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Zika: what we do and do not know based on the experiences of Brazil
Cristina Possas
Epidemiol Health. 2016;38:e2016023.   Published online May 31, 2016
  • 16,426 View
  • 368 Download
  • 21 Citations
AbstractAbstract PDF
Zika virus, which was first discovered in 1947, has become a global threat to human health as it is rapidly spreading through Latin America, the Caribbean, the US and Asia, after causing a large outbreak in the Northeast region of Brazil in 2015. There is ample evidence to support that Zika virus is associated with neurological complications such as microcephaly. The review aims to provide an overview on the complex issues involved in the emergence of Zika virus’s neurological disorders and to discuss possible explanations of Zika virus introduction and dissemination in Brazil. We also suggest national and global strategies to adequately respond to the Zika virus emergence.
We provide an analytical evaluation of the main issues related to the Zika outbreak in Brazil, based on available scientific literature, including government documents, and on epidemiological information from national surveillance databases.
The studies on the clinical manifestations of the Zika virus infection coupled with the epidemiological surveillance information in Brazil have provided significant evidence that the Zika virus is associated with neurological disorders such as microcephaly and Guillain-Barré syndrome. Based on phylogenetic and molecular analysis, the hypothesis regarding the introduction of Zika virus in the country is that it took place following international events in 2013 and 2014, when many foreign visitors could have brought Zika virus into Brazil. The immunologically naïve status of populations in the Americas, previous infection with dengue virus, and the increased activity of Aedes aegypti might be the contributing factors for such an outbreak in Brazil. The Zika virus emergence emphasized the importance of cross-disciplinary perspective. Besides the scientific-based vector control strategies, it is important to understand the nature of the evolutionary processes involved in the viral evolution in complex ecosystems and to have social and anthropological knowledge on the conditions related to the spread of the disease in order to properly respond to the spread of the Zika virus.
The experiences of Brazil have demonstrated the significance of multi-disciplinary approach in response to new and resurgent arboviral diseases and provided important lessons that could be applied to other developing countries.
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Citations to this article as recorded by  
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    Ciência & Saúde Coletiva.2022; 27(1): 231.     CrossRef
  • Survival and Replication of Zika Virus in Diapause Eggs of Aedes Albopictus From Beijing, China
    Qianghui Zhang, Yuting Jiang, Chaojie Li, Jian Gao, Teng Zhao, Hengduan Zhang, Chunxiao Li, Dan Xing, Yande Dong, Tongyan Zhao, Xiaoxia Guo
    Frontiers in Microbiology.2022;[Epub]     CrossRef
  • Decline in head circumference growth and associated factors in congenital Zika syndrome
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  • Entry of dengue virus serotypes and their geographic distribution in Brazilian federative units: a systematic review
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    Revista Brasileira de Epidemiologia.2021;[Epub]     CrossRef
  • COVID-19 and Future Disease X in Circular Economy Transition: Redesigning Pandemic Preparedness to Prevent a Global Disaster
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    Circular Economy and Sustainability.2021; 1(4): 1463.     CrossRef
  • The Politics of Disease Epidemics: a Comparative Analysis of the SARS, Zika, and Ebola Outbreaks
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  • Establishment of an Alphavirus-Specific Neutralization Assay to Distinguish Infections with Different Members of the Semliki Forest complex
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  • Diagnostic Value of Platelet and Leukocyte Counts in the Differential Diagnosis of Fever in the Returning Traveler
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  • Molecular Epidemiology and Genetic Diversity of Zika Virus from Field-Caught Mosquitoes in Various Regions of Thailand
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  • Dilemma in the Brazilian Tropical Medicine: ‘Is speed more important than direction?’
    Marcus V.G. Lacerda, Fernando F.A. Val, Wuelton M. Monteiro
    Anais da Academia Brasileira de Ciências.2019;[Epub]     CrossRef
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    Francisco Fernandes Abel Mangueira, Roberta Smania‐Marques, Izabelly Dutra Fernandes, Victor Alves Albino, Ricardo Olinda, Tais Acácia Santos‐Silva, John Traxler, David Matheson, Silvana Santos
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    Joseph L. Mathew, Suvasini Sharma, Satinder Aneja
    Indian Pediatrics.2018; 55(4): 326.     CrossRef
  • Zika virus incidence, preventive and reproductive behaviors: Correlates from new survey data
    Climent Quintana-Domeque, José Raimundo Carvalho, Victor Hugo de Oliveira
    Economics & Human Biology.2018; 30: 14.     CrossRef
  • Zika virus: - a review of the main aspects of this type of arbovirosis
    Ítala Keane Rodrigues Dias, Cicera Luciana da Silva Sobreira, Rosa Maria Grangeiro Martins, Kelly Fernanda Silva Santana, Maria do Socorro Vieira Lopes, Emanuella Silva Joventino, Maria Corina Amaral Viana
    Revista da Sociedade Brasileira de Medicina Tropical.2018; 51(3): 261.     CrossRef
  • Zika virus epidemiology: from Uganda to world pandemic, an update
    C. Talero-Gutiérrez, A. Rivera-Molina, C. Pérez-Pavajeau, I. Ossa-Ospina, C. Santos-García, M. C. Rojas-Anaya, A. de-la-Torre
    Epidemiology and Infection.2018; 146(6): 673.     CrossRef
  • A Pregnant Teen Living in an Area With Active Zika Virus Transmission
    Jane Cox
    Journal of Pediatric Health Care.2017; 31(2): 232.     CrossRef
  • Arbovirus epidemics and blood safety in Brazil
    J. E. Levi
    ISBT Science Series.2017; 12(1): 233.     CrossRef
  • Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China
    Zhuanzhuan Liu, Tengfei Zhou, Zetian Lai, Zhenhong Zhang, Zhirong Jia, Guofa Zhou, Tricia Williams, Jiabao Xu, Jinbao Gu, Xiaohong Zhou, Lifeng Lin, Guiyun Yan, Xiao-Guang Chen
    Emerging Infectious Diseases.2017; 23(7): 1085.     CrossRef
  • Zika puzzle in Brazil: peculiar conditions of viral introduction and dissemination - A Review
    Cristina Possas, Patricia Brasil, Mauro CA Marzochi, Amilcar Tanuri, Reinaldo M Martins, Ernesto TA Marques, Myrna C Bonaldo, Antonio GP Ferreira, Ricardo Lourenço-de-Oliveira, Rita Maria R Nogueira, Patricia C Sequeira, Keyla BF Marzochi, Akira Homma
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Original Article
Evaluation of Acute Flaccid Paralysis in Hamadan, Iran from 2002 to 2009
Jalal Poorolajal, Shadi Ghasemi, Leila Nezamabadi Farahani, Atefeh Sadat Hosseini, Seyyed Jalal Bathaei, Ali Zahiri
Epidemiol Health. 2011;33:e2011011.   Published online November 16, 2011
  • 13,381 View
  • 101 Download
  • 8 Citations
AbstractAbstract PDF

