Colombia confirms first three deaths of patients infected with Zika virus

Patients had contracted a seemingly related disease that attacks the nervous system and causes paralysis, and another two deaths were still unconfirmed

Colombia has confirmed the first three deaths of patients infected with the Zika virus who had contracted a seemingly related disease that attacks the nervous system and causes paralysis.

Alejandro Gaviria, the health minister, told the Guardian that another two deaths caused by the disease – known as Guillain-Barré syndrome – were still unconfirmed to be Zika-related.

Health officials in the country’s second city, Medellín, reported on Thursday that a man and a woman admitted from other areas died in the past week after presenting symptoms of Guillain-Barré, which include muscle weakness and paralysis. Another man died in late November. All three tested positive for the Zika virus.

Gaviria said Colombia has registered about 100 cases of GBS that are believed to be related to the Zika virus. Overall, Colombia has recorded more than 20,500 confirmed cases of Zika infection.

Guillain-Barré-related deaths are rare but Gaviria warned that recent cases of the disorder seen in Colombia have not responded to traditional treatments of immunoglobulin.

“Mortality is high,” Gaviria said in a phone interview a day after meeting with health ministers from around Latin America in Montevideo to address the crisis caused by the spread of Zika.

Zika virus by itself causes mild flu-like symptoms or no symptoms at all, but earlier this week the World Health Organization declared an international public health emergency because of suspected links to a birth defect known as microcephly, which causes babies to be born with abnormally small heads.

Reported microcepahly cases spiked in Brazil which has the world’s highest number of people infected with Zika.

But Gaviria said that in Colombia, which has the second highest Zika patients, no cases of related microcephaly have been reported. “It’s sort of a mystery,” he said adding that either Colombia will start seeing microcephaly cases soon, or there are factors in Brazil that predispose patients to it that do not exist in Colombia.

The science journal Nature reported that researchers of birth defects in Latin America were questioning the real size of the apparent surge in the number of microcephaly in Brazilian children.

But Jorge Lopez-Camelo and Ieda Maria Orioli, from the Latin American Collaborative Study of Congenital Malformations (ECLAMC), suggested that the baseline may have been underestimated and that heightened awareness of the birth defect, because of the possible link with Zika, may have led to an increase in reported cases.

“We are only now beginning to understand the dimensions of Zika,” Gaviria said.

Colombia has said that if microcephaly is detected in foetuses, women can opt to abort. Under Colombian law, abortion is legal for women whose foetuses show a malformation that makes life unviable, if the pregnancy was a result of rape, or if the woman’s health is in danger.

Gaviria has argued that includes women’s mental health, which could be cited in the case of giving birth to a child with microcephly.

http://www.theguardian.com/world/2016/feb/04/colombia-zika-virus-first-deaths-patients

Guillain-Barré Syndrome Fact Sheet

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Síndrome de Guillain-Barré 
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What is Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances the symmetrical weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until certain muscles cannot be used at all and, when severe, the person is almost totally paralyzed. In these cases the disorder is life threatening - potentially interfering with breathing and, at times, with blood pressure or heart rate - and is considered a medical emergency. Such an individual is often put on a ventilator to assist with breathing and is watched closely for problems such as an abnormal heart beat, infections, blood clots, and high or low blood pressure. Most individuals, however, have good recovery from even the most severe cases of Guillain-Barré syndrome, although some continue to have a certain degree of weakness.

Guillain-Barré syndrome can affect anybody. It can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, however, afflicting only about one person in 100,000. Usually Guillain-Barré occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally surgery will trigger the syndrome. In rare instances vaccinations may increase the risk of GBS.

After the first clinical manifestations of the disease, the symptoms can progress over the course of hours, days, or weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest.

What causes Guillain-Barré syndrome?

No one yet knows why Guillain-Barré — which is not contagious — strikes some people and not others. Nor does anyone know exactly what sets the disease in motion.

What scientists do know is that the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease. Usually the cells of the immune system attack only foreign material and invading organisms. In Guillain-Barré syndrome, however, the immune system starts to destroy the myelin sheath that surrounds the axons of many peripheral nerves, or even the axons themselves (axons are long, thin extensions of the nerve cells; they carry nerve signals). The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances.

In diseases in which the peripheral nerves' myelin sheaths are injured or degraded, the nerves cannot transmit signals efficiently. That is why the muscles begin to lose their ability to respond to the brain's commands, commands that must be carried through the nerve network. The brain also receives fewer sensory signals from the rest of the body, resulting in an inability to feel textures, heat, pain, and other sensations. Alternately, the brain may receive inappropriate signals that result in tingling, "crawling-skin," or painful sensations. Because the signals to and from the arms and legs must travel the longest distances they are most vulnerable to interruption. Therefore, muscle weakness and tingling sensations usually first appear in the hands and feet and progress upwards.

