Aug, 2021

Causes of Microcephaly in the Zika Era in Argentina: A Retrospective Study


Authors: G Berberian, R Bologna, MG Pérez, A Mangano, PhD, M Costa, MSc, S Calligaris, MA Morales, C Rugilo, E Ruiz-Burga, C Thorne

Published in: Sage Journals



There are gaps in understanding the causes and consequences of microcephaly. This paper describes the epidemiological characteristics, clinical presentations, and etiologies of children presenting microcephaly during the Zika outbreak in Argentina. This observational retrospective study conducted in the pediatric hospital of Juan P. Garrahan reviewed the medical records of 40 children presenting microcephaly between March 2017 and November 2019. The majority (60%) were males and born full-term. At first evaluation, microcephaly was defined as congenital (31/40, 77%) and associated with other features (68%) such as seizures, developmental delay, non-progressive chronic encephalopathy, and West Syndrome. It was found manifestations restricted to central nervous system (55%), ocular (8/40, 20%), and acoustic (9/40, 23%) defects, and abnormal neuroimaging findings (31/39, 79%). Non-infectious diseases were the primary cause of isolated microcephaly (21/37, 57%), largely related to genetic diseases (13/21, 62%). Only 3 were children were diagnosed with Congenital Zika infection (3/16, 7.5%).

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Jun, 2021

The use of mobile technologies for early detection of arbovirus infections in pregnancy

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The great expansion of mobile technology across the globe has facilitated the use of smartphone applications to improve health systems and engage people in public health processes. This approach has been specially applied in low and middle income countries where capitalizing on the ubiquity of mobile technology infrastructure can help to overcome widespread health system barriers such as health personnel shortages, cost of health service, and transportation. Mobile health (mHealth) is a growing field with several applications in maternal and child health programmes dedicated to health monitoring, surveillance, and information sharing, including improving coverage and accessibility of real-time information to clinicians and epidemiologists.

This article presents a brief overview of a mHealth initiative conducted in Jamaica that adapted a smartphone application  originally developed for travellers by the University Medical Center Utrecht (UMCU) for early detection of arbovirus infections.  In recent years, Jamaica has experienced numerous arbovirus outbreaks characterised by an increasing intensity and severity that have affected large numbers of women during pregnancy. This was a one-year pilot study that evaluated the feasibility and acceptability of using the “ZIKApp” by pregnant women in an arbovirus-endemic country, including its  utility as a clinical detection tool and communication aid, that will direct the adaptation of the App for future use.

Following ethics approvals, training of the local research team was conducted in Jamaica. Between January 2020 and March 2021, this study  enrolled 173 pregnant women from the antenatal clinic of the University of the West Indies (UWI) Hospital, Kingston. The App involved a daily self-report of presence/absence of symptoms consistent with arboviral infection and/or pregnancy complications, and also provided women with general pregnancy-related information to enhance their engagement. This pilot helped us to determine participants’ adherence to daily symptom reporting and to explore the App’s performance in detecting potential arbovirus symptom episodes, and its utility in collecting additional information via questionnaires. The local research nurses monitored the reports of symptoms, followed potential cases, and collected data on outcomes of pregnancy. The UMCU research team provided technical support and hosted the App’s data portal. The University College London (UCL) research team oversaw the development of this pilot, and conducted the analysis of the findings. This ZIKApp study was a collaboration between the Penta Foundation Onlus, UWI, UMCU and UCL.


Elisa Ruiz is a research associate at GOSICH-UCL specialized in public health with 24 years of experience working in sexual and reproductive health studies focused on vulnerable groups mostly living in impoverished environments in different regions. Most of these projects were community intervention trials based on the behaviour change theory that applied mixed research methods and appropriate frameworks to understand the linkages between social inequalities and health access. Currently, she is working in studies focused on vertical transmitted infections that are being conducted in Latin America and the Caribbean.