To achieve a polio-free certification in Iran, a nationwide active surveillance program for acute flaccid paralysis (AFP) was set up following World Health Organization guidelines. This article describes the results of an eight-year surveillance of AFP in Hamadan, in the west of Iran.


A standard set of minimum core variables were collected. All cases of non-polio AFP in children aged <15 years old were reported. Two stool specimens were collected within 14 days of the onset of paralysis.


During the eight-year survey, 88 AFP cases aged <15 years old were reported. About 40% (35/88) of cases were aged ≤5 years, 56% (49/88) were boys, 19 (21.6%) had fever at the onset of paralysis, 74 (84.0%) had complete paralysis within four days of onset, and 22 (24.7%) had asymmetric paralysis. More than one AFP case was detected per 100,000 children aged <15 years old in all years. The risk of AFP in patients aged <5 years old was almost double that of older patients. Guillain-Barré Syndrome was the major leading cause of AFP (66/88). Adequate stool specimens were collected from 85% of AFP patients. All stool specimens were tested virologically, but no wild polioviruses were detected.


The active surveillance of non-polio AFP was efficient over the last eight years and exceeded 1.0 case per 100,000 children aged <15 years old. Nonetheless, there was a decreasing trend in the detection of AFP cases during the last two years and should be the focus of the policymakers' special attention, although AFP cases were still above the target level.

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    Journal of Research in Health Sciences.2021; 21(4): e00530.     CrossRef
  • The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis
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    JMIR Public Health and Surveillance.2019; 5(4): e14413.     CrossRef
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  • Eradication of Polio in the World; Iran is at Risk for Reemerging of Polio: A Review of the Literature
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    Archives of Clinical Infectious Diseases.2016;[Epub]     CrossRef
  • An epidemiological analysis of acute flaccid paralysis in Khuzestan Province, southwest Iran, from 2006 to 2010
    Ali Akbar Momen, Abdolhussein Shakurnia
    Epidemiology and Health.2016; 38: e2016030.     CrossRef
  • Surveillance of acute flaccid paralysis (AFP) in Lombardy, Northern Italy, from 1997 to 2011 in the context of the national AFP surveillance system
    Laura Pellegrinelli, Valeria Primache, Lucia Fiore, Concetta Amato, Stefano Fiore, Laura Bubba, Elena Pariani, Antonella Amendola, Maria Barbi, Sandro Binda
    Human Vaccines & Immunotherapeutics.2015; 11(1): 277.     CrossRef
  • Clinical and enterovirus findings associated with acute flaccid paralysis in the republic of Korea during the recent decade
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    Journal of Medical Virology.2014; 86(9): 1584.     CrossRef
  • Characteristics of Acute Flaccid Paralysis Reported by the Surveillance System and Verified by WHO Officer in Akwa Ibom State-Nigeria, 2006-2012
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Epidemiol Health : Epidemiology and Health