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1.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 217-221, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31833744

RESUMO

Introduction: We present temporal and spatial variation of deaths from microcephaly in children under 1 year of age is analyzed at regional, state, and municipal level in the pre-Zika period in Brazil. Materials and Methods: Data on births and deaths of infants with microcephaly was obtained from DATASUS from 1996 to 2013. Infant mortality rate from microcephaly (IMR-M) was estimated at Region, Federative Unit (UF), and Municipality level. Secular trend (ST) and risk of death variation were estimated using a Poisson regression model. Satscan software was used to obtain a statistic spatial scan for the Poisson model. Results: IMR-M shows a non-significant negative ST in the Southeast, South and Central West Regions of Brazil. A greater IMR-M risk of death variation is found in the North and Northeast Regions. Most UFs in the Southeast, South and Central West Regions showed a negative ST, in contrast to what occurs in the UFs of the North and Northeast Regions showed a positive ST. Six high risk significant clusters were found: 3 in the North-Northeast and 3 in the South-SouthWest-Center-West. Conclusions: The North and Northeast Regions showed positive ST for IRM-M and higher death risk, which was not observed in the other regions. Cluster distribution for higher IMR-M and risk resembles the distribution of the microcephaly and Zika cases in the outbreak period.


Assuntos
Mortalidade Infantil , Microcefalia/mortalidade , Microcefalia/virologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/mortalidade , Brasil/epidemiologia , Surtos de Doenças , Humanos , Lactente , Recém-Nascido , Análise Espaço-Temporal
2.
Int J Infect Dis ; 88: 49-59, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31499212

RESUMO

INTRODUCTION: While death due to Zika virus (ZIKV) infection has been described, reports of fatal cases have been infrequent and no systematic reviews on the subject have been published. METHODS: A systematic review of the literature in four databases was performed to assess fatal outcomes of postnatal ZIKV infection and the available evidence that links ZIKV infection to death. RESULTS: Three hundred and eleven articles were retrieved; 20 of them were epidemiological reports from surveillance agencies and ministries of health. After screening by abstract and title, 59 articles were selected for full-text assessment. Of these, 35 were excluded (with reasons) and 24 were finally included for qualitative analysis. A total of 51 reported deaths associated with ZIKV infection in nine countries were identified. The majority of cases (56.9%) were not related to Guillain-Barré syndrome. Cases from three countries accounted for 67.6% of the deaths. ZIKV infection was laboratory-confirmed in the majority of cases (64.7%). DISCUSSION: ZIKV was not considered to be a dangerous, and much less a lethal pathogen, until very recently. However, an increasing number of fatalities have been published in the literature since the first death was reported in 2016. Additional research is needed to elucidate factors that may mediate the pathogenesis of severe, atypical, and fatal disease.


Assuntos
Infecção por Zika virus/epidemiologia , Zika virus/fisiologia , América/epidemiologia , Humanos , Infecção por Zika virus/mortalidade , Infecção por Zika virus/virologia
3.
Top Magn Reson Imaging ; 28(1): 29-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30817678

RESUMO

In the present case series, the cause of death of infants diagnosed with congenital Zika syndrome (CZS) was lung disease (pneumonia and sepsis with massive pulmonary aspiration), probably secondary to dysphagia and reflux. The main findings in infants with a confirmed diagnosis of CZS who died were as follows: (1) calcification and hypoplasia of the lentiform nuclei, hypoplasia of the caudate nuclei, and calcification at the cortical-subcortical junction was noted in all cases (100%) and calcification of the caudate nuclei was noted in 66.7% of cases; (2) calcification in the brainstem and along the lateral wall of the lateral ventricles was noted in only the case with arthrogryposis (33.3%); and (3) lesions in the posterior fossa (hypoplasia of the brainstem and cerebellum) were noted in two cases (66.7%), including the case with arthrogryposis. The findings concerning calcifications and brain malformations obtained from non-contrast computed tomography (CT) demonstrated good agreement with findings obtained from the postmortem pathological analysis; however, CT failed to detect discontinuity of the pia mater with heterotopia, invasion of the cerebral tissue into the subarachnoid space, and discontinuity of the ependyma in the lateral ventricles with gliosis; this last feature was only imaged in the most severe case of extreme microcephaly with a simplified gyral pattern. Only histopathology showed grouped calcifications associated with scattered calcifications suggestive of the neuron morphology.


