REDesastres

-------- Forwarded Message --------

Actualizacion mundial, abajo en el texto viene la situacion de cada  
pais y/o region
ZIKA VIRUS (05): AMERICAS, ASIA, PACIFIC
****************************************
Central America
---
El Salvador (national)
Guatemala (national)
Nicaragua (national)
Panama (Guna Yala, San Blas province)
Caribbean
---
Puerto Rico (national)
Jamaica (national)
Curacao (national)
South America
---
Brazil
- Americana, Campinas Metro, Sao Paulo state
- Vector control
- Vector species
- Olympic Games concerns
- Microcephaly
Colombia
- National
- Guillain-Barre syndrome
Peru (national)
Venezuela (national)
Pacific
---
Tonga (Nuku'alofa), Polynesia
Asia
---
Indonesia (Sumatra Island)
Imported cases with no possibility of ongoing transmission
---
USA
- Boston, Massachusetts
- New York
- Texas
- Virginia
Canada (national)
Netherlands (national)
New Zealand (national)
[2] Vaccines
******
[1] Cases in various countries:
Americas
Central America
---
El Salvador (national). 30 Jan 2016. (susp.) 6310 cases;
Guillain-Barre syndrome (GBS) 104 cases of which 54 are currently
hospitalized.
<http://www.laprensa.hn/mundo/924898-410/expertos-de-la-onu-llegan-a-el-salvador-por-virus-del-zika>
[in Spanish]
[Because of the ongoing Zika virus outbreak, the government in El
Salvador has urged women not to get pregnant until 2018 to avoid
having babies born with microcephaly. There is no indication of how
many of the GBS cases above had been infected by Zika virus. It is
possible that some of them had GBS due to other causes. - Mod.TY]
Guatemala (national). 30 Jan 2016. (conf.) 37 cases in 2016; 68 in
2015; the Minister of Health considers these case numbers to be an
underestimate.
<http://news.yahoo.com/guatemala-confirms-105-zika-cases-says-more-likely-215538851.html>
Nicaragua (national). 1 Feb 2016. (reported) 11 cases.
<http://www.laprensa.com.ni/2016/02/01/nacionales/1978889-11-casos-de-virus-del-zika-en-nicaragua>
[in Spanish]
[This report does not indicate how many of these 11 cases are locally
acquired. Clearly, some are. - Mod.TY.
Panama (Guna Yala, San Blas province). 1 Feb 2016. (conf.) 50 cases.
Virus thought to have been introduced through commercial traffic with
Colombia.
<http://laestrella.com.pa/panama/nacional/aumentan-50-casos-panama-virus-zika/23919463>
[in Spanish]
Caribbean
---
Puerto Rico (national). 31 Jan 2016. (conf.) 19 cases. Increasing.
<http://www.cnbc.com/2016/02/01/zika-as-if-puerto-rico-didnt-have-enough-to-worry-about.html>
Jamaica (national). 30 Jan 2016. (conf.) 1st case, a 4-year-old who
recently returned from Texas (USA), but the source of the infection is
unclear.
<http://www.usatoday.com/story/news/2016/01/30/jamaica-reports-first-case-zika-virus/79563246/>
Curacao (national). 21 Jan 2016. (conf.) 1st case, apparently locally
acquired.
<http://curacaochronicle.com/main/what-you-need-to-know-about-zika-virus/>
South America
---
Brazil
- Americana, Campinas Metro, Sao Paulo state. 28 Jan 2016. (conf.) 1st
case in the municipality, a 31-year-old pregnant woman with rash but
without fever.
<http://liberal.com.br/noticia/2B1BBFAC678-americana_tem_caso_suspeito_de_zika>
[in Portuguese]
[ProMED-mail thanks Arnaldo Gouveia Junior of the Municipal Hospital
Municipal of Americana for sending in this report. - Mod.TY]
- Vector control. 1 Feb 2016. The Brazil Provisional Measure published
today [1 Feb 2016] in the Union Official Daily authorizes forcible
entry by public agents fighting the _Aedes aegypti_ mosquito into
public or private buildings that have been abandoned, or in the
absence of the person who could permit entry. The document was signed
by President Dilma Rousseff and by Health Minister Marcelo Castro, and
grants permission to federal, state, and municipal health authorities.
The measure permits the execution of actions to combat the _Aedes
aegypti_ mosquito and its breeding sites.
