Because of mounting reports that maternal Zika virus infections are linked to a wider range of birth defects than previously thought, the World Health Organization (WHO) today announced that the collective effects represent a new congenital syndrome, with efforts under way to define it.

Health officials have been warning that babies born with Zika virus complications might face a host of still-unknown complications, and steps unveiled today signify the first major effort to define them. A team from several WHO departments laid out the case for the new syndrome and described the process for defining it in an editorial in the Bulletin of the World Health Organization.

In another scientific development related to the outbreak, South Korean researchers described the first detection of live virus in a patient's semen. Meanwhile, tracking systems revealed more Zika infections in Puerto Rico and in US travelers, including additional cases in pregnant women.

WHO: Cast surveillance net beyond microcephaly

Current evidence and unpublished data coming into the WHO are showing a wider range of birth defects besides microcephaly, including craniofacial disproportion, spasticity, seizures, irritability, eye problems, and brainstem dysfunction, leading to, for example, feeding difficulties.

The WHO said clinicians are seeing a range of severity, including neurologic problems in babies born with normal head circumference, similar to those associated with other maternal infections.

Unpublished data from Colombia and Panama, however, hint that Zika virus might be linked to other problems in babies, affecting the genitourinary, cardiac, and digestive systems, according to the report.

The WHO said it has established a process to define the new congenital syndrome, which will focus on mapping and analyzing the clinical manifestations. Experts will need good antenatal and postnatal histories and follow-up data, lab findings, and neuroimaging results to flesh out the syndrome, the agency added.

Most reports on Zika's congenital complications are still unpublished, and more data sharing is needed, as is further analysis of cohorts of pregnant women infected with Zika virus, the team said. The group issued an open invitation to all partners to join the effort to describe the new syndrome.

Surveillance guidance has been expanded, because health systems have been reporting microcephaly cases only as part of the outbreak response. With 37 countries in the Americas now reporting mosquito-borne transmission, "it is possible that many thousands of infants will incur moderate to severe neurological disabilities," the experts wrote.

Health system support for affected babies, women, and families will need to be fully resourced, the group said.

Live virus detection in semen

A recent report from South Korea described what may be the first detection of live Zika virus in semen. The virus is thought to persist in semen after it has cleared the bloodstream, and earlier reports have noted Zika RNA in semen as long as 62 days after illness onset.

Researchers detected the virus during the work-up on the country's first imported case-patient, a 42-year-old man who got sick after traveling to Brazil. They published their findings last week in the Journal of Korean Medical Science.

Live virus was isolated from the man's semen on the seventh day of illness, when reverse-transcriptase polymerase chain reaction testing was positive for the virus in blood, urine, and saliva. Tests were negative on the 21st day of illness.

The man recovered without any neurologic complications.

US number updates

In two updates yesterday, the US Centers for Disease Control and Prevention (CDC) reported more Zika infections in US travelers and in affected territories, as well as in pregnant women.

Affected territories reported 175 more Zika cases, mostly from Puerto Rico, lifting the total to 1,110 local infections. Three more Guillain-Barre syndrome (GBS) cases were reported, putting that total at eight.

On the US mainland, 27 more Zika infections in travelers were reported, raising that total to 618. The number of sexual transmission cases held steady at 11, while the number of GBS cases remained at 1.

According to the latest data from Zika pregnancy registries on the US mainland and for Puerto Rico, 31 more infections were reported in pregnant women, raising the nation's overall total to 341. Of that total, 195 are from the mainland and 146 are from US territories, mainly Puerto Rico.

Other developments

A brief analysis of Zika patterns in Dominica show a strong tilt toward higher numbers of infections in women, similar to findings reported recently from Rio de Janeiro, Brazil, according to a weekly epidemiologic update yesterday from the Pan American Health Organization. Dominica has reported 230 Zika infections in women, more than double the 107 cases reported in men. Women outnumbered men by two to three times in all age-groups except for those 61 years and older. The earlier Brazilian report noted that sexual spread might account for some of the higher totals in childbearing-age women.





More than 6 in 10 Americans agree with the idea of a presidential public health emergency fund that can be drawn from without waiting for Congress to act, according to a survey from the Annenberg Public Policy Center at the University of Pennsylvania. Such a fund was the subject of a May 22 editorial in the Washington Post by Ronald Klain, President Obama's former Ebola response coordinator. Support for the concept varied across party lines, with more support among self-identified Democrats. The phone survey of 1,033 adults was conducted May 25 through 29.





In the ongoing political battle over Zika emergency funding, Senate Democrats said at a press conference yesterday that they would try to force a vote on Obama's full request of nearly $2 billion, according to a report from The Hill. Senate minority leader Harry Reid, D-Nev., was quoted as saying the move is intended to make Republicans vote again against full funding for the request. Initial steps have been taken for the House and Senate to reconcile two different bills, a House version of $622 million through September funded by Ebola money and offsets and a Senate version of $1.1 billion that extends into the next fiscal year.

See also:

Jun 3 WHO editorial

May 27 J Korean Med Sci report

Jun 2 CDC number of cases in the United States and territories

Jun 2 CDC number of Zika cases in pregnant women