Assuntos
Encéfalo/diagnóstico por imagem , Complicações Infecciosas na Gravidez/mortalidade , Tomografia Computadorizada por Raios X/métodos , Infecção por Zika virus/congênito , Infecção por Zika virus/mortalidade , Autopsia , Encéfalo/ultraestrutura , Encéfalo/virologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/mortalidade , Causas de Morte , Feminino , Humanos , Lactente , Pneumopatias/etiologia , Pneumopatias/mortalidade , Microcefalia/etiologia , Microcefalia/mortalidade , Microcefalia/virologia , Gravidez , Sepse/etiologia , Sepse/mortalidade , Síndrome , Zika virus , Infecção por Zika virus/diagnóstico por imagem
4.
Sci Rep ; 8(1): 10491, 2018 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-30002446

RESUMO

ZIKV has emerged as a significant human pathogene for the severe neurological complications, including Guillain-Barré(GBS) syndrome in adults and a variety of fetal abnormalities such as microcephaly. A stable and efficient infectious clone of Brazilian ZIKV isolate is required to study pathogenesis of epidemic ZIKV and virus evolution impact on it. Here we successfully constructed infectious cDNA clone on an early Brazilian isolate by eliminating the activity of predicted bacterial promoter in 1-3000 nt of ZIKV genome, leading to a stable infectious cDNA clone (pZL1). pZL1 derived virus could infect different cell lines and cause lethal effect to AG6 mice. We further investigated the role of a recent emerged substitution in NS5 (M2634V). We found that a reverse mutation (V2634M) caused negligible effect on the ZIKV viral genome replication and infectious progeny production in multiple cell culture systems. Additionally, this mutation did not alter the pathogenesis feature and virulence of ZIKV in AG6 mice. In summary, our results present another robust infectious ZIKV clone from Brazilian isolate and provide evidences to support that M2634V single mutation did not alter virus life cycle in cell culture and pathogenesis in AG6 mouse model.


Assuntos
Genoma Viral/genética , Proteínas não Estruturais Virais/genética , Replicação Viral/genética , Infecção por Zika virus/virologia , Zika virus/genética , Células A549 , Substituição de Aminoácidos , Animais , Chlorocebus aethiops , Clonagem Molecular , DNA Complementar/genética , Modelos Animais de Doenças , Evolução Molecular , Humanos , Metionina/genética , Camundongos , Regiões Promotoras Genéticas/genética , Valina/genética , Células Vero , Zika virus/patogenicidade , Infecção por Zika virus/mortalidade
5.
Artigo em Inglês | MEDLINE | ID: mdl-29696134

RESUMO

The common small animal disease models for Zika virus (ZIKV) are mice lacking the interferon responses, but infection of interferon receptor α/ß knock out (IFNAR-/-) mice is not uniformly lethal particularly in older animals. Here we sought to advance this model in regard to lethality for future countermeasure efficacy testing against more recent ZIKV strains from the Asian lineage, preferably the American sublineage. We first infected IFNAR-/- mice subcutaneously with the contemporary ZIKV-Paraiba strain resulting in predominantly neurological disease with ~50% lethality. Infection with ZIKV-Paraiba by different routes established a uniformly lethal model only in young mice (4-week old) upon intraperitoneal infection. However, intraperitoneal inoculation of ZIKV-French Polynesia resulted in uniform lethality in older IFNAR-/- mice (10-12-weeks old). In conclusion, we have established uniformly lethal mouse disease models for efficacy testing of antivirals and vaccines against recent ZIKV strains representing the Asian lineage.