(<http://combateaedes.saude.gov.br/noticias/248-governo-federal-autoriza-entrada-em-casas-abandonadas-para-eliminacao-do-mosquito-aedes-aegypti>
[in Portuguese]
- Vector species. 28 Jan 2016. Brazilian experts at Oswaldo Cruz
Foundation said the virus -- thought to be confined to the _Aedes
aegypti_ mosquito in the tropics -- may have already crossed over to
the _Culex_ mosquito, which would increase its chances of spreading
around the world.
<http://www.independent.co.uk/news/uk/home-news/zika-may-spread-to-britain-after-experts-find-virus-carrying-mosquitoes-a6838436.html>
[If _Culex_ spp turn out to be vectors of Zika virus, that would be a
worrisome development indeed. Many steps must be completed before
vector status can be established. Experimentally, the mosquitoes would
have to become infected after consuming a blood meal containing a
quantity of virus found in a viremic individual and subsequently
transmit the virus by bite. In the field, virus would have to be found
in mosquitoes captured in areas where human cases were occurring. -
Mod.TY]
- Olympic Games concerns. 29 Jan 2016. There is concern about Zika
virus infections occurring during the Olympic Games, to be held 5-21
Aug 2016, in Rio de Janeiro. Athletes and visitors may be at risk of
exposure. Some 10 000 athletes will be competing at the games with
tens of thousands more staff, officials and media attending the
world's biggest sporting event, apart from the hundreds of thousands
of spectators and visitors in the Brazilian city. Rio de Janeiro's
mayor says there is no cause for concern because "the games will be
held in the cooler and drier winter months, when the mosquito
population is naturally lower." The IOC's [International Olympic
Committee] medical commission says, "We remain confident that there
will be a safe environment for successful and enjoyable Olympic Games
in Rio de Janeiro." There is concern that individuals participating in
or visiting Rio could become infected and further disseminate the
virus when they depart.
<http://www.npr.org/sections/thetwo-way/2016/01/29/464861254/zika-virus-spurs-concerns-over-summer-games-in-rio>
[The WHO has declared a Public Health Emergency of International
Concern (PHEIC). Declaring a PHEIC would be the kiss of death for
Brazil's economy, killing the anticipated huge influx of foreign
tourists for Carnival and the Rio Olympics, and most foreign
investment. - Mod.JW
It will be interesting to see if release of genetically modified
mosquitoes that produce larvae that do not survive (see ProMED-mail
archive no. http://promedmail.org/post/20160128.3974426), that have
reduced _Aedes aegypti_ populations in a pilot field trial in
Piracicaba, Sao Paulo state, will be extended to other localities,
such as Rio de Janeiro in time for the Olympic Games in August. -
Mod.TY]
- Microcephaly. 27 Jan 2016. New figures released [Wed 27 Jan 2016] by
Brazil's Health Ministry as part of a probe into the Zika virus have
found fewer confirmed cases of a rare brain defect than first feared.
So far, only 270 of 4180 suspected cases have been confirmed as
microcephaly, with the brain damage associated with the defect ruled
out in 462 cases. Researchers are still studying 3448 of the cases,
which were recorded from 22 Oct [2015]. Brazilian officials still say
they believe there's a sharp increase in cases of microcephaly and
strongly suspect the Zika virus, which appeared in the country last
year, is to blame. The rare birth defect, which also can be caused by
factors such as infections, malnutrition, or drugs, means babies have
unusually small heads, 32 centimeters (12.6 inches) or less in
circumference, and it can cause lasting developmental problems.
<http://medicalxpress.com/news/2016-01-brazil-microcephaly-cases.html>
[A 30 Jan 2016 report in the North Shore Journal raises questions
about the relationship of Zika virus to microcephaly. It is followed
by a lively discussion. Excerpts from the article follow. "Is there an
outbreak of microcephaly in Brazil? That is one of the 1st questions
that ought to be asked when examining the topic of the potential
effects of a prenatal Zika viral infection... Data exist that suggest
that the number of confirmed cases of microcephaly in Brazil will be
far lower than the number of reports. In addition, the actual number
of cases of microcephaly per year in Brazil prior to the arrival of
the Zika viral illness is less clear than it might be. It is
impossible to draw a sound conclusion that the Zika outbreak has or
has not added to the number of cases of microcephaly in Brazil. The
data are suggestive that the number of microcephaly cases will range,
in a given 12 months, from normal to 2 or 3 times normal. It remains
an issue of great concern but the hype seems to have far exceeded the
threat."