Apr, 2021

ZIKAction research in the face of COVID-19


A recollection by Isadora Siqueira, Chief Investigator of the Paediatric Registry Study, on how the ZIKAction team in Brazil adapted to the challenges brought on by COVID-19 in order to carry on with their research and recruitment into the paediatric study.


What impact has the COVID-19 pandemic had on ZIKAction’s study activities and what solutions has your site identified to cope with it?  

Brazil is one of the countries most affected by the COVID-19 pandemic and as of March 20th 2021, it had an incidence rate of 5,649 cases per 100,000 habitants, 4,726 cases per 100,000 women, and 1,536 per 100,000 children.

The COVID-19 pandemic significantly impacted the setup of ZIKAction Paediatric Registry in Bahia. The registry is an observational tool collecting information on children during their routine clinical care, who have been exposed to ZIKV and with congenital ZIKV. The registry will provide important information about the clinical characteristics of congenital zika infection, which will help local health professionals with these children’s clinical management. We had planned to implement the recruitment and enrolment of participants and the follow-up evaluations during the participants’ health care assistance, but with the pandemic and closure of health care institutions, we needed to find an alternative way of implementing the study.

Two things facilitated our contact with mothers of children with congenital zika and helped the recruitment process during the COVID-19 restrictions. Firstly, we hired two nurses and one physiotherapist who used to work in health services that offer public rehabilitation to the children. They had already established relationships with most of the mothers and children. They explained the study to these mothers on the phone and offered them the choice to have their children participate. The work that went into opening up recruitment into our registry was a very important activity for our region. Bahia was one of the first and most affected regions during the 2015-2016 microcephaly outbreak, with 696 cases of congenital zika infection confirmed.

Secondly, we had the support of “Abraço a Microcefalia” (Hug to Microcephaly), a community association of mothers with babies born with congenital microcephaly and other zika-related neurological issues. I used to know some of these mothers from previous studies that we conducted in 2016 and one of the nurses from our team volunteers at this association and knows most of the mothers and children. Currently, most of their children are around five years old and when the zika outbreak was ongoing, their children had more access, visibility and care. But over the years, I have witnessed how these mothers have progressively felt forgotten and invisible. They persistently struggle to ensure access to their children’s rehabilitation, a situation that got worse during the COVID-19 pandemic.


What is the legacy of ZIKAction in terms of improving the research capacity at your institution/country for emerging epidemics?  

ZIKAction offered an opportunity to work in a coordinated way with diverse groups of researchers from different countries and different expertise, and it also encouraged collaborative work between institutions and countries. The consortium implemented tools and built infrastructure for data collection that could be used in future epidemics. The platform with the registry database will be available even after the end of the ZIKAction project. In addition to this, our team was trained in Good Clinical Practice and General Data Protection Regulation and gained expertise in multicentric studies.


Has your experience in ZIKAction opened up new opportunities for you as a researcher?

As a researcher, the experience of participating in ZIKAction was amazing; it allowed me to work in collaboration with other institutions and countries and be part of a fantastic network of researchers. From this incredible experience, new opportunities are opening up, we are now involved in a recent study on COVID-19 in pregnancy and about to join the ORCHESTRA consortium, where we are going to conduct a prospective study on pregnant women with COVID-19 admitted in a local public maternity hospital, in order to characterize the COVID-19 clinical presentation in pregnant woman and also to identify the adverse outcome of their pregnancies. We are very excited to continue working in partnership with Penta.

Learn more about ZIKAction

Isadora Siqueira is a Public Health Researcher, Infectious Disease Specialist and Paediatrician at Instituto Gonçalo Moniz (FIOCRUZ) and Chief Investigator of the ZIKAction Paediatric Registry study.


