... But, there are some areas of medicine where these expectations can be difficult to meet. For example, Kelly et al. (2020) demonstrated how providers and scientists working to address the 2015 Brazilian Zika crisis were ill-prepared to meet patient's basic needs because they lacked clinical knowledge of the virus itself. As the crisis unfolded, the persistence of these knowledge gaps was exacerbated by the inability to study the timeline of transmission for the virus, and in the years since the crisis, the long-term effects of the virus remain unknown. ...
... As the crisis unfolded, the persistence of these knowledge gaps was exacerbated by the inability to study the timeline of transmission for the virus, and in the years since the crisis, the long-term effects of the virus remain unknown. While Kelly et al. (2020) were working at the cross section of medical emergencies, knowledge gaps, and decision-making, our work is framed by these broader areas of study in health decision-making and asks: how do providers respond to nonurgent medical requests when they do not have expertise within a particular medical domain, yet are called upon to exemplify their competence and medical knowledge? ...
... Furthermore, the effects and ravages that Zika caused in Colombian families, are unknown. The Ebola, Cholera, Zika, and COVID-19 outbreaks raised the need to understand the social pathways of disease transmission and barriers affecting populations at risk [32,33]. The role of Anthropology in emerging outbreaks has raised global awareness for the integration of sociocultural approaches in response to international health crises [32,33]. ...
... The Ebola, Cholera, Zika, and COVID-19 outbreaks raised the need to understand the social pathways of disease transmission and barriers affecting populations at risk [32,33]. The role of Anthropology in emerging outbreaks has raised global awareness for the integration of sociocultural approaches in response to international health crises [32,33]. The present study aimed to explore the views, perceptions, and attitudes, towards ZIKV, and challenges, including barriers and facilitators to medical follow-up of children born with microcephaly in the ZIKV epidemic in Caribbean Colombia, faced by their primary caregivers: their mothers. ...
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Background The epidemic of Zika virus (ZIKV) was associated with a sudden and unprecedented increase in infants born with microcephaly. Colombia was the second most affected country by the epidemic in the Americas. Primary caregivers of children with ZIKV-associated microcephaly, their mothers mainly, were at higher risk of suffering anxiety and depression. Often, these women were stigmatized and abandoned by their partners, relatives, and communities. Methodology/Principal findings This study aimed to understand the perceptions about ZIKV infection among mothers of children born with microcephaly during the ZIKV epidemic in Caribbean Colombia, and the barriers and facilitators affecting child health follow-up. An exploratory qualitative study, based on Phenomenology and Grounded Theory, was conducted in Caribbean Colombia. Data were collected through In-Depth Interviews (IDI) from women who delivered a baby with microcephaly during the ZIKV epidemic at Clínica Salud Social, Sincelejo, Sucre District (N = 11). The themes that emerged during the interviews included experiences from their lives before pregnancy; knowledge about ZIKV; experiences and perceptions when diagnosed; considering a possible termination of pregnancy, and children’s clinical follow-up. In some cases, women reported having been told they were having a baby with microcephaly but decided not to terminate the pregnancy; while in other cases, women found out about their newborn’s microcephaly condition only at birth. The main barriers encountered by participants during children’s follow-up included the lack of psychosocial and economic support, the stigmatization and abandonment by some partners and relatives, and the frustration of seeing the impaired development of their children. Conclusions This study contributed to identifying the social, medical, psychological, and economic needs of families with children affected by the ZIKV epidemic. Commitment and action by local and national governments, and international bodies, is required to ensure sustained and quality health services by affected children and their families.
... Estudiosos indicaram que a incerteza foi uma característica definidora da epidemia brasileira de Zika (Kelly et al. 2020), ao passo que nós identificamos duas certezas que rapidamente surgiram na narrativa de saúde pública: (1) a certeza de que o foco deveria ser a transmissão não humana (picadas de mosquito), definido como parte de uma questão histórica de saúde pública; ...
... While scholars have pointed out that uncertainty was a defining feature of the Brazilian Zika epidemic (Kelly et al. 2020), we identify how two certainties quickly emerged in the public health narrative: (1) a certainty that the focus should be on non-human transmission (mosquito's bites), framed as part of a historical public health matter and (2) a certainty that a gendered approach to assigning responsibility was the most effective solution to mitigate Zika's effects. In other words, women should be responsible for protecting themselves and their (future) children from the bite of a potentially infected mosquito. ...
... Enquanto a maioria dos estudos antropológicos examinando Zika no Brasil destacaram a incerteza como característica definidora da epidemia (DINIZ, 2016;HENDERSON;BARDOSH, 2020;KELLY et al., 2020;PRADO, 2018), neste artigo nós nos debruçamos sobre duas certezas que rapidamente se constituíram na narrativa de saúde pública. A primeira: a certeza de que o foco deveria ser a transmissão não humana (picadas de mosquito), enquadrado como parte de uma questão histórica. ...
... O sangue obtido da picada é necessário para que mosquitos possam assegurar sua reprodução, ao passo que para os humanos serem picados pode ser não apenas irritante, como também perigoso. O momento em que a probóscide do inseto entra em contato com a pele e em que sangue e saliva se misturam revela a permeabilidade e porosidade do corpo humano -uma interação multiespécie em que a troca de fluídos representa a sobrevivência para uns, mas uma potencial ameaça para outros (REIS-CASTRO, 2020 Os enunciados que abrem esta seção, proferidos pelo Ministro da Saúde durante a epidemia, remetem, de maneira quase caricaturada, ao cerne do nosso argumento: na resposta ao Zika, houve uma ênfase, não apenas na transmissão vetorial, mas também na transmissão vertical como uma responsabilidade de mulheres/mães. Abordamos aqui esta transmissão e a maneira pela qual, após as imagens de crianças com cabeças pequenas desencadear várias indagações científicas relacionadas à capacidade do vírus de cruzar a "barreira placentária", a obrigação de se proteger do Zika recaiu sobre gestantes e pessoas capazes de gestar. ...
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No Brasil, Zika é apresentado como um vírus transmitido somente por mosquitos e a epidemia como uma preocupação somente para mulheres. Para examinar essa errônea caracterização, este artigo investiga as múltiplas rotas de transmissão do vírus Zika: transmissão vetorial (através da picada de um mosquito), transmissão por fluidos (através, por exemplo, do sêmen) e transmissão vertical (através da placenta para o feto no útero). Ao analisarmos a passagem de patógenos de um organismo para outro e as formas como essas passagens são entendidas, investigadas e (des)consideradas, abordamos, simultaneamente, aspectos biológicos e culturais. Argumentamos que uma antropologia, centrada na transmissão, permite elucidar as materialidades corporais, os significados simbólicos e as consequências políticas do movimento de patógenos de um organismo para outro, como relações entre humanos e não humanos. Sugerimos que essa “antropologia da transmissão” também possibilita o desenvolvimento de políticas públicas mais abrangentes e inclusivas.
... Particularly, stress experienced during the pandemic is associated with less compliance [4]. Likewise, in previous infectious disease outbreaks, such as Ebola, Zika, and the H1N1 virus, experienced uncertainties and barriers to information have contributed to reduced public adherence to preventive measures [5][6][7][8][9]. Appropriate communication about the knowns and unknowns of an outbreak, therefore, becomes of utmost importance to avoid confusion with, and reluctance to, recommended public health measures among affected communities. ...
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Background During outbreaks, uncertainties experienced by affected communities can influence their compliance to government guidance on public health. Communicators and authorities are, hence, encouraged to acknowledge and address such uncertainties. However, in the midst of public health crises, it can become difficult to define and identify uncertainties that are most relevant to address. We analyzed data on COVID-19-related uncertainties from four socio-economic contexts to explore how uncertainties can influence people’s perception of, and response to Risk Communication and Community Engagement (RCCE) strategies. Results This qualitative study, which adopts an interpretative approach, is based on data from a documentary review, key informant interviews (KII), and focus group discussions (FGD) with members of the general public and people with barriers to information from Germany, Guinea, Nigeria, and Singapore. Transcripts from the KII and FGD were coded and analyzed thematically. We interviewed a total of 155 KIs and conducted 73 FGD. Our analysis uncovered a divergence between uncertainties deemed relevant by stakeholders involved in policy making and uncertainties that people reportedly had to navigate in their everyday lives and which they considered relevant during the pandemic. We identified four types of uncertainties that seemed to have influenced people’s assessment of the disease risk and their trust in the pandemic control strategies including RCCE efforts: epidemiological uncertainties (related to the nature and severity of the virus), information uncertainties (related to access to reliable information), social uncertainties (related to social behavior in times of heightened risk), and economic uncertainties (related to financial insecurities). Conclusion We suggest that in future outbreaks, communicators and policy makers could improve the way in which affected communities assess their risk, and increase the trust of these communities in response efforts by addressing non-epidemiological uncertainties in RCCE strategies.