<http://northshorejournal.org/microcephaly-and-zika>
A 31 Jan 2016 comment From Stephen Berger, Geographic Medicine, Tel
Aviv Medical Center, Tel Aviv Israel (<
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that "Zika virus infection has been documented in sub-Saharan Africa
since 1947, and numerous publications have already addressed the
epidemiology of microcephaly on the continent. I would propose a
simple case-control study of the seroprevalence of Zika virus( and
other arthropod-borne viruses) among African microcephalics and their
mothers." ProMED-mail thanks Steve Berger for this comment.
In a 28 Jan 2016 article, the USA CDC Principal Deputy Director Anne
Schuchat told reporters that proving these links would require
case-control studies that compare microcephalic babies with those born
around the same time and area. That type of information will provide
much-needed nuance about other exposures and factors that could
influence the health of these mothers and their offspring.
There is evidence that Zika virus can cross the placenta and infect
the fetus. The virus has been shown to be present in amniotic fluid in
2 cases, and in the tissues of a newborn who died shortly after birth.
One hopes that the prospective study being done by an
interdisciplinary team of medical specialists in Bahia will help to
clarify the relationship of maternal Zika virus infection and
transmission to the fetus. - Mod.TY]
Colombia
- National. 30 Jan 2016. (conf.) 20 297 cases including 2116 pregnant
women; no deaths or microcephaly cases have been reported.
<http://www.nytimes.com/2016/01/31/world/americas/colombia-reports-more-than-2100-pregnant-women-have-zika-virus.html>
- Guillain-Barre syndrome. 28 Jan 2016. (reported) Guillain-Barre
syndrome cases following Zika virus infections increased from 15 a
week ago to, "In the past week we have seen a substantial increase in
the number of people reported with Guillain-Barre," said health
minister Alejandro Gaviria.
<http://www.theguardian.com/world/2016/jan/28/zika-virus-colombia-paralysis-disorder-guillain-barre>
Peru (national). 29 Jan 2016. (conf.) 1st case, ex Venezuela or
Colombia.
<http://www.reuters.com/article/us-health-zika-peru-idUSKCN0V71XA>
[Because Peru has significant populations of _Aedes aegypti_ that
transmit dengue viruses, imported cases bring the risk of initiating
an outbreak of Zika virus. - Mod.TY]
Venezuela (national). 2 Feb 2016. (reported) 4700 cases officially
listed.
<http://www.npr.org/sections/goatsandsoda/2016/02/02/465246295/so-how-many-zika-cases-are-there-in-venezuela-4-000-or-400-000>
[Maps showing the location of the affected islands and countries in
the Americas mentioned above can be accessed at
<http://www.cdc.gov/chikungunya/images/maps/CHIK_Caribbean_Map-060214.jpg>
and <http://healthmap.org/promed/p/35574>; North America at
<http://healthmap.org/promed/p/106>; Central America at
<http://healthmap.org/promed/p/39455>; and South America at
<http://healthmap.org/promed/p/6186>. - Mod.TY]
Pacific
---
Tonga (Nuku'alofa), Polynesia. 30 Jan 2016. (conf.) as of 2 weeks ago,
1st case, no further cases currently.
<http://matangitonga.to/2016/01/30/tonga-registers-one-case-zika-virus>
[Maps of Tonga can be accessed at
<http://www.lib.utexas.edu/maps/islands_oceans_poles/tonga.jpg> and
<http://healthmap.org/promed/p/38217>. - Mod.TY]
Asia
---
Indonesia (Sumatra Island). 31 Jan 2016. (conf.) 1 case, locally
acquired. Virus reported as "circulating for awhile."
<http://www.scmp.com/news/asia/southeast-asia/article/1907984/zika-virus-found-indonesia-authorities-stumble-across>
Maps of Indonesia can be accessed at
<http://www.ezilon.com/maps/images/asia/political-map-of-Indonesia.gif>
and <http://healthmap.org/promed/p/534>. - Mod.TY]
Imported cases with no possibility of ongoing transmission
---
USA
- Boston, Massachusetts. 28 Jan 2016. (conf.) A previously healthy man
from Massachusetts was evaluated on 7 Jan 2016 for a febrile illness
with rash, conjunctivitis, and arthralgia. He went to Costa Rica with
2 family members from 19-26 Dec 2015, and stayed in Nosara, in the
northwestern coast of the country. The patient reported many mosquito
bites.