Mar, 2021

ZIKAHOST study shares findings on genetic predisposition to typical ZIKA effects at SEIP 2021

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The ZIKAHOST study aims to describe the Zika virus (ZIKV) infection taking into account the host, in this case humans, instead of the pathogen, which would be the zika virus, and we search for biomarkers of the increased likelihood of developing the disease, diagnosis and prognosis through a genomic approach. What this means is that we look at DNA to see if we could understand if patients can be genetically predisposed to develop typical ZIKV effects.

The study analysed 80 DNA samples from 40 mother and child pairs. The mothers had suffered ZIKV infection during pregnancy, 20 of the children born developed typical aftereffects associated with ZIKV, while the other 20 remained asymptomatic.

Overall, our study showed three genes in the children’s cohort which could explain some of the most important features of the Congenital Zika Syndrome. Specifically, PIDD1 was found to be related to microcephaly (small head circumference), while PANO1 and SLC25A22 were related to early infantile epilepsy. No significant genes were found in the mother’s cohort.

The Spanish Society of Pediatric Infectious Diseases has positioned itself as an influential speciality society within the Spanish Association of Pediatrics, based on its broad contribution towards science, its stable number of partners and impact and presence in the media. It is among the most important paediatric infectious diseases meetings in Latin-American countries. Presenting our research at such an event has allowed us to gain visibility and work towards establishing future collaborations for the replication of our studies in other cohorts.

View poster here

Find out more about ZIKAction

Visit the ZIKAction website




Nov, 2020

Vertical transmission of Zika virus and its outcomes: a Bayesian synthesis of prospective studies

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Authors: A E Ades, Antoni Soriano-Arandes, Ana Alarcon, Francesco Bonfante, Claire Thorne, Catherine S Peckham, Carlo Giaquinto

Published in: The Lancet

Background:  Prospective studies of Zika virus in pregnancy have reported rates of congenital Zika syndrome and other adverse outcomes by trimester. However, Zika virus can infect and damage the fetus early in utero, but clear before delivery. The true vertical transmission rate is therefore unknown. We aimed to provide the first estimates of underlying vertical transmission rates and adverse outcomes due to congenital infection with Zika virus by trimester of exposure.

Methods: This was a Bayesian latent class analysis of data from seven prospective studies of Zika virus in pregnancy. We estimated vertical transmission rates, rates of Zika-virus-related and non-Zika-virus-related adverse outcomes, and the diagnostic sensitivity of markers of congenital infection. We allowed for variation between studies in these parameters and used information from women in comparison groups with no PCR-confirmed infection, where available.

Funding: European Union Horizon 2020 programme.




Apr, 2020

Genomic and epidemiological surveillance of Zika virus in the Amazon region

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Authors: Giovanetti M, Faria NR, Lourenco J, et al.

Published in:  Cell Rep. 2020;30(7):2275-2283

Abstract Zika virus (ZIKV) has caused an explosive epidemic linked to severe clinical outcomes in the Americas. As of June 2018, 4,929 ZIKV suspected infections and 46 congenital syndrome cases had been reported in Manaus, Amazonas, Brazil. Although Manaus is a key demographic hub in the Amazon region, little is known about the ZIKV epidemic there, in terms of both transmission and viral genetic diversity. Using portable virus genome sequencing, we generated 59 ZIKV genomes in Manaus. Phylogenetic analyses indi- cated multiple introductions of ZIKV from northeastern Brazil to Manaus. Spatial genomic analysis of virus movement among six areas in Manaus suggested that populous northern neighborhoods acted as sources of virus transmission to other neighborhoods. Our study revealed how the ZIKV epidemic was ignited and maintained within the largest urban metropolis in the Amazon. These results might contribute to improving the public health response to outbreaks in Brazil.



Feb, 2020

ZIKAction at 3rd International Conference on Zika Virus and Aedes related infections

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ZIKAction Consortium will be presenting preliminary results of its vertical transmission study at the 3rd International Conference on Zika Virus and Aedes related infections that will be held in Washington DC, USA, from 13th to 16th February 2020.

The conference aims to bring together physicians, public health practitioners and researchers to address challenges that Zika and Aedes related infections pose around the globe and try to fill knowledge gaps that still remain, despite many published papers.

Details of the ZIKAction presentations taking place at the conference are shown below.


Friday, February 14, 2020

  • Aileen Lue, Pediatric Medicine Resident, Bustamante Hospital for Children & University of the West Indies, Kingston, Jamaica. Severity and Outcomes of Dengue in Hospitalized Children from Five Hospitals in Jamaica During the 2018-2019 Epidemic: Is this due to Antibody Dependent Immune Enhancement from ZIKA Virus Exposure?
  • Karen Webster-Kerr, National Epidemiology Unit, Ministry of Health and Wellness, Kingston, Jamaica. Trends in Dengue – The Jamaican Experience.


Saturday, February 15, 2020

  • Celia DC Christie, Child and Adolescent Health, University of the West Indies, Kingston, Jamaica. Overview and Preliminary Results of the ZIKAction Vertical Transmission Study in Jamaica.


Oct, 2019

ZikAction Consortium Meeting to take place in Guayaquil, 8-9 November 2019

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On 8-9 November the annual ZIKAction Consortium meeting will be held in Guayaquil, Ecuador. Around 40 researchers, health professionals and project managers from partner organizations are planning to participate in the meeting which aims at overviewing the ongoing project studies, their outcomes and setting goals for the upcoming year. The results of various studies, urgent issues and project management area updates will be presented and discussed during various sessions of the meeting. Special attention will be given to new studies currently starting under the framework of the project in Argentina, Brazil, Jamaica and Ecuador.

We look forward to seeing you all in Guayaquil and sharing the outcomes of the meeting with our wider community of researchers, practitioners, patients and families!


Jul, 2019

Minor groove binder modification of widely used TaqMan hydrolysis probe for detection of dengue virus reduces risk of false-negative real-time PCR results for serotype 4

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Authors: Gray ER, Heaney J, Ferns RB, Sequeira PC, Nastouli E, Garson JA

Published in: J Virol Methods. 2019;268:17-23

Abstract Dengue is a vector-transmitted viral infection that is a significant cause of morbidity and mortality in humans worldwide, with over 50 million apparent cases and a fatality rate of 2.5 % of 0.5 million severe cases per annum in recent years. Four serotypes are currently co-circulating. Diagnosis of infection may be by polymerase chain reaction, serology or rapid antigen test for NS1. Both pan-serotype and serotype-specific genome detection assays have been described, however, achieving adequate sensitivity with pan-serotype assays has been challenging. Indeed, as we show here, inspection of components and cycling parameters of a pan-serotype RT-qPCR assay in use in laboratories worldwide revealed insufficient probe stability to accommodate potential nucleotide mismatches, resulting in false-negatives. A minor–groove binder (MGB)-modified version of the probe was designed and its performance compared with that of the original probe in 32 samples. Eight of the samples were undetected by the original probe but detected by the MGB modified probe and six out of seven of these that could be serotyped belonged to serotype 4. Sequencing of the region targeted by the probe in these samples revealed two mismatches which were also universally present in all other serotype 4 sequences in a public database. We therefore recommend adoption of this MGB modification in order to reduce the risk of false-negative results, especially with dengue serotype 4 infections.



Jun, 2018

International Symposium on Zika Virus Research in Marseille – France

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Registrations are now open for the international conference on Zika Virus to be held in Marseille, France, next June. The event – organized by the EU-funded ZIKAlliance project in collaboration with three other EU-funded Zika projects (ZikaPLAN, ZIKAction, and ZIKAVAX) and the European Society for Virology – will take place at the Faculty of Medicine La Timone. The event will provide an overview of the current status of Zika research – covering from basic to clinical research, epidemiology, environmental studies and social sciences – and an opportunity to present the latest results from research conducted by the EU funded Zika consortia. Please visit the conference website for further details and register here.


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