Disease Detectives In Brazil Go Door-To-Door To Solve Zika Mystery | KUOW News and Information

Disease Detectives In Brazil Go Door-To-Door To Solve Zika Mystery

Feb 25, 2016
Originally published on February 25, 2016 11:14 am

It's the first thing in the morning at a crowded public health clinic in Joao Pessoa, Brazil, when a team of disease detectives from the United States and Brazil arrive.

They are searching for new mothers in the hope of solving one of the world's most urgent public health mysteries: Is the Zika virus really causing microcephaly, a birth defect that leaves babies with shrunken heads and badly damaged brains?

"The preponderance of evidence points to Zika being the culprit," says Megumi Itoh, an epidemic intelligence officer with the U.S. Centers for Disease Control and Prevention who is part of the four-member team. "But we don't know for certain yet. So this is one way of finding that out."

The team, which also includes representatives from Brazilian federal and local health departments, is helping launch the biggest study yet of Zika and its suspected link to microcephaly. A total of eight U.S.-Brazilian investigative groups are working for the next few weeks to track down more than 100 women who had babies with microcephaly since the Zika outbreak began.

Additionally, the teams will try to find hundreds of mothers who had healthy babies at about the same time for comparison. The idea is to produce the most convincing evidence yet as to whether Zika is really causing microcephaly and, if so, how often and how severely. It's unclear when the research might produce results, but it could possibly be as early as the spring.

Even though Joao Pessoa, which is on the northeast coast of Brazil, is part of the epicenter of the Zika outbreak, the investigators know that finding these women will not be easy. And the teams are under intense pressure to work fast to help Brazil — and the rest of the world — gain a better understanding of just how much of a threat is posed by the Zika virus.

On Tuesday, when Itoh and the other teams began their work, a handful of journalists accompanied their first forays. The experience illustrates the difficulties they'll face.

When Itoh's team arrives at the clinic, for example, a health worker gives them the disappointing news that the first mother on their list is working all day. So there's no way to contact her today.

The team asks about the next name. More bad news. The clinic workers don't think she'll cooperate because she's upset that she hasn't received the results of her Zika testing yet. The team decides to go to her house anyway.

Even though it's supposed to be the dry season, it's pouring rain. Everyone runs to the car.

The rain has let up a little when the group arrives at the woman's house, but now it's really starting to get hot and sticky. The person who answers the intercom says the mother's not home. As the team heads back to the car, Itoh acknowledges the day has been disappointing but not surprising.

"I think it's, you know, par for the course," she says.

After a quick lunch and stop at another health clinic for more guidance and advice, the team drives to the home of a third woman, Camila Alves. She's not there when the team arrives at the front door of her small brick house on a narrow cobblestone street. But her grandmother welcomes the group in, and her cousins and other family members offer chairs in their small courtyard to wait.

Finally, Alves comes in with her baby. She's young, just 22, petite, with dark brown hair pulled back and dark brown eyes. She's carrying her daughter, Maria, who at first glance looks like a normal 2-month-old. But as Alves sits down in a rocker, she turns her baby toward the visitors. Maria's forehead seems to just kind of disappear. Her head is tiny.

Itoh's Brazilian counterpart, Marcia Andrade, starts running through page after page of questions.

Did Alves get any other infections when she was pregnant that may have caused the microcephaly? Toxoplasmosis? No. Cytomegalovirus? No. Syphilis? No.

Then the next set of key questions: Was she exposed to any toxins? Pesticides? Insecticides? Rat poison? No. No. No.

Andrade takes a deep breath when she gets to a really important part: Did Alves have any Zika symptoms early in her pregnancy?

Do you remember having a fever? A rash? Joint pain? Yes, Alves says. She had a fever, and yes, a rash too. Probably in the first trimester, suggesting that maybe, just maybe, yes, she did have Zika.

After more than an hour of questioning, the investigators ask Alves if they can take Maria into the nursery so Itoh can measure the circumference of the baby's head with a tape measure. It looks like Maria has a severe case of microcephaly. Itoh also takes pictures of the baby lying in her crib.

Next, a technician takes a blood sample from Alves, then inserts a needle into Maria's tiny arm to draw some blood from her as well.

Everyone cringes as the baby cries. Alves has to step outside. But finally, they're done.

The researchers will send the blood back to the United States for detailed analysis to try to pinpoint whether Alves and her baby actually had Zika. If so, that would strengthen the link between Zika and microcephaly.

When everything's done and Maria's calm again, Alves explains why she decided to volunteer for the study.

"I wanted to know if she really was born this way because of Zika," says Alves. "It's difficult not to know why your baby's born this way. ... Nobody knows why babies are turning out like this."

She also hopes the answer will make the Brazilian government do more.

"I want the government to do something to combat this so more children aren't born like this," she says. "It's hurting a lot of children and a lot of families."

As the investigators are leaving, Itoh reflects on how things went.

"I think it went very well. We accomplished everything we came here to do," she says. "The mother was very gracious."

The investigators obviously need to track down many more patients, she notes, adding: "This is just the beginning."

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

DAVID GREENE, HOST:

And let's go now to Brazil, where investigators from the U.S. Centers for Disease Control and Prevention are starting the biggest study yet of the Zika virus and microcephaly. That's the birth defect where babies are born with shrunken heads and damaged brains. NPR health correspondent Rob Stein is with the CDC in Brazil, and he brings us this report.