... We characterise this assertion as 'uncertain data as implicit evidence of hidden data' and point to the structural effects that uncertainty plays in determining how scientific resources are distributed in order to fill 'knowledge gaps'. As Kelly et al. (2020) highlight, clinical and public health uncertainty define global health problems in ways that reflect wider cultures and power dynamics. ...
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For the past several decades, global health research and policy have raised the alarm about the growing threat of counterfeit and low-quality drugs (henceforth ‘fakes’). These high-profile and regularly-repeated claims about ‘fake drugs’ pepper scholarly publications, grey literature, and popular writing. We reviewed much of this work and found that it shares two characteristics that sit awkwardly alongside one another. First, it asserts that fake drugs constitute an urgent threat to lives. Second, it reports trouble with ‘gaps’ in the evidence on which their claims are based; that data is weaker and less conclusive than anticipated. Given the ubiquity of and urgency with these claims are made, we found this juxtaposition perplexing. To understand this juxtaposition better, we undertook a close reading of the strategies authors employed to negotiate and overcome data and evidence ‘gaps’ and asked questions about the cultures of scholarly publishing in global health research. We argue that a scholarly commitment to studying fakes despite--rather than because of—the evidence functions to support the continuation of similar research. It also works against asking different questions—for instance regarding the lack of easy access to pharmacological data that might make it possible to know fakes differently.
... The framing of epidemics defines public health policies and health research [28,29]. Some studies that showed how Zika's representation as an epidemic centered on mosquitoes and women are based on a limited conceptualization of virus transmission, human sexuality and reproduction [30]. ...
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Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences for pregnancies have made governments and both national and international agencies issue advice and recommendations to women. This study was designed to understand the impacts of Zika on women who were less directly affected and less vulnerable to Zika. Women were recruited from various locations in Brazil, Puerto Rico, and the United States. Data were collected through semi-structured interviews and analyzed using thematic analysis. Women perceived that public health systems placed an unfair responsibility for preventing health complications from Zika onto women who had limited ability to do so. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Gender inequality and discrimination must be recognized and rendered visible in the public health emergency response. The social effects of the epidemic affected women more than had been thought before and at deeper emotional levels.
... Dissemination is a learned response to stress; in uncertain circumstances, dissemination activities are frequent [24]. Uncertainty in public health emergency includes three dimensions: global health uncertainty, which is a "gap" in existing scientific knowledge about the virus; public health uncertainty, which is the difficulty in determining the epidemiological risk distribution; and clinical uncertainty, which refers to whether effective treatment can be provided [25]. Uncertainty can trigger negative feelings, such as stress and anxiety [26], and may cause people to engage in various communication behaviors, such as actively seeking information [27]. ...
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Background: COVID-19 has greatly attacked China, spreading in the whole world. Articles were posted on many official WeChat accounts to transmit health information about this pandemic. The public also sought related information via social media more frequently. However, little is known about what kinds of information satisfy them better. This study aimed to explore the characteristics of health information dissemination that affected users’ information behavior on WeChat. Methods: Two-wave data were collected from the top 200 WeChat official accounts on the Xigua website. The data included the change in the number of followers and the total number of likes on each account in a 7-day period, as well as the number of each type of article and headlines about coronavirus. It was used to developed regression models and conduct content analysis to figure out information characteristics in quantity and content. Results: For nonmedical institution accounts in the model, report and story types of articles had positive effects on users’ following behaviors. The number of headlines on coronavirus positively impacts liking behaviors. For medical institution accounts, report and science types had a positive effect, too. In the content analysis, several common characteristics were identified. Conclusions: Characteristics in terms of the quantity and content in health information dissemination contribute to users’ information behavior. In terms of the content in the headlines, via coding and word frequency analysis, organizational structure, multimedia applications, and instructions—the common dimension in different articles—composed the common features in information that impacted users’ liking behaviors.
... Emerging evidence from around the world indicates that women pregnant during the current COVID-19 pandemic are experiencing moderate to high levels of psychological distress (Saccone et al., 2020;Taubman -Ben-Ari et al., 2020;Wu et al., 2020). This finding is a likely the result of the social, economic, and healthcare disruptions that are affecting pregnant women and their families as well as uncertainty regarding the effect of COVID-19 on the fetus (Caparros-Gonzalez and Alderdice, 2020; Kelly et al., 2020;Lebel et al., 2020). ...
Article
Rationale: Women pregnant during the COVID-19 pandemic are experiencing moderate to high levels of emotional distress, which has previously been shown to be attributable to two types of pandemic-related pregnancy stress: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress) and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). Objective: Given the well-documented harms associated with elevated prenatal stress and the critical importance of developing appropriately targeted interventions, we investigated factors predictive of pandemic-related pregnancy stress. Method: Between April 25 and May 15, 2020, 4,451 pregnant women in the U.S. were recruited via social media to complete an online questionnaire that included sociodemographic, medical, and COVID-19 situational factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Binary logistic regression was used to calculate odds ratios for high stress. Results: Nearly 30% of participants reported high Preparedness Stress; a similar proportion reported high Perinatal Infection Stress. Abuse history, chronic illness, income loss due to the pandemic, perceived risk of having had COVID-19, alterations to prenatal appointments, high-risk pregnancy, and being a woman of color were associated with greater levels of one or both types of stress. Access to outdoor space, older age, and engagement in healthy behaviors were protective against stress. Conclusions: Practices that may alleviate pandemic-related stress such as minimizing disruptions to prenatal care, ensuring access to outdoor space, and motivating engagement in health behaviors are of vital importance. Particular attention is needed for more vulnerable populations including women of color, women with a history of abuse, and those with high-risk pregnancy. Research focused on the short and longer-term impact of pandemic-related pregnancy stress on maternal mental and physical health, perinatal outcomes, and child development is critical to identify these effects and marshal appropriate resources to reduce them.
... The whole spectrum of the consequences of the epidemics cannot be explained just from a clinical or epidemiological view. In turn, interdisciplinarity is essential to understand the toll of carrying a child with ZIKV-related disabilities; the mental health of populations affected by ZIKV, especially of caregivers of children with disabilities, suffering during pregnancy for uncertainties regarding to child health; socio-economic impoverishment due to special care needs; and ZIKV-associated stigma [6,7]. Studies addressing the socio-economic impact of the ZIKV infection among affected families are scarce. ...
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Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015-2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women's willingness to be vaccinated, and potential barriers and facilitators for vaccine acceptance in 1) migrant women living in Spain who travelled to their countries of origin and were diagnosed with ZIKV infection during pregnancy, and their healthcare providers, and 2) women living in Colombia who delivered a child with microcephaly. An exploratory qualitative study based on phenomenology and grounded theory was conducted. Data were collected through in-depth, paired and semi-structured interviews. Overall, women from both sites were willing to receive a hypothetical ZIKV vaccine. However, some expressed concerns of being vaccinated during pregnancy, yet they would accept it if the vaccine was recommended by a healthcare professional they trust. Main fears towards vaccination were related to vaccine safety and potential adverse effects on child's health. Women reported feeling hesitant to participate in a ZIKV vaccine trial. These results may contribute to guiding the effective delivery of future ZIKV vaccines among populations most at risk and particularly vulnerable.
... (3) Las situaciones de crisis asociadas a desastres (tanto naturales como producidos por el ser humano) desencadenan mucha ansiedad e incertidumbre para los individuos y las sociedades sobre lo que puede deparar el futuro. (4) Las crisis no afectan de forma directa a todas las personas, aunque, de forma indirecta, su impacto puede extenderse mucho más debido al efecto de la incertidumbre, el miedo y la angustia psicológica. Indudablemente, hay un impacto psicológico significativo asociado con un evento de crisis (5) ; por eso, para ayudar a las personas, es importante comprender cuál puede ser la magnitud de la crisis y qué desafíos puede plantear. ...
