Zika Virus and Health Systems in Brazil: From Unknown to a Menace

Screening Criteria Medical Care for Children with Microcephaly Reproductive Health and Abortion Understanding and Communicating the Risk of Microcephaly Vector Control References In 1947, Zika virus was first identified in Uganda. On February 1, 2016, a World Health Organization (WHO) emergency committee declared clusters of birth defects suspected of being linked to an epidemic of Zika virus in the Americas as a public health emergency of international concern. The 69year period between these two events was, for the most part, uneventful with regard to research and international awareness. When the virus made its way to the Americas, however, history changed course. An association between Zika infections during pregnancy and the birth of babies with microcephaly was first suggested by Brazilian physicians in August 2015, and in November microcephaly cases potentially associated with Zika started to be recorded; three months later the WHO made its announcement. In Brazil, the country hit hardest by the epidemic so far, there have been 6,906 suspected cases of microcephaly as of April 2, 2016; 1,046 have been confirmed for microcephaly, 1,814 have been discarded, and 4,046 remain under investigation. The exact number of Zika infections in Brazil is not known, but autochthonous transmission of the virus has been confirmed in all 27 states in Brazil. In addition, as of April 7 autochthonous transmission of Zika virus has been confirmed in 34 countries/territories of the Americas. The unfolding story of Zika virus in the Americas is much more than a mosquito-borne disease that may affect fetal development. It is the story of a disease that exposed problems and raised challenges that the affected health systems and governments cannot ignore. Next, based largely on lessons provided by Brazil’s Zika epidemic, we discuss five critical problems and challenges and reflect on opportunities to remedy them.