On the afternoon of November 17, 2015, the Ministry of Health announced that, for the first time, the zika virus had been confirmedly related to cases of microcephaly who by then had scared the country – especially the Northeast.
Since then, the number of cases has declined, but doubts about the problems related to the virus and the children who contracted it have only grown. Many questions remain unanswered after these three years.
Currently, it is known that microcephaly is only one of the problems of the so-called Zika Congenital Syndrome, which affects the neurological part of babies with infected mothers.
According to the Ministry of Health, since the beginning of the investigations, in October 2015, until October 6 of this year, 3,267 cases of changes in growth and development, possibly related to infection with the zika virus and other infectious etiologies, were confirmed. Of this total, there were 345 confirmed deaths, including fetal, neonatal, and child deaths.
The discovery of the relationship between zika and microcephaly was made by the physician Adriana Melo, from Campina Grande (PB), when harvesting amniotic fluid from pregnant mothers of children already diagnosed with microcephaly. The result was the presence of zika in the material.
"When we saw the images in the fetus, I expected even more damage, in the first cases we thought that they were going to be children who would stay in bed." The expectation was very low, but some surprised us. severe, but the result was better in most patients, "she said.
O case number one of the disease, the girl Catherine, was counted by UOL In August. She has more than expected development, can walk and started attending school in the middle of this year.
For the precursor of the discovery, after all these years, the great challenge in the area of rehabilitation lies in the development of therapies.
"What microcephaly has been the tip of the iceberg, we are writing the natural history of the disease." What is the life of these children with one, two, three years and what therapies can we do to improve their quality of life? know how these children get sick and how we can avoid it. The big challenge is the neurological part ", explains Melo.
How to detect the disease?
Researchers seek answers to the questions that plague those who study the syndrome and who coexists with its consequences.
According to the pediatrician and researcher of the Fernanda Figueira Institute, of Fiocruz (Oswaldo Cruz Foundation), there are still many issues that challenge science.
"To cite one example, 50% to 60% of people who have zika are asymptomatic and we do not yet have a good serological test to detect the virus. symptoms, there are no tests capable of detecting the antibody after infection, "he says.
"It is necessary to have a serological test with more sensitivity, because what we have today gives a lot of cross-reaction with dengue," he adds.
In addition, the doctor claims that little is known about the problems caused when babies are infected with the virus. "This is unclear. We do not yet know what happens to children in the first year of life when they get zika."
Another regional question is: "Why in the Northeast there were a lot more cases? We probably have some cofator, but we do not know what increases the risk," he says, noting that issues related to lack of basic sanitation and malnutrition contribute to aggravate any infection.
The infectologist Artur Timerman, president of the Brazilian Society of Dengue and Arbovirus, affirms that the reduction of the speed in the answers was due to the cuts of resources. "Of course this is hampering the elucidation of doubts," he says.
Timerman also agrees that the lack of more accurate testing is important: "We have major shortcomings."
"A great discussion that one has, and needs to research, is that we know that whoever had dengue once and comes in contact a second time has a greater chance of having the most severe form." Because dengue and zika viruses are similar structurally, there is speculation that this antibody against dengue in a mother who becomes infected with zika would be more likely to transmit this virus to her child and generate a child with malformation, "the doctor says.
The infectologist still reports that more research is missing for the moment after the acquisition of the disease. "How is the virus behaving now? What is the percentage of people in the Southeast who have been exposed to the virus and what percentage are infected?"
An old villain
Another point is that the country did not advance in the fight against mosquitoes Aedes aegypti. "No one discusses basic sanitation, waterproofing of cities, less green areas, anything that correlates with mosquitoes. That's what's behind this problem," says Timerman.
He says there must be a possible relationship between zika and dengue. "Today, it is known that zika has this correlation of malformation of the fetus, but there are more recent studies that point out that dengue infections in pregnancy are also associated with this, in chikungunya as well, that is, we can not size the real magnitude of the problem, "he says.
For researcher Fernando Figueira, however, time is a limiting factor. "The science is not so fast at times.The epidemic is over, but we know that we have 30 years of dengue in the country and we still can not stop the mosquito.
What the Ministry of Health says
According to the Ministry of Health, since November 2015, "about R $ 465 million for research and development of vaccines and new technologies involving zika and Zika's Congenital Syndrome" have been allocated.
The agency says that "another front of continuous action is in the assistance network, organized by states and municipalities." "To increase the attention to this population, the folder passed on R $ 27 million and the federal government granted 2,200 continuing benefits, which guarantee a monthly income for the family of the child," the note continues.
"It is necessary to understand that the SUS constitutionally is tripartite, that is, with shared management between federal entities: municipalities, states and federal government." Federal resources are passed on to states and municipalities, responsible for the management of assistance, "he explained.