Assuntos
Modelos Animais de Doenças , Receptor de Interferon alfa e beta/genética , Infecção por Zika virus/mortalidade , Infecção por Zika virus/patologia , Zika virus/isolamento & purificação , Aedes , Fatores Etários , Animais , Linhagem Celular , Chlorocebus aethiops , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Células Vero , Zika virus/patogenicidade , Infecção por Zika virus/virologia
6.
Nat Commun ; 9(1): 1624, 2018 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-29691387

RESUMO

Zika virus (ZIKV) infection of pregnant women is associated with pathologic complications of fetal development. Here, we infect pregnant rhesus macaques (Macaca mulatta) with a minimally passaged ZIKV isolate from Rio de Janeiro, where a high rate of fetal development complications was observed. The infection of pregnant macaques with this virus results in maternal viremia, virus crossing into the amniotic fluid (AF), and in utero fetal deaths. We also treated three additional ZIKV-infected pregnant macaques with a cocktail of ZIKV-neutralizing human monoclonal antibodies (nmAbs) at peak viremia. While the nmAbs can be effective in clearing the virus from the maternal sera of treated monkeys, it is not sufficient to clear ZIKV from AF. Our report suggests that ZIKV from Brazil causes fetal demise in non-human primates (NHPs) without additional mutations or confounding co-factors. Treatment with a neutralizing anti-ZIKV nmAb cocktail is insufficient to fully stop vertical transmission.


Assuntos
Anticorpos Antivirais/administração & dosagem , Complicações na Gravidez/tratamento farmacológico , Infecção por Zika virus/tratamento farmacológico , Zika virus/fisiologia , Animais , Anticorpos Neutralizantes/administração & dosagem , Feminino , Morte Fetal , Humanos , Macaca mulatta , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/virologia , Zika virus/efeitos dos fármacos , Zika virus/genética , Infecção por Zika virus/mortalidade , Infecção por Zika virus/virologia
8.
Sci Rep ; 8(1): 4510, 2018 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-29540804

RESUMO

Zika virus (ZIKV) is an emerging mosquito-borne virus that can cause ZIKV congenital syndrome when a pregnant woman is infected. Sexual transmission has also been described for ZIKV, though the relationship between sexual transmission and vertical transmission has not been investigated. Here, viral dissemination to the female reproductive tract and fetuses was assessed in immunodeficient (AG129) female mice that were exposed to ZIKV by subcutaneous (s.c.) inoculation, intravaginal (ivag.) inoculation, or sexual transmission from infected male AG129 mice. Pregnant females had significantly increased ZIKV dissemination to the female reproductive tract compared to non-pregnant females when exposed by s.c. or ivag. inoculation. Sexual transmission resulted in significantly greater morbidity and mortality in females and higher ZIKV titers in the female reproductive tract than s.c. or ivag. inoculation. Ovaries from females infected sexually contained ZIKV RNA within the ovarian follicles. Furthermore, ZIKV titers were significantly higher in fetuses from dams exposed sexually compared to fetuses from dams exposed by s.c. or ivag. inoculation. These results demonstrate that sexual transmission enhances dissemination of ZIKV to the female reproductive tract and developing fetuses in a mouse model.


Assuntos
Transmissão Vertical de Doença Infecciosa , Infecção por Zika virus/transmissão , Infecção por Zika virus/virologia , Zika virus , Animais , Modelos Animais de Doenças , Feminino , Masculino , Camundongos , Gravidez , RNA Viral , Útero/virologia , Vagina/virologia , Carga Viral , Zika virus/genética , Infecção por Zika virus/mortalidade
9.
EBioMedicine ; 24: 189-194, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29033372

RESUMO

Zika virus (ZIKV) has become a global public health emergency due to its rapidly expanding range and its ability to cause severe congenital defects such as microcephaly. However, there are no FDA-approved therapies or vaccines against ZIKV infection. Through our screening of viral entry inhibitors, we found that chloroquine (CQ), a commonly used antimalarial and a FDA-approved drug that has also been repurposed against other pathogens, could significantly inhibit ZIKV infection in vitro, by blocking virus internalization. We also demonstrated that CQ attenuates ZIKV-associated morbidity and mortality in mice. Finally, we proved that CQ protects fetal mice from microcephaly caused by ZIKV infection. Our methodology of focusing on previously identified antivirals in screens for effectiveness against ZIKV proved to be a rapid and efficient means of discovering new ZIKV therapeutics. Selecting drugs that were previously FDA-approved, such as CQ, also improves the likelihood that they may more quickly reach stages of clinical testing and use by the public.