The patient noted myalgias starting 30 Dec 2015, followed by a red
rash, red face, red eyes, headache, and arthralgia. He presented to
the Walk-In Center on 2-3 Jan 2016 (day 4-5 of illness) where he had a
low-grade fever and laboratory tests found leukopenia, lymphopenia,
bandemia (19 percent), but normal platelets, basic metabolic profile,
and negative malaria smears. C-reactive protein was mildly elevated:
18.7 mg/dL (normal)
(report submitted by Lin H Chen, MD, Director, Travel Medicine Center,
Mount Auburn Hospital Associate Professor of Medicine, Harvard Medical
School Site Director, GeoSentinel Surveillance Network Cambridge,
Massachusetts <
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 ;).
Reference: Chen LH, Hamer DH. Zika Virus: Rapid Spread in the Western
Hemisphere. Ann Intern Med. 2016 Feb 2. doi: 10.7326/M16-0150. [Epub
ahead of print] <http://annals.org/article.aspx?articleid=2486362>
[Laboratory confirmed as Zika by CDC. - ProMED]
[ProMED-mail thanks Dr Chen for submitting this report. It will be of
interest to clinicians who are seeing patients from countries where
Zika virus is being transmitted. - Mod.TY]
- New York. 28 Jan 2016. (conf.) 7 cases ex country with
transmission.
<http://wxxinews.org/post/zika-virus-found-monroe-county>
- New Jersey. 28 Jan 2016. (conf.) 1 case ex Colombia.
<http://www.nj.com/healthfit/index.ssf/2016/01/state_confirms_case_of_zika_virus_in_northern_nj.html>
- Oregon. 29 Jan 2016. (reported) 3 cases ex Polynesia, of which 1 in
2014 and 2 in 2015.
<http://www.oregonlive.com/health/index.ssf/2016/01/3_oregonian_infected_with_zika.html>
- Texas. 29 Jan 2016. (conf.) 6 cases.
<http://www.nbcdfw.com/news/health/Pregnant-Women-Grow-Concerned-About-Zika-Virus-Cancel-Trips-367050111.html>
[In a 2 Feb 2016 report, the Texas Department of State Health Services
stated that the possibility of sexual transmission from an infected
person to a non-infected person is likely in this case (1 of the 6)
(<http://www.msn.com/en-us/news/us/dallas-county-reports-first-us-case-of-zika-virus-transmission/ar-BBp261K?li=BBnb7Kz&ocid=iehp>).
If confirmed, this becomes the 3rd case of sexual transmission.
ProMED-mail thanks Dr Charles H Calisher for bringing this report to
our attention. - Mod.TY]
 - Virginia. 29 Jan 2016. (conf.) 2 cases ex Central America.
<https://news.virginia.edu/content/zika-virus-spreads-uva-infectious-diseases-expert-answers-key-questions>
[A map of the USA showing the states mentioned above can be accessed
at <http://www.mapsofworld.com/usa/>. - Mod.TY]
Canada (national). 30 Jan 2016. (conf.) 4 cases in provinces: British
Columbia 2 cases, Alberta 1 case, Quebec 1 cases. All, ex countries
with Zika virus transmission.
<http://www.sakshipost.com/index.php/news/international/73173-four-canadians-test-positive-for-zika.html?psource=Home-Latest>
[A map of Canada showing the provinces can be accessed at
<https://canadaalive.files.wordpress.com/2014/02/canada_political_map.gif>.
- Mod.TY]
Netherlands (national). 29 Jan 2016. (conf.) 1 case ex Curacao.
<http://curacaochronicle.com/main/zika-virus-contracted-in-curacao/>
[A map showing the location of the Netherlands in Europe can be
accessed at <http://healthmap.org/promed/p/104>. - Mod.TY]
New Zealand (national). 28 Jan 2016. (reported) 8 cases ex Tonga and
Samoa.
