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| City at centre of Brazil's Zika epidemic reeling from disease's insidious effects | |
| (35 minutes later) | |
| With her three-month-old baby nestling in her arms, Gleyse Kelly recalled how overjoyed she was when the doctor told her that after three boys, her fourth child would be a girl. | With her three-month-old baby nestling in her arms, Gleyse Kelly recalled how overjoyed she was when the doctor told her that after three boys, her fourth child would be a girl. |
| But in the seventh month of her pregnancy, the ultrasound showed that the girl’s head was not developing properly. In the report accompanying the images, her doctor had scribbled the word: “Microcephaly?” | But in the seventh month of her pregnancy, the ultrasound showed that the girl’s head was not developing properly. In the report accompanying the images, her doctor had scribbled the word: “Microcephaly?” |
| “I’d never even heard of it before,” said the 27-year-old toll-booth attendant who lives in Recife, in the state of Pernambuco. “On the internet, it said she wouldn’t be able to walk or talk. I was terrified.” | “I’d never even heard of it before,” said the 27-year-old toll-booth attendant who lives in Recife, in the state of Pernambuco. “On the internet, it said she wouldn’t be able to walk or talk. I was terrified.” |
| After weeks of uncertainty, and further inconclusive ultrasounds, on 16 October her obstetrician finally confirmed the diagnosis. | After weeks of uncertainty, and further inconclusive ultrasounds, on 16 October her obstetrician finally confirmed the diagnosis. |
| “It was devastating,” she said. “But we had no time to react.” | “It was devastating,” she said. “But we had no time to react.” |
| The next day her daughter, Maria Giovanna, was born. So far, she has proven a healthy baby, who eats well, sleeps well and reacts to visual and audio stimuli. “She is just like any other child,” Ms Kelly says. “It’s just that she has a small head.” | The next day her daughter, Maria Giovanna, was born. So far, she has proven a healthy baby, who eats well, sleeps well and reacts to visual and audio stimuli. “She is just like any other child,” Ms Kelly says. “It’s just that she has a small head.” |
| It was only after her birth that doctors mentioned a possible link between her condition and the Zika virus, a disease first registered in north-east Brazil in May 2015. | It was only after her birth that doctors mentioned a possible link between her condition and the Zika virus, a disease first registered in north-east Brazil in May 2015. |
| Related: Zika virus: its effects, how it is spread, and the possible threat to women | Related: Zika virus: its effects, how it is spread, and the possible threat to women |
| Virologists have yet to understand how the disease – first recognised in Uganda in the 1940s – reached Brazil, or why it has spread so fast. On Monday, the World Health Organisation warned that the virus is likely to spread to every country in the Americas apart from Canada and Chile. | Virologists have yet to understand how the disease – first recognised in Uganda in the 1940s – reached Brazil, or why it has spread so fast. On Monday, the World Health Organisation warned that the virus is likely to spread to every country in the Americas apart from Canada and Chile. |
| At present there is neither a vaccine nor a cure for the virus, and authorities across the hemisphere are scrambling to come up with a response. | At present there is neither a vaccine nor a cure for the virus, and authorities across the hemisphere are scrambling to come up with a response. |
| Like other tropical fevers, such as dengue and chikungunya, Zika is transmitted by Aedes aegypti, a species of mosquito that thrives in the stagnant water pools that proliferate across Brazilian cities during the country’s hot, wet summers. | Like other tropical fevers, such as dengue and chikungunya, Zika is transmitted by Aedes aegypti, a species of mosquito that thrives in the stagnant water pools that proliferate across Brazilian cities during the country’s hot, wet summers. |
| The virus results in many of the same symptoms as dengue and chikungunya: fever, joint pain and rashes. If anything, its distinguishing feature, at least at first, appeared to be its relative mildness. | The virus results in many of the same symptoms as dengue and chikungunya: fever, joint pain and rashes. If anything, its distinguishing feature, at least at first, appeared to be its relative mildness. |
| By the time Maria Giovanna was born, doctors in Pernambuco had noticed a surge in the number of cases of microcephaly, which appeared to be connected to an outbreak of Zika. | By the time Maria Giovanna was born, doctors in Pernambuco had noticed a surge in the number of cases of microcephaly, which appeared to be connected to an outbreak of Zika. |
| On one day in August last year, Dr Vanessa Van Der Linden, a neuro-paediatrician working at Recife’s Hospital Barão de Lucena, saw three babies with the condition. | On one day in August last year, Dr Vanessa Van Der Linden, a neuro-paediatrician working at Recife’s Hospital Barão de Lucena, saw three babies with the condition. |
| “I thought this was very strange, because usually you would get one a month at most,” she said. “Sometimes you could go for three months without seeing a single case.” | “I thought this was very strange, because usually you would get one a month at most,” she said. “Sometimes you could go for three months without seeing a single case.” |
