We must maintain epidemiological surveillance, although Zika virus infections cases have dropped, alerts Celina Turchi

Publicação: 8 de March de 2018

The outbreak of Zika Congenital Syndrome has ended, but the challenges of children with compromised central nervous systems and other clinical manifestations remain

We must monitor the viral circulation and be ready for the possibility of future outbreaks among the susceptible populations with adverse neurological events and Zika Congenital Syndrome in newborns

Internationally recognized for leading the first case-control study that demonstrated the relation between Zika virus and microcephaly cases in newborns, epidemiologist physician Celina Turchi was recently nominated by the Brazilian Society of Tropical Medicine – BSTM [Sociedade Brasileira de Medicina Tropical, SBMT] to join the triple list to be sent to the Science, Technology, Innovation and Communication Minister, Gilberto Kassab, to choose a representative of the scientific community in each of the great fields (Human and Social Sciences, Biological and Health and Exact Sciences, Earth and Engineering), to compose the CNPq Advisory Board (CD-CNPq). She was highlighted by Nature Journal, in 2016, and listed one of the world’s 100 most influent people by Time Magazine in 2017. In 2018, Dr. Celina Turchi was granted the Mietta Santiago Medal, on the International Women’s Day, when she was interviewed by the BSTM’s Press Advisory. Find the full interview below:

BSTM: What is the current Zika situation?

Dr. Celina Turchi: After the Zika exanthematic disease outbreak in Brazil’s northeast in 2015, there was a reduction of cases among adults with a following reduction in reported cases of Zika Congenital Syndrome. There was a reduction of viral circulation with sporadic cases of exanthematic disease in several states in 2017.

BSTM: Are children still being born with microcephaly?

Dr. Celina Turchi: If the question refers to Zika congenital syndrome, there was a reduction of cases; however, sporadic cases of this syndrome are still reported from different places of the Country. Microcephaly is just the tip of the iceberg of Zika Congenital Syndrome, found in Zika Virus Congenital Infection. Moreover, children are in fact still being born with microcephaly due to other causes (genetic, infectious, etc.).

BSMT: Which are the effects of Zika virus over babies born and infected during the first disease’s outbreak, who years ago?

Dr. Celina Turchi: Among the live births affected by the Zika virus infection, the Central Nervous System malformations, with brain calcifications and ophthalmic changes were the first changes evidenced in this syndrome. Deglutition changes, hearing reduction are also among the observed involvement.  

BSTM: A new cheap and fast test able to identify Zika in the infected person’s organism was developed by North-American scientists with collaboration of Brazilian schools. When do you believe this test will arrive in Brazil? Until then, will Zika cases have disappeared?

Dr. Celina Turchi: Tests able to evaluate recent Zika virus infections without returning cross reactions with dengue virus will be good to diagnose infection and also for population tracking. Currently there are numerous tests for Zika virus infection diagnostic being tested in endemic areas. Implementing any of these tests depends on their performance evaluation in different geographic areas, besides approval by control agencies. It is important to remember that arboviral diseases are seasonal and the Zika virus’ transmission dynamics in urban environments is little known. We must monitor viral circulation and be ready for possible future outbreaks among the susceptible populations with adverse neurological events and even Zika Congenital Syndrome in newborns.

BSTM: How are scientific researches for a broader and more precise diagnostic of the disease evolving?

Dr. Celina Turchi: There was and there still is a great mobilization of the scientific community for a broader and more precise diagnostic. Having this in sight, clinical epidemiological studies of Zika virus are performed, besides basic researches, including searches for tests with greater sensitivity and specificity. Regarding clinical epidemiological researches, the following of pregnant women (cohort) with and without exanthema with tracking of Zika virus are being held in different regions of the Country. Children infected by or with suspicion of Zika Congenital Syndrome (those who were exposed to Zika virus infection during pregnancy) are monitored to evaluate the cognitive and neurological development, to detect other conditions and even estimate life expectancy. This detailed evaluation will allow us to understand the clinical spectrum of this new disease, providing early stimulation and minimization of the inabilities. It is worth noting that different research groups harmonized protocols and share data to achieve more robust researches as fast as possible. A research effort has been given to assess the disease’s load (Zika Congenital Syndrome) in families and the society.

BSTM: How is the development of a vaccine against Zika?

Dr. Celina Turchi: Different vaccines against Zika virus are in initial licensure and clinical research phases. As far as I know, the vaccine(s) against Zika virus are not yet being produced for large-scale use.

BSTM: Would you like to add anything?

Dr. Celina Turchi: Yes, I would like to remind that although the number of Zika virus infection cases has reduced we should maintain epidemiological surveillance. The Zika Congenital Syndrome has ended, but the follow-up challenges of children with central nervous system impairment and other clinical manifestations remain, requiring multi-specialty assistance (pediatrics, Infectology, neurology, ophthalmology, physical therapy, otolaryngology, gastroenterology, nutrition, etc.). From a public health perspective, we should be prepared to prevent new (un)known arboviral diseases outbreaks in urban areas.