Assuntos
Cloroquina/administração & dosagem , Microcefalia/prevenção & controle , Infecção por Zika virus/tratamento farmacológico , Animais , Linhagem Celular , Chlorocebus aethiops , Cloroquina/farmacologia , Modelos Animais de Doenças , Aprovação de Drogas , Avaliação Pré-Clínica de Medicamentos , Humanos , Camundongos , Microcefalia/mortalidade , Microcefalia/virologia , Células Vero , Internalização do Vírus/efeitos dos fármacos , Zika virus/efeitos dos fármacos , Zika virus/fisiologia , Infecção por Zika virus/complicações , Infecção por Zika virus/mortalidade
10.
Sci Rep ; 7(1): 10047, 2017 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-28855646

RESUMO

The global spread of Zika virus (ZIKV) as well as its unexpected link to infant microcephaly have resulted in serious public health concerns. No antiviral drugs against ZIKV is currently available, and vaccine development is of high priority to prepare for potential ZIKV pandemic. In the present study, a truncated E protein with the N-terminal 90% region reserved (E90) from a contemporary ZIKV strain was cloned and expressed in Escherichia coli, purified by a Ni-NTA column, and characterized by Western blotting assays. Immunization with recombinant E90 induced robust ZIKV-specific humoral response in adult BALB/c mice. Passive transfer of the antisera from E90-immunized mice conferred full protection against lethal ZIKV challenge in a neonatal mice model. Our results indicate that recombinant ZIKV E90 described here represents as a promising ZIKV subunit vaccine that deserves further clinical development.


Assuntos
Anticorpos Neutralizantes/biossíntese , Anticorpos Antivirais/biossíntese , Proteínas do Envelope Viral/imunologia , Vacinas Virais/imunologia , Infecção por Zika virus/prevenção & controle , Zika virus/imunologia , Animais , Clonagem Molecular , Modelos Animais de Doenças , Escherichia coli/genética , Escherichia coli/metabolismo , Feminino , Expressão Gênica , Humanos , Soros Imunes/administração & dosagem , Imunidade Humoral/efeitos dos fármacos , Imunização , Camundongos , Camundongos Endogâmicos BALB C , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Análise de Sobrevida , Vacinas de Subunidades , Proteínas do Envelope Viral/administração & dosagem , Proteínas do Envelope Viral/genética , Vacinas Virais/administração & dosagem , Vacinas Virais/genética , Zika virus/química , Infecção por Zika virus/imunologia , Infecção por Zika virus/mortalidade , Infecção por Zika virus/virologia
11.
Sci Rep ; 7(1): 9409, 2017 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-28842610

RESUMO

Zika virus (ZIKV) causes significant public health concerns because of its association with congenital malformations, neurological disorders in adults, and, more recently, death. Considering the necessity to mitigate ZIKV-associated diseases, antiviral interventions are an urgent necessity. Sofosbuvir, a drug in clinical use against hepatitis C virus (HCV), is among the FDA-approved substances endowed with anti-ZIKV activity. In this work, we further investigated the in vivo activity of sofosbuvir against ZIKV. Neonatal Swiss mice were infected with ZIKV (2 × 107 PFU) and treated with sofosbuvir at 20 mg/kg/day, a concentration compatible with pre-clinical development of this drug. We found that sofosbuvir reduced acute levels of ZIKV from 60 to 90% in different anatomical compartments, such as the blood plasma, spleen, kidney, and brain. Early treatment with sofosbuvir doubled the percentage and time of survival of ZIKV-infected animals. Sofosbuvir also prevented the acute neuromotor impairment triggered by ZIKV. In the long-term behavioural analysis of ZIKV-associated sequelae, sofosbuvir prevented loss of hippocampal- and amygdala-dependent memory. Our results indicate that sofosbuvir inhibits ZIKV replication in vivo, which is consistent with the prospective necessity of antiviral drugs to treat ZIKV-infected individuals.