When Guillain-Barré is preceded by a viral or bacterial infection, it is possible that the virus has changed the nature of cells in the nervous system so that the immune system treats them as foreign cells. It is also possible that the virus makes the immune system itself less discriminating about what cells it recognizes as its own, allowing some of the immune cells, such as certain kinds of lymphocytes and macrophages, to attack the myelin. Sensitized T lymphocytes cooperate with B lymphocytes to produce antibodies against components of the myelin sheath and may contribute to destruction of the myelin. In two forms of GBS, axons are attacked by antibodies against the bacteria Campylobacter jejuni, which react with proteins of the peripheral nerves.  Acute motor axonal neuropathy is particularly common in Chinese children.  Scientists are investigating these and other possibilities to find why the immune system goes awry in Guillain-Barré syndrome and other autoimmune diseases. The cause and course of Guillain-Barré syndrome is an active area of neurological investigation, incorporating the cooperative efforts of neurological scientists, immunologists, and virologists.

How is Guillain-Barré syndrome diagnosed?

Guillain-Barré is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. A syndrome is a medical condition characterized by a collection of symptoms (what the patient feels) and signs (what a doctor can observe or measure). The signs and symptoms of the syndrome can be quite varied, so doctors may, on rare occasions, find it difficult to diagnose Guillain-Barré in its earliest stages.

Several disorders have symptoms similar to those found in Guillain-Barré, so doctors examine and question patients carefully before making a diagnosis. Collectively, the signs and symptoms form a certain pattern that helps doctors differentiate Guillain-Barré from other disorders. For example, physicians will note whether the symptoms appear on both sides of the body (most common in Guillain-Barré) and the quickness with which the symptoms appear (in other disorders, muscle weakness may progress over months rather than days or weeks). In Guillain-Barré, reflexes such as knee jerks are usually lost. Because the signals traveling along the nerve are slower, a nerve conduction velocity (NCV) test can give a doctor clues to aid the diagnosis. In Guillain-Barré patients, the cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual. Therefore a physician may decide to perform a spinal tap, a procedure in which a needle is inserted into the patient's lower back and a small amount of cerebrospinal fluid from the spinal column is withdrawn for study.

How is Guillain-Barré treated?

There is no known cure for Guillain-Barré syndrome. However, there are therapies that lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease.

Currently, plasma exchange (also called plasmapheresis) and high-dose immunoglobulin therapy are used. Both of them are equally effective, but immunoglobulin is easier to administer. Plasma exchange is a method by which whole blood is removed from the body and processed so that the red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. Scientists still don't know exactly why plasma exchange works, but the technique seems to reduce the severity and duration of the Guillain-Barré episode. This may be because plasmapheresis can remove antibodies and other immune cell-derived factors that could contribute to nerve damage.

In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that, in small quantities, the immune system uses naturally to attack invading organisms. Investigators have found that giving high doses of these immunoglobulins, derived from a pool of thousands of normal donors, to Guillain-Barré patients can lessen the immune attack on the nervous system. Investigators don't know why or how this works, although several hypotheses have been proposed.

The use of steroid hormones has also been tried as a way to reduce the severity of Guillain-Barré, but controlled clinical trials have demonstrated that this treatment not only is not effective but may even have a deleterious effect on the disease.

The most critical part of the treatment for this syndrome consists of keeping the patient's body functioning during recovery of the nervous system. This can sometimes require placing the patient on mechanical ventilatory assistance, a heart monitor, or other machines that assist body function. The need for this sophisticated machinery is one reason why Guillain-Barré syndrome patients are usually treated in hospitals, often in an intensive care ward. In the hospital, doctors can also look for and treat the many problems that can afflict any paralyzed patient - complications such as pneumonia or bed sores.

Often, even before recovery begins, caregivers may be instructed to manually move the patient's limbs to help keep the muscles flexible and strong and to prevent venous sludging (the buildup of red blood cells in veins, which could lead to reduced blood flow) in the limbs which could result in deep vein thrombosis.  Later, as the patient begins to recover limb control, physical therapy begins. Carefully planned clinical trials of new and experimental therapies are the key to improving the treatment of patients with Guillain-Barré syndrome. Such clinical trials begin with the research of basic and clinical scientists who, working with clinicians, identify new approaches to treating patients with the disease.

What is the long-term outlook for those with Guillain-Barré syndrome?

Guillain-Barré syndrome can be a devastating disorder because of its sudden and unexpected onset. In addition, recovery is not necessarily quick. As noted above, patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. Symptoms then stabilize at this level for a period of days, weeks, or, sometimes, months. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.

Guillain-Barré syndrome patients face not only physical difficulties, but emotionally painful periods as well. It is often extremely difficult for patients to adjust to sudden paralysis and dependence on others for help with routine daily activities. Patients sometimes need psychological counseling to help them adapt.

What research is being done?

Scientists are concentrating on finding new treatments and refining existing ones. Scientists are also looking at the workings of the immune system to find which cells are responsible for beginning and carrying out the attack on the nervous system. The fact that so many cases of Guillain-Barré begin after a viral or bacterial infection suggests that certain characteristics of some viruses and bacteria may activate the immune system inappropriately. Investigators are searching for those characteristics. Certain proteins or peptides in viruses and bacteria may be the same as those found in myelin, and the generation of antibodies to neutralize the invading viruses or bacteria could trigger the attack on the myelin sheath. As noted previously, neurological scientists, immunologists, virologists, and pharmacologists are all working collaboratively to learn how to prevent this disorder and to make better therapies available when it strikes.

Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

First Zika-linked deaths reported in Colombia

Bogota (AFP) - The mosquito-borne Zika virus sweeping through Latin America has claimed three lives in Colombia, as the United Nations urged increased access to abortion because of fears of severe birth defects.

In the first direct statements from government health officials blaming Zika for causing deaths, Colombia's National Health Institute (INS) said Friday that the patients died after contracting the virus and developing a rare neurological disorder called Guillain-Barre syndrome.

Cases of the syndrome -- in which the immune system attacks the nervous system, causing weakness and sometimes paralysis -- have increased in tandem with the Zika outbreak, fueling suspicions that it is a complication of the otherwise mild tropical fever, which is also blamed for causing brain damage in babies born to infected mothers.

"Other cases (of deaths linked to Zika) are going to emerge," said epidemiologist Martha Lucia Ospina, director of the INS.

"The world is realizing that Zika can be deadly. The mortality rate is not very high, but it can be deadly."

Most Guillain-Barre patients recover, but the syndrome sometimes causes paralysis or even death.

Citing the rise in babies born with microcephaly, or abnormally small heads and brains, the UN human rights office urged countries hit by Zika to give women access to contraception and abortion.

Women's reproductive rights are a touchy subject in largely Catholic Latin America, but the UN human rights office said countries urging women to avoid pregnancy -- a list that comprises Colombia, Ecuador, El Salvador, Jamaica and Panama -- had to give them ways to control their fertility.

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Earlier this week, US health officials confirmed the first case of sexually transmitted Zika (AFP Ph …

"How can they ask these women not to become pregnant, but not offer... the possibility to stop their pregnancies?" spokeswoman Cecile Pouilly told reporters.

Many Latin American countries outlaw abortion or allow it only if the mother's life is in danger. In El Salvador, one of those warning against pregnancy, abortion is punishable by up to 40 years in prison.

Honduras, which earlier this week declared a state of emergency after tallying some 3,700 cases of Zika since mid-December, said it is planning a full day dedicated to eradicating the mosquitoes that carry the virus.

President Juan Orlando Hernandez has allocated an initial tranche of $10 million in an attempt to halt the spread of the virus.

- Safe sex or none at all -

Health officials in Brazil and the United States meanwhile warned that sex or even kissing could potentially spread the typically mosquito-borne disease.

Brazil's top research center, the Fiocruz institute in Rio de Janeiro, said Zika had been detected in urine and saliva.

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A Health Ministry employee fumigates a home against the Aedes aegypti mosquito in the San Lucia del  …

The scientists were careful to clarify that there is no proof the virus can be transmitted through those fluids, but said people should take precautions, especially expecting mothers.

"Avoid sharing glasses, silverware, contact with someone who has symptoms of a possible infection. Don't kiss, obviously," said the institute's director Paulo Gadelha.

The US Centers for Disease Control (CDC) for their part urged people to use condoms or abstain from having sex if they live in or have traveled to Zika-infected areas.

Earlier this week, US health officials confirmed the first case of sexually transmitted Zika -- a person who had traveled to Venezuela and infected a sexual partner in Texas upon return.

In the US territory of Puerto Rico, officials declared a health emergency over Zika and confirmed a pregnant woman had been infected, bringing the number of cases on the island to 22.

The emergency measures included freezing the price of condoms and combatting mosquitoes.

- Calls for more research -

The World Health Organization, which has declared the rise in Zika-linked birth defects an international emergency, warns that Zika could infect up to four million people in the Americas and spread worldwide.

The WHO has advised countries against accepting blood donations from people who have traveled to affected regions.

The new warnings on intimate contact highlight how little is known about Zika, a virus that was first identified in Africa in 1947 but had been considered relatively mild until the current eruption of apparent complications.

Both the US CDC and Fiocruz in Brazil said more research was needed on person-to-person transmission.

Brazil has been the country hardest hit by the outbreak, with an estimated 1.5 million cases. Colombia is next on the list, with more than 20,000 cases.

Zika often goes unnoticed, and causes a relatively mild fever and rash in those who do develop symptoms.

But Brazil sounded the alarm after recording a surge in babies born with microcephaly. It has registered 404 cases since October and 3,670 suspected cases, up from 147 in all of 2014.

http://news.yahoo.com/un-prods-latin-america-abortion-zika-spreads-185202353.html