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RESUMEN Introducción: Las situaciones de crisis asociadas con los desastres (naturales y ocasionados por el ser humano) tienen efectos importantes en el bienestar psicológico de los trabajadores. Objetivo: Este documento examina estos efectos a nivel personal, familiar, laboral y organizacional, sintetizando los resultados de 30 artículos incluidos en esta revisión bibliográfica. Material y método: En una búsqueda de bibliografía de 240 artículos en varias bases de datos, se seleccionaron 30 artículos que cumplieron los criterios para ser incluidos en esta revisión. Resultados: el deterioro del bienestar psicológico (miedo, ansiedad, estrés), de las relaciones familiares y sociales, el aislamiento, los cambios en los sistemas y estructuras de trabajo (teletrabajo, reestructuración de equipos y tareas), y los cambios en las políticas organizacionales, son algunos de los principales efectos de las crisis que afectan el bienestar de los trabajadores. Conclusiones: Conocer los efectos de las crisis sobre el bienestar psicológico ayuda a elaborar mejores planes de apoyo y recuperación. Se señalan algunas estrategias que facilitan la recuperación de los efectos negativos de las crisis. ABSTRACT Introduction: Crises associated with disasters (natural and man-made) have important effects on the psychological well-being of workers. Objective: This document examines these effects at a personal , family, work and organizational level, synthesizing the results of 30 articles included in this bibliographic review. Material and method: In a bibliography search of 240 articles in various databases, 30 articles were selected that met the criteria for inclusion in this review. Results: Psychological well-being deterioration (fear, anxiety, stress), family and social relationships decline, isolation, changes in work systems and structures (telework, restructuring of teams and tasks), and changes in organizational policies, are some of the main effects of crises that affect the well-being of workers. Conclusions: Knowing the effects of crises on psychological well-being helps to develop better support and recovery plans. Some strategies are pointed out that facilitate recovery from the negative effects of crises.
... We argue that the failure for a meaningful national discussion on reproductive rights as part of the response to the Zika outbreak was the dominance of global health security's biomedical, clinical, public health and epidemiological narratives (Kelly et al., 2020;Harris et al., 2016) in Brazil, Colombia and El Salvador. Whether this was strategic decision or a downstream effect of the dominance of global health security narratives within mainstream response to national disease control, the result was that SRH was ignored (González Vélez and Diniz, 2016;Roa, 2016). ...
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The Zika outbreak of 2015-7 is a lens to analyse the positioning of abortion within in global health security. The sequelae of the virus almost exclusively affected newborn children, manifested through Congenital Zika Syndrome (CZS), and a focus on women at risk of, planning or being pregnant. At the global level, debate considered whether Zika would provide impetus for regulatory change for reproductive rights in Latin America, a region with some of the most restrictive abortion regulation in the world. However, regulatory change for abortion did not occur. We analyse why the Zika health emergency did not lead to any changes in abortion regulation through multi-method analysis of the intersection between Zika, health emergencies and abortion in Brazil, Colombia and El Salvador. These case study countries were purposefully selected; each had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for abortion. Our comparative research is multi-method: framework analysis of key informant interviews (n = 49); content analysis of women's enquiries to a medical abortion telemedicine provider; and, policy analysis of (inter)national-level Zika response and abortion policies. We consider this within literature on global health security, and the prioritisation of a particular approach to epidemic control. Within this securitized landscape, despite increased public debate about abortion regulatory change, no meaningful change occurred, due to a dominant epidemiological approach to the Zika health emergency in all three countries and prominent conservative forces in government and within anti-abortion rights movements. Simultaneously, we demonstrate that regulation did not deter all women from seeking such service clandestinely.
... Well before the COVID-19 crisis, the response to the HIV, Ebola or Zika epidemics showed that 'therapeutic geographies' continued to be profoundly shaped by histories of race, colonial legacies and postcolonial geopolitics. [19][20][21] Longstanding discontent over the exclusion of expertise from the global South, the growing bifurcation between those providing and those receiving global health assistance, and the racialised nature of access to care in the global North have also come into sharper focus. [22][23][24][25] In the meantime, new geopolitical cleavages, growing protectionism, the sidelining of the climate emergency, and the dissemination of powerful but unevenly impactful digital technologies are changing the meaning of 'global' and 'health' in rapid and at times unpredictable ways. ...
... Even the accurate detection and etiological diagnosis of congenital microcephaly in general can be difficult, especially in developing countries [35]; consequently, patients may remain undiagnosed [36]. Some of the charts available for measurement of occipitofrontal circumference are the WHO chart [19], INTERGROWTH study charts [20] and Fenton growth charts [37], which are used worldwide, thus providing a comparable standard. ...
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Purpose To describe ocular findings in infants with signs of congenital Zika virus syndrome (CZS) in Paraíba, Brazil, as well as to conduct a literature review and report correlations with published clinical cases. Methods In the Paraíba sample, infants with microcephaly suggestive of CZS were classified as Z (confirmed), PZ (probable), or SZ (suspected) according to serological testing and/or clinical findings of CZS. The patients underwent a clinical eye examination, and the results were correlated with published clinical cases. Results Ocular findings were present in 24 (42.9%) of 56 patients, consisting of gross retinal pigmentation in 11 (45.8%), macular chorioretinal atrophy in 11 (45.8%), optic nerve hypoplasia in 1 (4.2%), optic nerve pallor in 14 (58.3%), and increased cup-to-disk ratio in 2 (8.3%). The study revealed retina and optic nerve findings consistent with previous reports of ophthalmic involvement in CZS. However, external ocular changes observed in other studies were not detected. Conclusion Ocular findings similar and consistent with the literature on CZS were observed with considerable frequency and severity, regardless of the patients’ serological confirmation or classification. Infants with signs of CZS should undergo ocular examination.
... As the Brazilian government struggled to mount an effective response in what was quickly becoming the epicentre of a global outbreak, key gaps in virological, pathological and epidemiological knowledge became the focus of urgent attention. On 1 February 2016, the WHO declared a Public Health Emergency of International Concern (PHEIC), with the explicit goal of addressing these epistemic and technical deficits (Heymann et al., 2016;Kelly et al., 2020). Without a rapid and significant investment in Zika research and development (R&D), the options for intervening in the epidemic, let alone bringing it to a halt, appeared limited. ...
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When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of ‘emergency R&D’ to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.
... Five years after the public health emergency caused by the Zika Virus (ZIKV) and its teratogenic power, it was concluded that microcephaly was just "the tip of the iceberg", which later led to a broader definition called Congenital Zika Syndrome (CZS) (1) . This is because, as affected children grow, a range of associated abnormalities arises, such as musculoskeletal malformations, seizures, dysphagia, hearing and visual impairment (2) . Thus, the challenge of providing care to children who experience chronic illness and their families is enhanced by the particularities of CZS, whose clinical, social and political consequences unfold over time (3) . ...
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Objective: to know health professionals' perceptions about care actions provided to children with Congenital Zika Virus Syndrome and their families. Methods: this is a qualitative study, carried out in a capital of center-western Brazil, based on the Unified Health System theoretical precepts. Data were collected in September and October 2020, through audio-recorded interviews with 12 health professionals from a specialized service and submitted to analysis of content, thematic modality. Results: the implementation of care actions with these children occurs through multidimensional assessment of children and their families, use of the Unique Therapeutic Project, therapeutic interventions for the development of children and the communication and exchange of interprofessional and family experiences, in addition to considering professionals' prior knowledge and their search for it. Final considerations: children with CZS and their families need individualized, frequent, integrated and continuous care.
... The challenge in global health emergencies such as the Covid-19 pandemic is not only the need to make life-altering decisions when facing uncertainty, but also the urgency and speed needed in arriving at a course of action (Lakoff 2017). Instead of simply contending with medical uncertainty, credentialed experts also confronted global health uncertainty and public health uncertainty, with the lack of basic scientific knowledge about the disease and with the lack of knowledge over its transmission (Kelly et al. 2020). These areas of "undone science" (Frickel et al. 2009) and "strategic unknowns" (McGoey 2012) invite a wider range of experts to make claims. ...
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During the initial months of the Covid-19 pandemic, credentialed experts-scientists, doctors, public health experts, and policymakers-as well as members of the public and patients faced radical uncertainty. Knowledge about how Covid-19 was spread, how best to diagnose the disease, and how to treat infected patients was scant and contested. Despite this radical uncertainty, however, certain users of Covid-19 Together, a large online community for those who have contracted Covid-19, were able to dispense advice to one another that was seen as credible and trustworthy. Relying on Goffman's dramaturgical theory of social interaction, we highlight the performative dimension of claims to lay expertise to show how credibility is accrued under conditions of radical uncertainty. Drawing on four months of data from the forum, we show how credible performances of lay expertise necessitated the entangling of expert discourse with illness experience, creating a hybrid interlanguage. A credible performance of lay expertise in this setting was characterized by users' ability to switch freely between personal and scientific registers, finding and creating resonances between the two. To become a credible lay expert on this online community, users had to learn to ask questions and demonstrate a willingness to engage with biomedical knowledge while carefully generalizing their personal experience.
... For more discussions about the challenges of global disease surveillance, see for instance(Keck 2020;Shapin 2020;Kelly et al. 2020;Sanches and Brown 2018;Lakoff 2017;Caduff 2015;MacPhail 2014;Mackenzie 2014;Fearnley 2008). 2 Quote from my fieldnotes from the European Centre for Disease Control and Prevention. The surveillance of signs of health challenges is today called syndromic surveillance, and has become an important part of the arsenal of health surveillance in the modern world(Henning 2004;Fearnley 2008;Cakici and Sanches 2014;Hulth, Rydevik, and Linde 2009;Roberts and Elbe 2017). ...