ROB STEIN, BYLINE: It's first thing in the morning at a crowded public health clinic on the northeast coast of Brazil. I'm with Meg Itoh of the CDC and a team of investigators.

MEG ITOH: It's a really important study. This is the first study to really get at the link between Zika and microcephaly. The preponderance of evidence points to Zika, but we don't know for certain yet.

STEIN: Itoh's team and seven others fanning out across the state, rushing to find hundreds of mothers and their babies as fast as they can. Even though this is the epicenter of the Zika outbreak in Brazil, they know this will not be easy. And they're under a lot of pressure.

UNIDENTIFIED WOMAN #1: (Speaking Portuguese).

STEIN: Turns out the first mother on their list works all day, so no way they'll find her today. They ask about the next day.

UNIDENTIFIED WOMAN #1: (Speaking Portuguese).

UNIDENTIFIED WOMAN #2: (Speaking Portuguese).

STEIN: Bad news - the folks at the clinic don't think she'll do it. The team decides to go to her house anyway. Even though it's supposed to be the dry season, it's pouring rain. Everyone runs back to the car.

(CAR ENGINE REVVING)

STEIN: The rain has let up a little when we get to the house, but now it's starting to get hot and sticky.

UNIDENTIFIED WOMAN #1: (Speaking Portuguese).

UNIDENTIFIED WOMAN #3: (Speaking Portuguese).

UNIDENTIFIED WOMAN #1: (Speaking Portuguese).

UNIDENTIFIED WOMAN #3: (Speaking Portuguese).

UNIDENTIFIED WOMAN #1: (Speaking Portuguese).

UNIDENTIFIED WOMAN #3: (Speaking Portuguese).

STEIN: Whoever answers says the mom's not home. As we head back to the car, I ask Meg Itoh how she thinks things are going.

Wow, this is tough.

ITOH: It is tough, yeah.

STEIN: It's getting really hot now, and everyone's clearly getting really tired. We head out to find the last name on their list for today. She's not there when we arrive at the front door of a small brick house on a narrow cobblestone street.

UNIDENTIFIED WOMAN #4: (Speaking Portuguese).

STEIN: But her grandmother welcomes us in, and her cousins offer us chairs in their small courtyard to wait.

STEIN: Finally, Camila Alves comes in with her baby. Camila's young, just 22, petite, with dark brown hair pulled back and dark brown eyes. She's carrying her daughter, Maria. At first, the baby looks like a normal 2-month-old. But as Camila sits down in a rocker, she turns her baby towards us. Maria's forehead kind of just disappears. Her head is tiny.

MARCIA ANDRADE: (Speaking Portuguese).

STEIN: Meg Itoh's Brazilian counterpart, Marcia Andrade, starts running through page after page of questions.

ANDRADE: (Speaking Portuguese).

STEIN: Did she get any other infections when was pregnant that may have caused the microcephaly?

ANDRADE: (Speaking Portuguese).

STEIN: Toxoplasmosis? No. Cytomegalovirus? No. Syphilis? No.

ANDRADE: (Speaking Portuguese).

STEIN: Then the next set of key questions. Were you exposed to any toxins, pesticides, insecticides, rat poison? No. No. No. Marcia takes a deep breath when she gets to a really important part. Did Camila have any Zika symptoms early in her pregnancy?

ANDRADE: (Speaking Portuguese).

STEIN: Do you remember having a fever? A rash? Joint pain? Yes, Camila says. She did have a fever. And yes, a rash, too. And probably in the first trimester, suggesting that maybe, just maybe, yes, she did have Zika. After more than an hour of this, they ask Camila if they can take Maria into the nursery so Itoh can measure the circumference of her head with a tape measure. It looks like Maria has a severe case of microcephaly.

UNIDENTIFIED WOMAN #5: (Speaking Portuguese).

STEIN: And take pictures of her lying in her crib. Next -

UNIDENTIFIED WOMAN #6: Hold on.

STEIN: A technician takes a blood simple from Camila and -

UNIDENTIFIED WOMAN #6: I know, I'm sorry. OK, here we go.

MARIA: (Crying).

STEIN: Inserts a needle into Maria's tiny arm to get some blood from her too. Everyone cringes, and Camila has to step outside as it goes on. But finally, they're done. They'll send the blood back to the United States for detailed analysis to try to pinpoint whether Camila and her baby actually had Zika or not. When everything's done and Maria's calm again, I ask Camila why she decided to volunteer for the study.

CAMILA ALVES: (Through interpreter) I wanted to know if she really was born this way because of Zika. It's difficult not to know why your baby's born this way.

STEIN: And it is for you and your baby? Is it for other people too?

ALVES: (Through interpreter) For me and for other people to know. Where I go and I where I see all these other mothers, they all have the same doubt. Nobody knows why babies are turning out like this.

STEIN: As for leaving, I checked back with Meg Itoh of the CDC to see how she thinks things went.

ITOH: I think it went very well. We accomplished everything we came here to do. The mother was very gracious.

STEIN: But obviously, you need to get a lot more patients.

ITOH: Yeah. This is just the beginning.

STEIN: The CDC will spend weeks tracking down more than 100 women who had babies with microcephaly and hundreds more who had healthy babies to compare them in hopes to have some answers by the spring about just how much of a threat the Zika virus poses for Brazil and the rest of the world. Rob Stein, NPR News, Joao Pessoa, Brazil. Transcript provided by NPR, Copyright NPR.

Tags: