Response letter: Serological evidence confirms the presumed diagnosis of Zika virus congenital infection in infants with microcephaly and ocular findings

FAV, Recife, PE, BrazilHosp Olhos HOPE, Recife, PE, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, BrazilInst Visiao, Sao Paulo, SP, BrazilHosp Barao de Lucena, Recife, PE, BrazilHUOC, Recife, PE, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, BrazilWeb of Scienc

Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection

ABSTRACT Purpose: In 2015, a twenty-fold increase in the prevalence of microcephaly in Brazil was reported, and the Ministry of Health associated this abnormal prevalence with the maternal-fetal Zika virus (ZIKV) transmission. Methods: We assessed the ophthalmological findings of ten mothers and their infants that had been clinically diagnosed with ZIKV-related microcephaly and presented ocular abnormalities, born from May to December 2015. Results: Seven mothers (70.0%) referred symptoms during pregnancy (malaise, rash and arthralgia), of which six (85.7%) were in the first trimester. At the time of exam, no ophthalmological abnormalities were identified in the mothers and they did not report ocular symptoms during pregnancy. Serology was negative in all infants for Toxoplasmosis, Rubella, Cytomegalovirus, Syphilis and Human Immunodeficiency Viruses. Ocular findings included macular alterations (gross pigment mottling and/or chorioretinal atrophy) in fifteen eyes (75.0%), and optic nerve abnormalities (hypoplasia with double-ring sign, pallor, and/or increased cup-to-disk ratio) in nine eyes (45.0%). Conclusions: Patients presented normal anterior segment and important macular and optic nerve abnormalities. Further studies will assess the visual significance of these alterations

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil.

BACKGROUND: While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. METHODS: Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. FINDINGS: 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages

The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile.

This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG-PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG-PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case-Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a 'task force' of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children's characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil

Projeto Mutirão de Catarata em centro de referência oftalmológico, em Pernambuco: perfil, grau de satisfação e benefício visual do usuário Medical Social Cataract Project ("Mutirão de Catarata") in an ophthalmologic center - Pernambuco State, Brazil: user profile, patient satisfaction and visual outcome

OBJETIVOS: Identificar o perfil e o grau de satisfação do paciente, além do benefício visual do usuário do Sistema Único de Saúde atendido no Projeto de Mutirão de Catarata da Fundação Altino Ventura. MÉTODOS: Foram selecionados 163 pacientes submetidos à cirurgia da catarata, de outubro a novembro de 2002, obtendo-se dados do perfil sociodemográfico. Aplicou-se questionário visando analisar a qualidade do atendimento aos pacientes nos vários setores da Instituição, além da acuidade visual final e do seguimento clínico. RESULTADOS: A média de idade dos pacientes foi de 68,4 anos. O gênero feminino foi o mais freqüente (67,5%). A freqüência de analfabetos foi de 20,2%. A ocupação mais observada foi do lar (43,6%). A freqüência dos parâmetros usados para avaliação do grau de satisfação dos usuários situou-se acima de 95,0%. Houve melhora estatisticamente significante da acuidade visual pós-operatória, em ambos os olhos. Olho direito - pré-operatória = X&plusmn; DP - 0,193 &plusmn; 0,135 - pós-operatória = 0,650 &plusmn; 0,293, "t" = 13,469 - p < 0,0001. Olho esquerdo - pré-operatória = X&plusmn; DP - 0,217 &plusmn; 0,197 - pós-operatória = 0,666 &plusmn; 0,301, "t" = 11,300 - p < 0,0001. CONCLUSÕES: A maioria dos pacientes incluídos no Projeto tinha baixa escolaridade e era excluído do mercado de trabalho. O grau de satisfação do usuário foi excelente, observando-se boa qualidade do serviço prestado e significante benefício visual, aspectos fundamentais para a maior credibilidade da Instituição.<br>PURPOSES: To identify the social and demographic patient profile, and to evaluate the visual outcome of patients enrolled in the Medical Social Cataract Project, developed by the "Altino Ventura Foundation" - Pernambuco State, Brazil. METHODS: 163 patients who underwent cataract surgery and were seen at follow-up in October and November 2002. Data were obtained by a questionnaire, which also included questions about the service qualities provided by several sectors of the institution. The patients were also evaluated as regards the visual acuity and clinical outcome. RESULTS: The patient mean age was 68.4 years. Females were more frequent (67%). Illiteracy was present in 20% of the patients. Housewifeliness (44%) represented the majority of the patient activities. It was found that the relative frequency of several parameters used to assess patient satisfaction with the hospital care was greater than 95%. There was statistically significant improvement, of visual acuity after surgery, in both eyes. Right eye - preoperative = X&plusmn; SD - 0.193 &plusmn; 0.135 - postoperative = 0.650 &plusmn; 0.293 "t" = 13.469 - p < 0.0001. Left eye - preoperative = X&plusmn; SD - 0.217 &plusmn; 0.197 - postoperative = 0.666 &plusmn; 0.301, "t" = 11.300 - p < 0.0001. CONCLUSIONS: The degree of satisfaction in this group of patients, with high illiteracy and excluded from the work force, was very good. An association between the quality of the provided services and benefit of visual acuity improvement was observed. These results were fundamental for greater credibility of the institution

Ocular Findings in Children with Congenital Zika Syndrome

The zones of active Zika virus (ZIKV) infection are expanding globally with the northeastern part of Brazil being a major epicenter of the virus [1, 2]. When ZIKV first stroke Brazil in May 2015, the population was by far unprepared for the subsequent implications of this new disease to the Americas [1, 3]