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The sociological study of knowledge infrastructures and classification has traditionally focused on the politics and practices of classifying things or people. However, actors’ work to escape dominant infrastructures and pre-established classification systems has received little attention. In response to this, this article argues that it is crucial to analyze, not only the practices and politics of classification, but also actors’ work to escape dominant classification systems. The article has two aims: First, to make a theoretical contribution to the study of classification by proposing to pay analytical attention to practices of escaping classification, what the article dubs classification egress. This concept directs our attention to—not only the practices and politics of classifying things—but also how actors work to escape or resist classification systems in practice. Second, the article aims to increase our understanding of the history of quantified and statistical health surveillance. In this, the article investigates how actors in health surveillance assembled a knowledge infrastructure for surveilling, quantifying, and detecting unknown patterns of congenital malformations in the wake of the Thalidomide disaster in the early 1960s. The empirical account centers on the actors’ work to detect congenital malformations and escaping the dominant nosological classification of diseases, the International Classification of Diseases (ICD), by replacing it with a procedural standard for reporting of symptoms. Thus, the article investigates how actors deal with the tension between the-already-known-and-classified and the unknown-unclassified-phenomenon in health surveillance practice.
... Midwives are equally facing added challenges, stress and anxiety in providing maternity care during the pandemic [14][15][16][17][18][19]. These may include adapting to rapidly changing guidelines and unfamiliar ways of working [19][20][21]; moral distress if not able to provide optimal and woman-centred care in line with professional values [19,21,22]; concerns on how to prepare women and families and manage their anxieties, including not being able to answer questions due to lack of information and evidence [18,19]; fears for personal and own family safety [19,[23][24][25]. Health care professionals' stress, burnout and post-traumatic stress disorder are commonly reported in studies conducted during other major global emergencies [26][27][28][29], which may eventually contribute to reduced quality of care [30]. ...
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Problem The COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line with professional values. Background Healthcare professionals’ stress and burnout are commonly reported during other global emergencies, which may eventually contribute to reduced quality of care. There is lack of evidence of the challenges faced by midwives in Italy during the COVID-19 pandemic. Aim To explore midwives’ experiences of providing care to women and families during the COVID-19 pandemic. Methods Qualitative interpretive phenomenological approach, using semi-structured interviews and thematic analysis. The sample included 15 midwives. Ethical approval was obtained. Findings Four themes were identified: 1) adjusting to the ever-evolving organisation of care; 2) physical, psychological and relational challenges; 3) support network; 4) deferred sense of awareness. Discussion Midwives faced professional and personal challenges during the pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of support and knowledge with potential long-term effects. Adjusting to the continuous, rapid and drastic re-organisation of maternity services was particularly challenging. Factors facilitating a safe, supportive and empowering workplace included support from colleagues and managers, access to appropriate PPE, reliable guidelines, good communication and emotional support. Positive aspects of personal and professional development included communication skills, establishment of trusting relationships, sense of empowerment and teamwork. Conclusion In the context of a pandemic, optimisation of midwives’ physical, emotional and psychological wellbeing should be considered. Timely and comprehensive guidelines and appropriate resources should be provided to assist midwives in facilitating family-centred respectful maternity care and preserving childbirth as a bio-psychosocial event.
... The framing of epidemics defines public health policies and health research [28,29]. Some studies that showed how Zika's representation as an epidemic centered on mosquitoes and women are based on a limited conceptualization of virus transmission, human sexuality and reproduction [30]. ...
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Background and Objectives Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies have made governments, national and international agencies issue advice and recommendations to women. This study was designed to develop an initial understanding of the impacts of Zika on women of reproductive age who lived in areas with or without local transmission. The impacts on women who were less directly affected and less vulnerable to Zika were analyzed. The hypothesis was that all women were impacted by the epidemic. Methods A qualitative study was carried out. Women were recruited through the snowball sampling technique from various locations in Brazil, Puerto Rico, and the United States. They were of different nationalities and ethnicities. Data were collected through semi-structured interviews. The data transcripts were analyzed using thematic analysis. Results The social effects of the epidemic affect more women than had been thought before and at deeper emotional levels. Women perceived that the public health systems were placing an unfair responsibility for preventing health complications from Zika onto women who have limited ability. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Conclusions Women appeared to be disproportionately affected by the reproductive implications of the epidemic, even when they were only indirectly affected. Gender inequality and gender discrimination must be recognized and rendered visible in the public health emergency response. It is shown the importance of considering cultural aspects and behaviors when implementing health prevention or protection measures to control epidemics.
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Introduction Voluntary organisations provide essential support to vulnerable populations and front-line health responders to the COVID-19 pandemic. The French Red Cross (FRC) is prominent among organisations offering health and support services in the current crisis. Comprised primarily of lay volunteers and some trained health workers, FRC volunteers in the Paris (France) region have faced challenges in adapting to pandemic conditions, working with sick and vulnerable populations, managing limited resources and coping with high demand for their services. Existing studies of volunteers focus on individual, social and organisational determinants of motivation, but attend less to contextual ones. Public health incertitude about the COVID-19 pandemic is an important feature of this pandemic. Whether and how uncertainty interacts with volunteer understandings and experiences of their work and organisational relations to contribute to Red Cross worker motivation is the focus of this investigation. Methods and analysis This mixed-methods study will investigate volunteer motivation using ethnographic methods and social network listening. Semi-structured interviews and observations will illuminate FRC volunteer work relations, experiences and concerns during the pandemic. A questionnaire targeting a sample of Paris region volunteers will allow quantification of motivation. These findings will iteratively shape and be influenced by a social media (Twitter) analysis of biomedical and public health uncertainties and debates around COVID-19. These tweets provide insight into a French lay public’s interpretations of these debates. We evaluate whether and how socio-political conditions and discourses concerning COVID-19 interact with volunteer experiences, working conditions and organisational relations to influence volunteer motivation. Data collection began on 15 June 2020 and will continue until 15 April 2021. Ethics and dissemination The protocol has received ethical approval from the Institut Pasteur Institutional Review Board (no 2020-03). We will disseminate findings through peer-reviewed articles, conference presentations and recommendations to the FRC.
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Vulnerable low-income groups were most affected by Zika virus (ZIKV)-related neurologic syndrome during the 2014–2016 outbreak in Brazil. Major ZIKV infection response took place in Primary Health Care (PHC), including prevention strategies and risk communication. We aimed to detect knowledge and beliefs, as well as knowledge gaps among vulnerable women at the PHC level. A cross-sectional study was carried out in two low-income urban community settings: a small municipality with few ZIKV infection cases and a large municipality hard-hit by the epidemic. An open-ended data collection instrument centred on ZIKV infection knowledge, sources of information, possible causes, symptoms, risk perception, consequences for pregnant women and PHC point-of-care communication was developed. Interviews were recorded, transcribed and content coded for thematic analysis. Most of the seventy-nine respondents had some knowledge of the disease, acknowledging the vector as the source of infection and associating microcephaly with the disease, but distanced themselves from possible ZIKV infection and related risk. PHC services in both communities did not adequately communicate risk for women and children. In an uncertain future scenario as to disease re-emergence, awareness may be diminished and acquired knowledge lost, configuring a public health challenge that must be overcome.
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Title: The “zika children” as Brazilian newspapers told us: a retrospective reading from the news coverage. Abstract: This study is based on the premise that the Zika epidemic is an unfinished story, as its consequences will extend forever. Such consequences are evident in the sequelae suffered by children affected by the congenital syndrome - people with multiple disabilities, who will continue to demand, from both their families and the State, perennial care. For this reason, I conducted a documentary research that analyzed the narrative regarding the Congenital Zika Syndrome/Microcephaly, presented in the first two and a half years widely read Brazilian newspapers. The focus was to understand how the media discourse regarding the effects of brain damage and anomalies, in childhood and in the future life of affected babies, took place. The results show that the historical permanence of the microcephaly epidemic and, therefore, of the Congenital Zika Syndrome, was not adequately anticipated by the newspapers that reported the phenomenon at that time. Keywords: Discourse analysis; microcephaly; Congenital Zika Syndrome; journalistic narrative; history of epidemics.
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Due to the increasing amount of new information that is emerging about COVID-19, traditional and web-based information sources are commonly used to spread and seek information. This study compared differences in information seeking, trust of information sources, and use of protective behaviors (e.g., mask wearing) among individuals in the US and China during the COVID-19 pandemic. A total of 722 valid responses in the US and 493 valid responses in China were collected via online surveys in May 2020. Pearson's Chi-square tests, independent samples t-tests, and multiple linear regressions were used to conduct the analyses. Results showed that US respondents accessed significantly fewer COVID-19 information sources, rated significantly lower levels of trust in these sources, and reported significantly lower levels of protective behaviors than the Chinese respondents. In both countries, trust in newspapers, radio/community broadcasting, and news portals were significantly positively correlated with protective behaviors. While trust of TV was significant in both populations, in China it was positively correlated, whereas in the US was negatively correlated, with protective behaviors. Findings from this study showed that coordinated and consistent messages from governmental officials, health authorities, and media platforms are important to promote and encourage protective behaviors.
