The Zika outbreak almost certainly began in the Brazilian city of Recife, where doctors figured out what was happening to pregnant women
It’s a Sunday in the Brazilian city of Recife, but a team of infectious disease, pediatric and neurology experts are working overtime, huddled in a back room of the Oswaldo Cruz Hospital. They are collaborating research paper about an outbreak they helped uncover: the mysterious spike in cases of microcephaly among newborns that may be linked to the Zika virus.
The team is made up of doctors from hospitals around the city including Dr. Vanessa Van Der Linden, a neurologist in this Brazilian city in Pernambuco state who helped sound the alarm over Zika early. In August 2015, Dr. Van der Linden saw a baby with severe microcephaly, a severe birth defect that involves an abnormally small head and incomplete brain development. The mother remembered that in the first month of her pregnancy she had come down with a rash, but nothing that seemed too severe.
Yet when Dr. Van Der Linden conducted the usual brain scans to determine the cause of the child’s small head, the usual suspects like rubella or toxoplasmosis were ruled out. The images of calcification in the brain looked different from other cases of microcephaly that she had seen in the past.
One day during a later hospital shift Dr. Van der Linden saw three cases of microcephaly in a single day. “It’s not normal,” she says. “Sometimes we go three or four months and don’t see a baby with microcephaly, so it was very strange.”
In the weeks that followed, she continued to see more cases, and Dr. Van der Linden started warning her colleagues that something strange was happening. Her mother, Ana, a doctor who works at a separate medical center in Recife, called her daughter to tell her that she saw seven babies in one day with microcephaly—and some of the mothers had also reported a rash in early pregnancy.
In October, Dr. Van Der Linden went to the state health secretary to alert the Brazilian authorities about the apparent spike in microcephaly cases—and the brain scan evidence that indicated a new, not yet identified agent could be the cause. That same month, the Brazil Ministry of Health reviewed birth certificates and confirmed that there was in fact an increase in cases of microcephaly in the northeast region of Brazil. The ministry also opened up a microcephaly registry for doctors and hospitals to report recent cases.
There was some suggestion from the mothers’ descriptions that the infection could be linked to the chikungunya or the Zika virus, two mosquito-borne illnesses that circulate in the region. But chikungunya was ruled out since it’s a much more severe and painful disease, and wasn’t in line with what the mothers were describing. At that point, the city of Recife launched investigations into the virus, and intensified mosquito control precautions that were already ongoing due to a massive outbreak of dengue fever—more than 1.5 million cases of dengue were reported in Brazil in 2015. In Recife alone, there was an 800% increase in cases of dengue in 2015 compared to 2014, but many of those cases may turn out to be Zika.