| CT scans of the babies’ brains showed signs of calcification caused by an infectious disease rather than a genetic abnormality, leading Van Der Linden to suspect that there was a new virus at work. Many of the babies’ mothers told the doctor they had experienced dengue-like symptoms during their pregnancies. | CT scans of the babies’ brains showed signs of calcification caused by an infectious disease rather than a genetic abnormality, leading Van Der Linden to suspect that there was a new virus at work. Many of the babies’ mothers told the doctor they had experienced dengue-like symptoms during their pregnancies. |
| But it was a conversation between Van Der Linden and her mother, Ana, another neuro-paediatrician, that proved key. “She told me there were seven patients in her waiting room with microcephaly. Immediately after that, I informed the state’s health secretary.” | But it was a conversation between Van Der Linden and her mother, Ana, another neuro-paediatrician, that proved key. “She told me there were seven patients in her waiting room with microcephaly. Immediately after that, I informed the state’s health secretary.” |
| According to the latest figures available from Brazil’s health ministry, published on 20 January, 3,893 cases of microcephaly have been recorded since the start of 2015. Pernambuco accounts for 1,306 of those, around a third of the total. In 2014, there were 150 cases across the whole of Brazil. | According to the latest figures available from Brazil’s health ministry, published on 20 January, 3,893 cases of microcephaly have been recorded since the start of 2015. Pernambuco accounts for 1,306 of those, around a third of the total. In 2014, there were 150 cases across the whole of Brazil. |
| No hospital in the country has dealt with more cases than the Osvaldo Cruz University hospital, a weather-worn collection of buildings in the centre of Recife. Angela Rocha, 67, a paediatrician specialising in infectious diseases, estimates the hospital has treated more than 300 babies with the condition. | No hospital in the country has dealt with more cases than the Osvaldo Cruz University hospital, a weather-worn collection of buildings in the centre of Recife. Angela Rocha, 67, a paediatrician specialising in infectious diseases, estimates the hospital has treated more than 300 babies with the condition. |
| Most of the women whose babies she has been treating are from the poorer parts of the city or the state, where rubbish collection is sporadic and the lack of running water means residents have to store their own, creating potential mosquito breeding sites. | Most of the women whose babies she has been treating are from the poorer parts of the city or the state, where rubbish collection is sporadic and the lack of running water means residents have to store their own, creating potential mosquito breeding sites. |
| “Women from the periphery also tend to get pregnant more easily,” Rocha said. “The weather is hot and they wear shorts so they are more exposed.” | “Women from the periphery also tend to get pregnant more easily,” Rocha said. “The weather is hot and they wear shorts so they are more exposed.” |
| The prognosis for children born with microcephaly varies enormously, with some unlikely to live for long, while others have only slight difficulties with their hearing and sight. | The prognosis for children born with microcephaly varies enormously, with some unlikely to live for long, while others have only slight difficulties with their hearing and sight. |
| But the potential consequences can be hard for an expectant mother to accept, said Rocha. “They keep asking me, ‘Is his head going to grow any more? He will get better, won’t he?’” | But the potential consequences can be hard for an expectant mother to accept, said Rocha. “They keep asking me, ‘Is his head going to grow any more? He will get better, won’t he?’” |
| No one knows how many children will be born with this condition, and Rocha expressed concern that Brazil may not yet have considered the long-term implications of the epidemic. “They are going to have serious emotional, financial and social problems, and this is going to be a very big challenge for the state and for society.” | No one knows how many children will be born with this condition, and Rocha expressed concern that Brazil may not yet have considered the long-term implications of the epidemic. “They are going to have serious emotional, financial and social problems, and this is going to be a very big challenge for the state and for society.” |
| City authorities are fighting the source of the disease: the Aedes aegypti mosquito. | City authorities are fighting the source of the disease: the Aedes aegypti mosquito. |
| Since late November, Recife’s 600 health workers, accompanied by 200 soldiers, have been going house to house to eliminate potential breeding grounds and educate the public about the diseases the mosquito carries. | Since late November, Recife’s 600 health workers, accompanied by 200 soldiers, have been going house to house to eliminate potential breeding grounds and educate the public about the diseases the mosquito carries. |
| According to Cristiane Penaforte, the executive secretary of health monitoring in the city, the presence of uniformed soldiers reassures the public. | According to Cristiane Penaforte, the executive secretary of health monitoring in the city, the presence of uniformed soldiers reassures the public. |
| “Previously, people didn’t always want to let us into their homes,” she said. “But the army is respected and so residents are more likely to let us in.” | “Previously, people didn’t always want to let us into their homes,” she said. “But the army is respected and so residents are more likely to let us in.” |
| The extra numbers also help the team to cover a wider area, though Penaforte said the programme will only succeed if the public actively participates. The city’s health ministry estimates that about 85% of mosquito breeding sites are inside people’s homes. “We need the population to join in, to change their attitudes to rubbish and the environment.” | The extra numbers also help the team to cover a wider area, though Penaforte said the programme will only succeed if the public actively participates. The city’s health ministry estimates that about 85% of mosquito breeding sites are inside people’s homes. “We need the population to join in, to change their attitudes to rubbish and the environment.” |
| On a recent visit to one property in the run-down neighbourhood of Vasco da Gama, the scale of the challenge soon became clear. The health workers stared at a wall lined with dozens of caged songbirds, each with its own water bowl. On the earth floor, a couple of tortoises chased a third around two plant pots brimming with water. The owner also had a huge tank for drinking water that he had failed to seal properly. | On a recent visit to one property in the run-down neighbourhood of Vasco da Gama, the scale of the challenge soon became clear. The health workers stared at a wall lined with dozens of caged songbirds, each with its own water bowl. On the earth floor, a couple of tortoises chased a third around two plant pots brimming with water. The owner also had a huge tank for drinking water that he had failed to seal properly. |
| Related: Zika virus: health experts fear Carnival celebrations will lead to spread | |
| For the most part, residents appeared to welcome the team, though some complained that it was the first time they have visited the area. | For the most part, residents appeared to welcome the team, though some complained that it was the first time they have visited the area. |
| Nubia Delmas, 52, came out to remonstrate with the team. “You haven’t been round my house for ages,” she said. “Lots of people round here are getting sick, including my husband, and there haven’t been nearly enough checks by the city authorities.” | Nubia Delmas, 52, came out to remonstrate with the team. “You haven’t been round my house for ages,” she said. “Lots of people round here are getting sick, including my husband, and there haven’t been nearly enough checks by the city authorities.” |
| Others blamed their neighbours. Maria Calado, 81, who has lived in the same house for more than 50 years, said that despite the clear instructions as to when to put out the rubbish, many residents leave it on the street whenever they feel like it. | Others blamed their neighbours. Maria Calado, 81, who has lived in the same house for more than 50 years, said that despite the clear instructions as to when to put out the rubbish, many residents leave it on the street whenever they feel like it. |
| As part of their mission, members of the health taskforce are gathering egg samples from breeding sites to determine the number of mosquitoes in the area. | As part of their mission, members of the health taskforce are gathering egg samples from breeding sites to determine the number of mosquitoes in the area. |
| Fumigation and spraying are used to kill off the insects, as is a biological larvicide, harmless to humans, in residents’ water tanks. The city is also testing the use of drones, both to monitor potential breeding sites and to deliver larvicide. | Fumigation and spraying are used to kill off the insects, as is a biological larvicide, harmless to humans, in residents’ water tanks. The city is also testing the use of drones, both to monitor potential breeding sites and to deliver larvicide. |
| For the city, the state, and the country, the epidemic could not have come at a worse time, as Brazil struggles through its deepest recession since the 1930s. | For the city, the state, and the country, the epidemic could not have come at a worse time, as Brazil struggles through its deepest recession since the 1930s. |
| “This is a major public health challenge, and Brazil’s municipalities have limited finances,” Dr Jailson Correia, Recife’s health secretary, says. | “This is a major public health challenge, and Brazil’s municipalities have limited finances,” Dr Jailson Correia, Recife’s health secretary, says. |
| Rocketing inflation and the plummeting value of Brazil’s currency, the real, is taking its toll. When the city asked for R$29m (£4.9m/$7m) from the federal health ministry to tackle the epidemic, it was given just R$1.3m (£200,000/$300,000). | Rocketing inflation and the plummeting value of Brazil’s currency, the real, is taking its toll. When the city asked for R$29m (£4.9m/$7m) from the federal health ministry to tackle the epidemic, it was given just R$1.3m (£200,000/$300,000). |
| “We are just doing all we can now. We’ll have to count the cost later,” Correia said. | “We are just doing all we can now. We’ll have to count the cost later,” Correia said. |