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This article has two objectives: First, the article seeks to make a methodological intervention in the social study of algorithms. Today, there is a worrying trend to analytically reduce algorithms to coherent and stable objects whose computational logic can be audited for biases to create fairness, accountability, and transparency (FAccT). To counter this reductionist and determinist tendency, this article proposes three methodological rules that allows an analysis of algorithmic power in practice. Second, the article traces ethnographically how an algorithm was used to enact a pandemic, and how the power to construct this disease outbreak was moved around through by an algorithmic assemblage. To do this, the article traces the assembling of a recent epidemic at the European Centre for Disease Control and Prevention—the Zika outbreak starting in 2015—and shows how an epidemic was put together using an array of computational resources, with very different spaces for intervening. A key argument is that we, analysts of algorithms, need to attend to how multiple spaces for agency, opacity, and power open and close in different parts of algorithmic assemblages. The crux of the matter is that actors experience different degrees of agency and opacity in different parts of any algorithmic assemblage. Consequently, rather than auditing algorithms for biased logic, the article shows the usefulness of examining algorithmic power as enacted and situated in practice.
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Resumo: Com base na experiência de um programa de intervenção para famílias de crianças com a síndrome congênita do vírus Zika, que inclui múltiplas deficiências, em uma instituição de educação, foram observados os desafios e conquistas encontrados com a entrada dessas famílias no sistema escolar. O objetivo deste artigo foi explorar os achados de pesquisa realizada após a conclusão de um programa de intervenção mediante entrevistas semiabertas com profissionais da instituição, e as possíveis contribuições para a construção das relações intersetoriais visando à inclusão escolar de crianças com deficiência. É possível constatar uma mudança provocada pelo programa na relação entre as famílias e os profissionais da instituição de educação; as famílias tiveram espaço para elaborar seus receios e discutir o papel da escola na vida de crianças com deficiência. Dessa forma, os profissionais passaram a vê-las em uma posição mais ativa. Acredita-se que esta experiência possa favorecer outros serviços e municípios que busquem a inclusão escolar de crianças e adolescentes com deficiência assim como sua inclusão social e de suas famílias.
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Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes—congenital Zika syndrome (CZS)—and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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The Congenital Zika Syndrome (CZS) epidemic took place in Brazil between 2015 and 2017 and led to the emergence of at least 3194 children born with CZS. We explored access to healthcare services and activities in the Unified Health Service (Sistema Único de Saúde: SUS) from the perspective of mothers of children with CZS and professionals in the Public Healthcare Network. We carried out a qualitative, exploratory study, using semi-structured interviews, in two Brazilian states-Pernambuco, which was the epicentre of the epidemic in Brazil, and Rio de Janeiro, where the epidemic was less intense. The mothers and health professionals reported that healthcare provision was insufficient and fragmented and there were problems with follow-up care. There was a lack of co-ordination and an absence of communication between the various specialized services and between different levels of the health system. We also noted a public-private mixture in access to healthcare services, resulting from a segmented system and related to inequality of access. High reported household expenditure is an expression of the phenomenon of underfunding of the public system. The challenges that mothers and health professionals reported exposes contradictions in the health system which, although universal, does not guarantee equitable and comprehensive care. Other gaps were revealed through the outbreak. The epidemic provided visibility regarding difficulties of access for other children with disabilities determined by other causes. It also made explicit the gender inequalities that had an impact on the lives of mothers and other female caregivers, as well as an absence of the provision of care for these groups. In the face of an epidemic, the Brazilian State reproduced old fashioned forms of action-activities related to the transmitting mosquito and to prevention with an emphasis on the individual and no action related to social determinants.
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Background: In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. Methods and findings: We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015-23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015-2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2-49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2-369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk < 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. Conclusions: This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason.
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Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes—congenital Zika syndrome (CZS)—and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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This article discusses conceptions of conception, gestation and childbirth shortly after the boom of the Zika epidemic in Brazil, from the narratives of female mothers of babies with microcephaly. His children were conceived and gestated in a sui generis context, quite chaotic and insecure, due to the deconditioning of the deficit, the roads of Recife and the neighborhoods of popular litters. Most were born in public hospitals in the state capital of Pernambuco. This way, trying to comprehend these sexual and reproductive experiences of these women, with her we were in 2016 and then in 2017, in this case, from the memory of your gestations and births. Try to be more of the particularity of sexual and reproductive life of Brazilian women, to be thought, for this reason we recover their ideals and practices, comparing them to others, a little wider, on the subject.
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An increase in microcephaly, associated with an epidemic of Zika virus (ZIKV) in Brazil, prompted the World Health Organization to declare a Public Health Emergency of International Concern in February 2016. While knowledge on biological and epidemiological aspects of ZIKV has advanced, demographic impacts remain poorly understood. This study uses time-series analysis to assess the impact of ZIKV on births. Data on births, fetal deaths, and hospitalizations due to abortion complications for Brazilian states, from 2010 to 2016, were used. Forecasts for September 2015 to December 2016 showed that 119,095 fewer births than expected were observed, particularly after April 2016 (a reduction significant at 0.05), demonstrating a link between publicity associated with the ZIKV epidemic and the decline in births. No significant changes were observed in fetal death rates. Although no significant increases in hospitalizations were forecasted, after the ZIKV outbreak hospitalizations happened earlier in the gestational period in most states. We argue that postponement of pregnancy and an increase in abortions may have contributed to the decline in births. Also, it is likely that an increase in safe abortions happened, albeit selective by socioeconomic status. Thus, the ZIKV epidemic resulted in a generation of congenital Zika syndrome (CZS) babies that reflect and exacerbate regional and social inequalities. Since ZIKV transmission has declined, it is unlikely that reductions in births will continue. However, the possibility of a new epidemic is real. There is a need to address gaps in reproductive health and rights, and to understand CZS risk to better inform conception decisions.
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The 2013–2016 West African Ebola outbreak was both a catastrophic public health disaster and a rare research opportunity. This paper analyses how the tensions between the humanitarian imperatives of disease control and the epistemic conventions of bioscientific inquiry played out in the accelerated development, testing and licensure of Ebola vaccines. Beginning with the epidemiological projections of the disease’s spread, the paper develops the notion of evidentiary charisma to capture the power of experimental designs and data packages to marshal public health salience, recruit moral legitimacy and short-circuit scientific contestation. Attention to the charismatic dimensions of Ebola vaccine R&D helps to unpick the simultaneous appeals to exception and convention in the unfolding of a global health crisis, and to trace the normative and technical contours of the emerging paradigm of emergency research.
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Between 2015 and 2016, Zika became an epidemic of global concern and the focus of intense media coverage. Using a hybrid model of frame and social representations theory, we examine how the Zika outbreak was reported in two major newspapers in Brazil: O Globo and Folha de São Paulo. The analysis of 186 articles published between December 2015 and May 2016 reveals a dominant 'war' frame supported by two sub-frames: one focused on eradicating the vector (mosquito) and another on controlling microcephaly, placing the burden of prevention on women. Scientific uncertainties about the virus and its relationship to microcephaly coupled with political uncertainties in Brazil increased the power of the war frame. This frame gave prominence and legitimacy to certain representations of disease management during the crisis, masking social and gender inequalities. We show how the cartography of the disease overlaps with that of poverty and regional inequality in Brazil to argue that addressing socio-economic aspects is essential, but normally neglected, in media communications during disease outbreaks like Zika.
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Background: Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015-2016), which is in Northeast Brazil, and its association with the living conditions in this city. Methods: This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of -2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. Results: During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. Conclusion: This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.
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The first confirmed case of Zika virus infection in the Americas was reported in Northeast Brazil in May 2015, although phylogenetic studies indicate virus introduction as early as 2013. Zika rapidly spread across Brazil and to more than 50 other countries and territories on the American continent. The Aedes aegypti mosquito is thought to be the principal vector responsible for the widespread transmission of the virus. However, sexual transmission has also been reported. The explosively emerging epidemic has had diverse impacts on population health, coinciding with cases of Guillain–Barré Syndrome and an unexpected epidemic of newborns with microcephaly and other neurological impairments. This led to Brazil declaring a national public health emergency in November 2015, followed by a similar decision by the World Health Organization three months later. While dengue virus serotypes took several decades to spread across Brazil, the Zika virus epidemic diffused within months, extending beyond the area of permanent dengue transmission, which is bound by a climatic barrier in the south and low population density areas in the north. This rapid spread was probably due to a combination of factors, including a massive susceptible population, climatic conditions conducive for the mosquito vector, alternative non-vector transmission, and a highly mobile population. The epidemic has since subsided, but many unanswered questions remain. In this article, we provide an overview of the discovery of Zika virus in Brazil, including its emergence and spread, epidemiological surveillance, vector and non-vector transmission routes, clinical complications, and socio-economic impacts. We discuss gaps in the knowledge and the challenges ahead to anticipate, prevent, and control emerging and re-emerging epidemics of arboviruses in Brazil and worldwide.