<http://www.msn.com/en-nz/news/other/nine-zika-cases-reported-so-far-in-2016/ar-BBoPVGq>
[A map showing the location of New Zealand in the South Pacific can be
accessed at <http://healthmap.org/promed/p/164>. - Mod.TY]
--
Communicated by:
ProMED-mail
<
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******
[2] Vaccines
Date: Tue 2 Feb 2016
Source: Science Magazine [edited]
<http://www.sciencemag.org/news/2016/02/fears-zika-causes-brain-damage-infants-sparks-vaccine-hunt>
Fears that Zika causes brain damage in infants sparks vaccine hunt
------------------------------------------------------------------
Just last summer [2015], Zika seemed too trivial for anyone to bother
developing countermeasures. The mosquito-borne virus was racing
through countries in the Southern Hemisphere, but, at worst, it
appeared to cause a mild fever and rash. No longer: on [1 Feb 2016],
the World Health Organization (WHO) declared the "extraordinary"
cluster of microcephaly and other neurological complications that have
now been linked to Zika a public health emergency of international
concern. And vaccine makers, big and small, have begun the race to
head it off. They have a good shot at success, several experts say --
cautioning that vaccine development requires years of testing.
Zika [virus] first caused serious concern in May 2015 after it arrived
in South America and suspicions grew that infection during pregnancy
could cause brain-damaging microcephaly in babies. The link, WHO
Director-General Margaret Chan stresses, is "strongly suspected though
not yet scientifically proven"-- as is a potential connection to
Guillain-Barre syndrome, which causes a temporary paralysis in adults.
With viral spread increasing, a vaccine is now a top priority.
Vaccine pioneer, Stanley Plotkin of the University of Pennsylvania,
predicts "a straightforward developmental pathway" for a vaccine. He
notes that Zika belongs to the flavivirus family, and vaccines exist
for several of its relatives, including dengue, yellow fever, and
Japanese encephalitis. "I don't see any technical issues such as the
ones that obviously exist for vaccines against HIV, tuberculosis, and
many other agents," says Plotkin, who consults with several
vaccinemakers.
Still, "there are many puzzles," says Thomas Monath, a virologist who
studied Zika [virus infections] in wild monkeys in Nigeria in the
1970s and is now the chief scientific officer at NewLink Genetics in
Devens, Massachusetts, whose team helped develop a promising Ebola
vaccine. For Zika [virus], one unknown is whether infection leads to
lifelong protection -- a key feature of diseases for which vaccines
are most effective, such as yellow fever. Another question is whether
natural or vaccine-induced immunity against other related viruses --
particularly yellow fever -- could offer a measure of "cross
protection," which might confuse efforts to evaluate Zika vaccines.
Nor have researchers yet established a much-needed monkey model to
enable comparisons of candidate vaccines.
Approaches have proliferated. Monath, who has developed vaccines
against several flaviviruses, says NewLink will pursue a traditional
strategy that inactivates, or kills, the virus with a chemical so it
cannot replicate in the body. He thinks an inactivated vaccine has the
best chance of winning regulatory approval for a product that pregnant
women might use.
At the nonprofit Butantan Institute in Sao Paulo, Brazil, immunologist
and director Jorge Kalil is betting that a weakened, live vaccine can
be safe and potentially more effective than killed virus. His team
plans to exploit a technology that researchers at the US National
Institute of Allergy and Infectious Diseases (NIAID) used to make a
dengue vaccine, which Butantan licensed and is now testing in an
efficacy trial. To weaken that virus, researchers deleted genes so it
can copy itself but not cause disease. "Perhaps we can attenuate the
Zika virus by using the same deletions of the same sites," Kalil says,
noting that Butantan likely would partner with NIAID to develop its
vaccine. The Brazilian institute has a key advantage: Unlike almost
every other institution in the world that does vaccine research, it
has an industrial-scale manufacturing plant--last year the institute
cranked out 40 million doses of influenza vaccine--so it might be able
to supply enough product for Brazil without needing help from big
pharma.
NIAID Director Anthony Fauci says his institute has a "head start"
with a different technology it used to make an experimental vaccine
for West Nile, another flavivirus. The manufacturing process begins
with a circular "plasmid" of DNA that holds key viral genes. When it
is inserted into bacterial cells, they produce "virus-like particles"
that can serve as an inactivated vaccine, because they cannot copy
themselves. (The West Nile vaccine worked well in early human studies,
but NIAID could not find a commercial partner to take it forward).
Inovio Pharmaceuticals of Plymouth Meeting, Pennsylvania, boasts it
already has an experimental Zika [virus] vaccine containing nothing
more than a plasmid made of Zika genes. With the help of an electrical
zap on the skin, the plasmid goes directly into human cells, which
make Zika proteins that stimulate the immune system. CEO Jerome Kim
says his team already has begun tests in mice. But although
researchers can quickly make such simple DNA vaccines, they have lost
their luster over the past 20 years because they have not triggered
strong immune responses against other diseases. "There are people very
knowledgeable in the field who have lost faith in this technology,"
Kim concedes. "I want to prove to the field that this technology is
viable and perhaps the best option for these types of outbreaks."