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Objectives To assess knowledge, pregnancy attitudes and contraceptive practices in relation to the Zika virus outbreak in Brazil. Methods We interviewed 526 women 18 to 49 years old in primary health services in a Northeastern capital of Brazil, in 2016. They provided information about their knowledge of Zika transmission and health consequences, their receipt of counseling related to sexual and perinatal transmission of Zika, their pregnancy intentions and reassessment of contraceptive options in the context of the Zika virus outbreak. Results Awareness about Zika congenital syndrome was high, but knowledge about sexual transmission was low. Few women had changed pregnancy intentions or contraceptive practices in response to Zika. Pregnant women were more likely to access counseling about family planning, condom use and pregnancy postponement due to Zika virus than non-pregnant women, which may suggest that health system responses followed pregnancy occurrence. Conclusions We observed missed opportunities for prevention of perinatal transmission of Zika virus through behavioral change, including effective contraception to prevent pregnancy and condoms to prevent perinatal transmission, as a complement to vector control.
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Background: Zika Virus (ZIKV), member of Flaviviridae family and Flavivirus genus, has recently emerged as international public health emergency after its association with neonatal microcephaly cases. Clinical diagnosis hindrance involves symptom similarities produced by other arbovirus infections, therefore laboratory confirmation is of paramount importance. Discussion: The most reliable test available is based on ZIKV RNA detection from body fluid samples. However, short viremia window periods and asymptomatic infections diminish the success rate for RT-PCR positivity. Beyond molecular detection, all serology tests in areas where other Flavivirus circulates proved to be a difficult task due to the broad range of cross-reactivity, especially with dengue pre-exposed individuals. Conclusion: Altogether, lack of serological diagnostic tools brings limitations to any retrospective evaluation. Those studies are central in the context of congenital infection that could occur asymptomatically and mask prevalence and risk rates.
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Background Since its initial detection in Brazil in 2015, Zika Virus (ZIKV) has spread rapidly throughout most of the Caribbean and South, Central and North America. An upsurge in congenital syndrome associated with ZIKV and Guillain-Barre Syndrome (GBS) has been associated with the increase in ZIKV. This amplification in numbers led to the need for funded research initiatives focusing on various countries globally and on specific experimental types. Objectives To determine the financial institutions involved in the production of primary research into the ZIKV epidemic. This research also intends to draw attention to the investigative areas that are dominating, experimental types being conducted and the geographical areas that are producing the bulk of the research utilizing available funds. Methods A cross sectional search of published primary research was conducted using Pan American Health Organization (PAHO) Zika platform and PubMed between January 2007 and October 2016. Titles, abstract and full articles were assed and one researcher extracted data. Information was crossed checked by a second researcher to ensure accuracy. Findings 268 articles were included and investigations occurred across 48 countries with Brazil and USA dominating the research. Applied Research and Laboratory based studies were most frequently utilized. 38.1% of articles did not report financial sources. Public institutions were the major known contributors. Other financiers included private, non-profits and mixed funders exclusive of public sources. 156 individual financial bodies assisted with National Institute of Health being most frequently mentioned followed by The National Council for Scientific and Technological Development (CNPq) and the Institut Pasteur. Virus, vectors and reservoirs was most frequently used (99/268, 36.9%) followed by clinical management (70/268, 26.1%) and epidemiology (46/268, 17.2%). Interpretation The evidence suggests international efforts to fund ZIKV research and a need to foster collaborative and synchronized priority setting for resource allocation.
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The Zika virus was first isolated in 1947 in Uganda. If the disease has existed since then, why is it only now that there is attention from the media, science, funding agencies and national and international bodies? From the standpoint of critical global health that considers the social, political and ideological contexts which Zika is framed, we aim to analyse the Zika epidemic in four aspects: (1) investigation of the social, cultural and political processes; (2) analysis of signification practices; (3) study of neglected/silenced zones; and (4) attention to the diversity of individual experiences related to health and disease. The political tensions here identified and discussed - related to the control of neglected diseases, social, class and gender determinants - fall into dynamics that go beyond national borders. In this sense, processes of signification and responses to the epidemic show the current limits of global health.
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It is not surprising that anthropologists, being academics, should value knowledge. After all, an academic life is a vocation to generate data, to act as a critic in order to detect and eradicate error, and to transmit the state of the art to the next generation. This pursuit of knowledge entails an ethics: knowledge is the value that justifies all aspects of academic activity, whether it is desired as a means of promoting other goods (health, happiness, wealth, well-being) or as an end in itself. The argument that underlies this volume is that anthropologists have too easily attributed to the people they study the same unambiguous desire for knowledge, and the same aversion to ignorance, that motivates their own work, with the result that situations in which ignorance is viewed neutrally—or even positively—have been misunderstood and overlooked.
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Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.
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The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition.
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Zika virus (ZIKV) is an arbovirus belonging to the genus Flavivirus (family Flaviviridae) and was first described in 1947 in Uganda following blood analyses of sentinel rhesus monkeys(1). Until the twentieth century, the African and Asian lineages of the virus did not cause meaningful infections in humans. However, in 2007, vectored by Aedes aegypti mosquitoes, ZIKV caused the first noteworthy epidemic on Yap Island in Micronesia(2). Patients experienced fever, skin rash, arthralgia and conjunctivitis(2). From 2013 to 2015, the Asian lineage of the virus caused further massive outbreaks in New Caledonia and French Polynesia. In 2013, ZIKV reached Brazil, later spreading to other countries in South and Central America3. In Brazil, the virus has been linked to congenital malformations, including microcephaly and other severe neurological diseases, such as Guillain-Barre syndrome(4,5). Despite clinical evidence, direct experimental evidence showing that the Brazilian ZIKV (ZIKVBR) strain causes birth defects remains absent(6). Here we demonstrate that ZIKVBR infects fetuses, causing intrauterine growth restriction, including signs of microcephaly, in mice. Moreover, the virus infects human cortical progenitor cells in vitro, leading to an increase in cell death. We also report that the infection of human brain organoids results in a reduction of proliferative zones and disrupted cortical layers. These results indicate that ZIKVBR crosses the placenta and causes microcephaly by targeting cortical progenitor cells, inducing cell death by apoptosis and autophagy, and impairing neurodevelopment. Our data reinforce the growing body of evidence linking the ZIKVBR outbreak to the alarming number of cases of congenital brain malformations. Our model can be used to determine the efficiency of therapeutic approaches to counteracting the harmful impact of ZIKVBR in human neurodevelopment.
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Brazil has experienced an unprecedented epidemic of Zika virus (ZIKV), with ~30,000 cases reported to date. ZIKV was first detected in Brazil in May 2015 and cases of microcephaly potentially associated with ZIKV infection were identified in November 2015. Using next generation sequencing we generated seven Brazilian ZIKV genomes, sampled from four self-limited cases, one blood donor, one fatal adult case, and one newborn with microcephaly and congenital malformations. Phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, estimated to have occurred between May-Dec 2013, more than 12 months prior to the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV endemic areas, and with reported outbreaks in Pacific Islands. ZIKV genomes from Brazil are phylogenetically interspersed with those from other South American and Caribbean countries. Mapping mutations onto existing structural models revealed the context of viral amino acid changes present in the outbreak lineage; however no shared amino acid changes were found among the three currently available virus genomes from microcephaly cases. Municipality-level incidence data indicate that reports of suspected microcephaly in Brazil best correlate with ZIKV incidence around week 17 of pregnancy, although this does not demonstrate causation. Our genetic description and analysis of ZIKV isolates in Brazil provide a baseline for future studies of the evolution and molecular epidemiology in the Americas of this emerging virus.
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While experts have suspected a causal link between outbreaks of Zika virus and microcephaly, it was not demonstrated. The currently available data are here organized into the Austin Bradford Hill's aspects of evidence for the consideration of causality.
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Background Zika virus (ZIKV) has been linked to neonatal microcephaly. To characterize the spectrum of ZIKV disease in pregnancy, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in fetuses. Methods We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase–polymerase-chain-reaction assays. We followed the women prospectively and collected clinical and ultrasonographic data. Results A total of 88 women were enrolled from September 2015 through February 2016; of these 88 women, 72 (82%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 5 to 38 weeks of gestation. Predominant clinical features included pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 28% had fever (short-term and low-grade). Women who were positive for ZIKV were more likely than those who were negative for the virus to have maculopapular rash (44% vs. 12%, P=0.02), conjunctival involvement (58% vs. 13%, P=0.002), and lymphadenopathy (40% vs. 7%, P=0.02). Fetal ultrasonography was performed in 42 ZIKV-positive women (58%) and in all ZIKV-negative women. Fetal abnormalities were detected by Doppler ultrasonography in 12 of the 42 ZIKV-positive women (29%) and in none of the 16 ZIKV-negative women. Adverse findings included fetal deaths at 36 and 38 weeks of gestation (2 fetuses), in utero growth restriction with or without microcephaly (5 fetuses), ventricular calcifications or other central nervous system (CNS) lesions (7 fetuses), and abnormal amniotic fluid volume or cerebral or umbilical artery flow (7 fetuses). To date, 8 of the 42 women in whom fetal ultrasonography was performed have delivered their babies, and the ultrasonographic findings have been confirmed. Conclusions Despite mild clinical symptoms, ZIKV infection during pregnancy appears to be associated with grave outcomes, including fetal death, placental insufficiency, fetal growth restriction, and CNS injury.
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In early 2015, an outbreak of Zika virus, a flavivirus transmitted by Aedes mosquitoes, was identified in northeast Brazil, an area where dengue virus was also circulating. By September, reports of an increase in the number of infants born with microcephaly in Zika virus-affected areas began to emerge, and Zika virus RNA was identified in the amniotic fluid of two women whose fetuses had been found to have microcephaly by prenatal ultrasound. The Brazil Ministry of Health (MoH) established a task force to investigate the possible association of microcephaly with Zika virus infection during pregnancy and a registry for incident microcephaly cases (head circumference ≥2 standard deviations [SD] below the mean for sex and gestational age at birth) and pregnancy outcomes among women suspected to have had Zika virus infection during pregnancy. Among a cohort of 35 infants with microcephaly born during August-October 2015 in eight of Brazil's 26 states and reported to the registry, the mothers of all 35 had lived in or visited Zika virus-affected areas during pregnancy, 25 (71%) infants had severe microcephaly (head circumference >3 SD below the mean for sex and gestational age), 17 (49%) had at least one neurologic abnormality, and among 27 infants who had neuroimaging studies, all had abnormalities. Tests for other congenital infections were negative. All infants had a lumbar puncture as part of the evaluation and cerebrospinal fluid (CSF) samples were sent to a reference laboratory in Brazil for Zika virus testing; results are not yet available. Further studies are needed to confirm the association of microcephaly with Zika virus infection during pregnancy and to understand any other adverse pregnancy outcomes associated with Zika virus infection. Pregnant women in Zika virus-affected areas should protect themselves from mosquito bites by using air conditioning, screens, or nets when indoors, wearing long sleeves and pants, using permethrin-treated clothing and gear, and using insect repellents when outdoors. Pregnant and lactating women can use all U.S. Environmental Protection Agency (EPA)-registered insect repellents according to the product label.
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On March 26, 2015, serum samples were obtained from 24 patients (Table) at Santa Helena Hospital in Camaçari who were given a presumptive diagnosis of an acute viral illness by emergency department physicians. These patients were given treatment for a dengue-like illness, and blood samples were obtained for complete blood counts and serologic testing by using an ELISA specific for IgG and IgM against DENV. Serum samples were analyzed at the Federal University of Bahia by reverse transcription PCR (RT-PCR) to detect DENV, CHIKV, WNV, Mayaro virus, and ZIKV. In brief, serum samples were subjected to RNA extraction by using the QIAamp Viral RNA Mini Kit (QIAGEN, Hilden, Germany). RNA was reverse transcribed by using the SuperScript II Reverse Transcription Kit (Invitrogen, Carlsbad, CA, USA) and subjected to PCRs specific for DENV (5) CHIKV (6), WNV (7) and Mayaro virus (8). A positive RT-PCR for a partial region of the envelope gene with primers ZIKVENF and ZIKVENVR (positions 1538–1558 and 1902–1883, respectively) (9) was considered indicative of ZIKV infection. PCR products (362 bp) were sequenced at the ACTGene Analises Moleculares, Alvorada, Rio Grande do Sul (Porto Allegre, Brazil), and sequences were deposited in GenBank under accession nos. KR816333–KR816336. All patients were negative by RT-PCR for DENV, Mayaro virus, and WNV. Samples from 7 (29.2%) patients were positive by RT-PCR for ZIKV (369-bp fragment) and from 3 (12.5%) patients for CHIKV (305-bp fragment). There was no simultaneous detection of ZIKV and CHIKV. Most (85.7%) patients positive for ZIKV were women; they had a median age of 28 years and no history of international travel. Patients positive for ZIKV sought medical care after a 4-day (range 1–5 days) history of rash, myalgias, arthralgias, or fever. Three patients had IgG against DENV, which is consistent with a previous DENV infection, and none of the 7 ZIKV-positive patients had a positive response for DENV. Mean laboratory findings for patients with acute ZIKV infection were a leukocyte count of 3,750 cells/mm3 (range 2,790 cells/mm3–6,150 cells/mm3) and a platelet count of 180,000 platelets/mm3 (range 151,000 platelets/mm3–274,000 platelets/mm3). The mean C-reactive protein level was 16.3 mg/L (range 0.9 mg/L–19.7 mg/L). Sign and symptom duration was 1–5 days, and most patients had a maculopapular rash, myalgias, fever, and headache. Arthralgia was seen less frequently. ZIKV infections were assessed by sequencing partial ZIKV envelope gene regions of isolates. Phylogenetic analysis rooted with Spondwei virus showed that ZIKV sequences obtained belonged to the Asian lineage and showed 99% identity with a sequence from a ZIKV isolate from French Polynesia (KJ776791) (10). We report ZIKV infection in Brazil in association with an ongoing outbreak of an acute maculoexantematic illness. Although the patient population samples were not randomly selected, 42% (10/24) of the patients were positive for ZIKV (n = 7) or CHIKV (n = 3) and had maculopapular rash, fever, myalgias and headache. After detection of ZIKV in Bahia, many cases have been identified in other states (http://www.promedmail.org, archive no. 20152015602.343.1158). Cases of infection with DENV, CHIKV, and ZIKV in Brazil and elsewhere will make diagnosis based on clinical and epidemiologic grounds unreliable. These issues show the need for laboratory confirmation of these arboviral infections. More studies are needed to address the effects of these concurrent arboviruses infections in Brazil.
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In December 2013, during a Zika virus (ZIKV) outbreak in French Polynesia, a patient in Tahiti sought treatment for hematospermia, and ZIKV was isolated from his semen. ZIKV transmission by sexual intercourse has been previously suspected. This observation supports the possibility that ZIKV could be transmitted sexually.
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This article offers a critical account of efforts to engage people with the issue of antimicrobial resistance (AMR). It analyses how public health workers encourage what they understand as responsible antibiotic use or antibiotic stewardship, and how their efforts are shaped by different theories of ‘behaviour’ or social action. Discourse analysis of all major UK campaigns and their evaluations over the last two decades reveals how different versions of the citizen jostle for attention in a public health that draws on sociology, psychology, and increasingly behavioural economics. Rejecting an explanation which focuses solely on the appeal of emotion in new forms of governance, I deploy theories of expert and lay ignorance to show how public health is pushed towards new approaches as it struggles with an apparently recalcitrant public in the case of AMR. Here ignorance is both problematic and productive, prompting a shift to campaigns based on unreflective action, that are accompanied by decisions to work with potential misunderstandings about antibiotics and their effects. I suggest the term ‘shrug’ as a provocative counterpart to the ‘nudge’ of behavioural economics, drawing attention to the ways in which behavioural interventions may be linked to strategic retreats from engagement, when policy makers feel unable to affect or predict the understanding and views of non-experts. The article thus contributes to sociological and political critique of narrow forms of behavioural thinking and their effects on relations between governments and their citizens.
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Pregnancy infections with Zika virus are associated with a spectrum of fetal brain injuries beyond microcephaly. Nonmicrocephalic children exposed to Zika virus in utero or early life should undergo neurodevelopmental testing to identify deficits and allow for early intervention. Additionally, long-term monitoring for higher order neurocognitive deficits should be implemented.