The small Jenner Institute in Oxford, UK, is putting the Zika surface
protein into harmless chimpanzee adenoviruses, which serve as a
"vector" -- an approach similar to one used in GSK's [GlaxoSmithKline]
Ebola vaccine, which was tested during the West African epidemic.
Vaccine makers Protein Sciences of Meriden, Connecticut, and Hawaii
Biotech of Honolulu -- which both specialize in producing viral
proteins in insect cell lines -- also have projects underway.
Predicting when a vaccine will come to market is a mug's game, but
NIAID's Fauci thinks animal studies could be completed in a few months
and small human studies to evaluate safety and immune responses could
begin by the end of 2016. Even if a promising candidate surfaces,
large-scale efficacy trials are probably years away, he says. Getting
a vaccine approved and supplying millions of doses could take the
resources of a major manufacturer. Of the 4 big pharma companies that
make vaccines, only Sanofi Pasteur of Lyon, France -- makers of 3
flavivirus vaccines -- has launched a Zika program, though the others
say they are watching the field closely.
As a stopgap measure, Kalil says Butantan hopes to produce a
protective serum for pregnant women, which the institute already makes
for several diseases, by injecting Zika virus into horses and
harvesting the antibodies the animals make. "This would take a little
over a year," Kalil says. "That's the best timeline -- if you're very,
very optimistic."
[Byline: Jon Cohen]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The progress that these vaccines make will be watched with
considerable interest. Even assuming no adverse reactions to a vaccine
in phase 1 trials, proof of efficacy in phase 2 and 3 will require
considerable time. The cost of development will be substantial. -
Mod.TY]
[See Also:
Zika virus (04): WHO declares worldwide PHEIC
http://promedmail.org/post/20160201.3985366
Zika virus (03): Americas, Asia
http://promedmail.org/post/20160128.3974426
Zika virus (02): Americas http://promedmail.org/post/20160111.3925377
Zika virus - Americas http://promedmail.org/post/20160108.3921447
2015
----
Zika virus - Americas (05)
http://promedmail.org/post/20151231.3902686
Zika virus - Americas, Atlantic Ocean
http://promedmail.org/post/20151223.3886435
Zika virus - Netherlands ex Suriname
http://promedmail.org/post/20151213.3858300
Zika virus - Americas (04)
http://promedmail.org/post/20151211.3855107
Zika virus - Americas (03)
http://promedmail.org/post/20151205.3842908
Zika virus - Americas (02)
http://promedmail.org/post/20151127.3824009
Zika virus - Colombia (08)
http://promedmail.org/post/20151121.3808431
Zika virus - Colombia (07)
http://promedmail.org/post/20151120.3807205
Zika virus - Colombia (06)
http://promedmail.org/post/20151113.3788787
Zika virus - Colombia (05)
http://promedmail.org/post/20151110.3781280
Zika virus - Colombia (04): (AT) susp
http://promedmail.org/post/20151108.3775023
Zika virus - Colombia (03)
http://promedmail.org/post/20151102.3760111
Zika virus - Colombia (02)
http://promedmail.org/post/20151030.3756619
Zika virus - Colombia http://promedmail.org/post/20151018.3723954
Zika virus - Brazil (08) http://promedmail.org/post/20150716.3513770
Zika virus - Brazil (07) http://promedmail.org/post/20150630.3473420
Zika virus - Brazil (06): (BA)
http://promedmail.org/post/20150619.3449500
Zika virus - Brazil (05) http://promedmail.org/post/20150612.3431148
Zika virus - Americas: PAHO alert, country alerts, Brazil update
http://promedmail.org/post/20150609.3422423
Zika virus: possible sexual transmission
http://promedmail.org/post/20150516.3367156
Undiagnosed illness - Brazil (02): Zika virus conf
http://promedmail.org/post/20150515.3364149
Undiagnosed illness - Brazil: (Northeast, RJ) Zika virus susp, RFI
http://promedmail.org/post/20150501.3334749
Zika virus - Pacific: Vanuatu
http://promedmail.org/post/20150501.3334549]

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