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Background In 2015, the number of infants born with microcephaly increased in Paraíba, Brazil, after a suspected Zika virus outbreak. We did a retrospective case-control investigation to assess the association of microcephaly and Zika virus. Methods We enrolled cases reported to the national database for microcephaly and born between Aug 1, 2015, and Feb 1, 2016, on the basis of their birth head circumference and total body length. We identified controls from the national birth registry and matched them to cases by location, aiming to enrol a minimum of two controls per case. Mothers of both cases and controls were asked about demographics, exposures, and illnesses and infants were measured at a follow-up visit 1–7 months after birth. We took blood samples from mothers and infants and classified those containing Zika virus IgM and neutralising antibodies as evidence of recent infection. We calculated prevalence of microcephaly and odds ratios (ORs) using a conditional logistic regression model with maximum penalised conditional likelihood, and combined these ORs with exposure probability estimates to determine the attributable risk. Findings We enrolled 164 of 706 infants with complete information reported with microcephaly at birth, of whom we classified 91 (55%) as having microcephaly on the basis of their birth measurements, 36 (22%) as small, 21 (13%) as disproportionate, and 16 (10%) as not having microcephaly. 43 (26%) of the 164 infants had microcephaly at follow-up for an estimated prevalence of 5·9 per 1000 livebirths. We enrolled 114 control infants matched to the 43 infants classified as having microcephaly at follow-up. Infants with microcephaly at follow-up were more likely than control infants to be younger (OR 0·5, 95% CI 0·4–0·7), have recent Zika virus infection (21·9, 7·0–109·3), or a mother with Zika-like symptoms in the first trimester (6·2, 2·8–15·4). Once Zika virus infection and infant age were controlled for, we found no significant association between microcephaly and maternal demographics, medications, toxins, or other infections. Based on the presence of Zika virus antibodies in infants, we concluded that 35–87% of microcephaly occurring during the time of our investigation in northeast Brazil was attributable to Zika virus. We estimate 2–5 infants per 1000 livebirths in Paraíba had microcephaly attributable to Zika virus. Interpretation Time of exposure to Zika virus and evidence of infection in the infants were the only risk factors associated with microcephaly. This investigation has improved understanding of the outbreak of microcephaly in northeast Brazil and highlights the need to obtain multiple measurements after birth to establish if an infant has microcephaly and the need for further research to optimise testing criteria for congenital Zika virus infection. Funding Centers for Disease Control and Prevention.
Book
Recent years have witnessed an upsurge in global health emergencies-from SARS to pandemic influenza to Ebola to Zika. Each of these occurrences has sparked calls for improved health preparedness. This book addresses the question, how did we become “unprepared?" Emerging disease has only recently come to be understood as a problem of preparedness. Andrew Lakoff follows the history of health preparedness from its beginnings in 1960s Cold War civil defense to the early twenty-first century, when international health authorities carved out a global space for governing potential outbreaks. Alert systems and trigger devices now link health authorities, government officials, and vaccine manufacturers, all of whom manage the possibility of a global pandemic. Funds have been devoted to cutting-edge research on pathogenic organisms, and a system of post hoc diagnosis analyzes sites of failed preparedness to find new targets for improvement. Yet, despite all these developments, the project of global health security continues to be unsettled by the prospect of surprise.
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Background: A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. Methods: We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. Findings: We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0-∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. Interpretation: The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. Funding: Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.
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This occasionally biographical paper deals with three cognitive and social patterns in the practice of science (not 'the scientific method’). The first, “establishing the phenomenon,” involves the doctrine (universally accepted in the abstract) that phenomena should of course be shown to exist or to occur before one explains why they exist or how they come to be; sources of departure in practice from this seemingly self-evident principle are examined. One parochial case of such a departure is considered in detail. The second pattern is the particular form of ignorance described as “specified ignorance”: the express recognition of what is not yet known but needs to be known in order to lay the foundation for still more knowledge. The substantial role of this practice in the sciences is identified and the case of successive specification of ignorance in the evolving sociological theory of deviant behavior by four thought-collectives is sketched out. Reference is made to the virtual institutionalization of specified ignorance in some sciences and the question is raised whether scientific disciplines differ in the extent of routinely specifying ignorance and how this affects the growth of knowledge. The two patterns of scientific practice are linked to a third: the use of “strategic research materials (SRMs)” i.e. strategic research sites, objects, or events that exhibit the phenomena to be explained or interpreted to such advantage and in such accessible form that they enable the fruitful investigation of previously stubborn problems and the discovery of new problems for further inquiry. The development of biology is taken as a self-exemplifying case since it provides innumerable SRMs for the sociological study of the selection and consequences of SRMs in science. The differing role of SRMs in the natural sciences and in the Geisteswissenschaften is identified and several cases of strategic research sites and events in sociology, explored.
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In 1958, the Pan American Health Organization declared that Brazil had successfully eradicated the mosquito Aedes aegypti, responsible for the transmission of yellow fever, dengue fever, chikungunya, and Zika virus. Yet in 2016 the Brazilian minister of health described the situation of dengue fever as "catastrophic." Discussing the recent epidemic of Zika virus, which amplified the crisis produced by the persistence of dengue fever, Brazil's president declared in January 2016 that "we are in the process of losing the war against the mosquito Aedes aegypti." I discuss the reasons for the failure to contain Aedes in Brazil and the consequences of this failure. A longue durée perspective favors a view of the Zika epidemic that does not present it as a health crisis to be contained with a technical solution alone but as a pathology that has the persistence of deeply entrenched structural problems and vulnerabilities. (Am J Public Health. Published online ahead of print February 16, 2017: e1-e8. doi:10.2105/AJPH.2017.303652).
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The re-emergence of Zika virus (ZIKV) and its suspected link with various disorders in newborns and adults led the World Health Organization to declare a global health emergency. In response, the stem cell field quickly established platforms for modeling ZIKV exposure using human pluripotent stem cell-derived neural progenitors and brain organoids, fetal tissues, and animal models. These efforts provided significant insight into cellular targets, pathogenesis, and underlying biological mechanisms of ZIKV infection as well as platforms for drug testing. Here we review the remarkable progress in stem cell-based ZIKV research and discuss current challenges and future opportunities.
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It is well-documented that structural economic inequalities in Latin America are expressed through and reinforce existing gender gaps. This article aims to look at the relationship between structural inequalities and reproductive health in the case of the Zika epidemic. The consequences of the epidemic will continue to affect the same women whose access to comprehensive reproductive health services, including safe abortion, is restricted at best. Résumé Il est bien établi que les inégalités économiques structurelles en Amérique latine sont exprimées par les écarts entre hommes et femmes et qu’elles les accentuent. Cet article souhaite examiner les relations entre les inégalités structurelles et la santé génésique dans le cas de l’épidémie de maladie à virus Zika. Les conséquences de l’épidémie continueront de toucher les femmes dont l’accès à des services complets de santé génésique, y compris d’avortement médicalisé, est au mieux restreint. Resumen Está bien documentado que las desigualdades económicas estructurales en Latinoamérica se expresan por medio de las brechas de género existentes y las refuerzan. Este artículo busca examinar la relación entre las desigualdades estructurales y la salud reproductiva en el caso de la epidemia de Zika. Las consecuencias de la epidemia continuarán afectando a las mismas mujeres cuyo acceso a los servicios integrales de salud reproductiva, que incluyen aborto seguro, está restringido en el mejor de los casos.
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The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this . . .
Article
Background: The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified. Methods: We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk. Findings: The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62-70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0-8) per 10 000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34-191) per 10 000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data. Interpretation: Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus. Funding: Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.
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This article argues that the 2014 Ebola outbreak in West Africa reinscribed the neglect that has surrounded this disease. The argument develops theoretical tools for understanding how neglect is produced in global health. Arguing that neglect is connected with the production of harm and vulnerability, it stresses the importance of emotions in issue-prioritisation in global health. Focusing on the dynamics of abjection, the article shows how the 2014 Ebola outbreak was framed as a (racialised) African problem and obfuscated by a political and media spectacle. The result was the preference for short-term crisis-management responses that detracted from long-term structural solutions.
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The suspected link between infection by Zika virus (ZIKV), a re-emerging flavivirus, and microcephaly is an urgent global health concern. The direct target cells of ZIKV in the developing human fetus are not clear. Here we show that a strain of the ZIKV, MR766, serially passaged in monkey and mosquito cells efficiently infects human neural progenitor cells (hNPCs) derived from induced pluripotent stem cells. Infected hNPCs further release infectious ZIKV particles. Importantly, ZIKV infection increases cell death and dysregulates cell-cycle progression, resulting in attenuated hNPC growth. Global gene expression analysis of infected hNPCs reveals transcriptional dysregulation, notably of cell-cycle-related pathways. Our results identify hNPCs as a direct ZIKV target. In addition, we establish a tractable experimental model system to investigate the impact and mechanism of ZIKV on human brain development and provide a platform to screen therapeutic compounds.
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Keywords: Aedes; Arboviruses; Flavivirus; Flaviviridae Infections.