Assuntos
Antivirais/farmacologia , Sofosbuvir/farmacologia , Infecção por Zika virus/tratamento farmacológico , Zika virus/fisiologia , Animais , Animais Recém-Nascidos , Antivirais/administração & dosagem , Chlorocebus aethiops , Memória , Camundongos , RNA Viral , Reflexo de Endireitamento , Sofosbuvir/administração & dosagem , Células Vero , Replicação Viral/efeitos dos fármacos , Infecção por Zika virus/mortalidade
12.
Am J Trop Med Hyg ; 97(4): 1085-1087, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28722594

RESUMO

Coinfection with pathogens that cause acute febrile illness (AFI) can complicate patient diagnosis and management. This report describes a fatal case of Leptospira spp./Zika virus (ZIKV) coinfection in Puerto Rico. The patient presented with a 5-day history of AFI; reported behavioral risk factors for leptospirosis; was diagnosed with possible leptospirosis, dengue, chikungunya, or ZIKV disease; and received appropriate treatment for leptospirosis and dengue. Following a 3-day hospitalization, the patient died due to acute gastrointestinal hemorrhage, and kidney and liver failure. Serologic diagnostic testing for leptospirosis and ZIKV disease was negative; however, molecular diagnostic testing performed postmortem was positive for detection of Leptospira spp. and ZIKV nucleic acid. This case demonstrates the need for continued clinical awareness of leptospirosis in areas experiencing outbreaks of pathogens that cause AFI and the need for evaluation of coinfection with AFI-causing pathogens as a risk factor for increased severity of disease.


Assuntos
Leptospirose/epidemiologia , Leptospirose/mortalidade , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/mortalidade , Coinfecção/epidemiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia
13.
Pediatr Infect Dis J ; 36(5): 528-530, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28403061

RESUMO

Considering the currently confirmed cases of microcephaly and related deaths associated with Zika virus in Brazil, the estimated case fatality rate is 8.3% (95% confidence interval: 7.2-9.6). However, a third of the reported cases remain under investigation. If the confirmation rates of cases and deaths are the same in the future, the estimated case fatality rate will be as high as 10.5% (95% confidence interval: 9.5-11.7).


Assuntos
Surtos de Doenças , Microcefalia/epidemiologia , Mortalidade Perinatal/tendências , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Feto , Humanos , Lactente , Recém-Nascido , Microcefalia/etiologia , Microcefalia/mortalidade , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/virologia , Análise de Sobrevida , Zika virus/patogenicidade , Zika virus/fisiologia , Infecção por Zika virus/complicações , Infecção por Zika virus/mortalidade , Infecção por Zika virus/virologia
14.
Proc Natl Acad Sci U S A ; 114(1): 119-124, 2017 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-27994145

RESUMO

Zika, a mosquito-borne viral disease that emerged in South America in 2015, was declared a Public Health Emergency of International Concern by the WHO in February of 2016. We developed a climate-driven R0 mathematical model for the transmission risk of Zika virus (ZIKV) that explicitly includes two key mosquito vector species: Aedes aegypti and Aedes albopictus The model was parameterized and calibrated using the most up to date information from the available literature. It was then driven by observed gridded temperature and rainfall datasets for the period 1950-2015. We find that the transmission risk in South America in 2015 was the highest since 1950. This maximum is related to favoring temperature conditions that caused the simulated biting rates to be largest and mosquito mortality rates and extrinsic incubation periods to be smallest in 2015. This event followed the suspected introduction of ZIKV in Brazil in 2013. The ZIKV outbreak in Latin America has very likely been fueled by the 2015-2016 El Niño climate phenomenon affecting the region. The highest transmission risk globally is in South America and tropical countries where Ae. aegypti is abundant. Transmission risk is strongly seasonal in temperate regions where Ae. albopictus is present, with significant risk of ZIKV transmission in the southeastern states of the United States, in southern China, and to a lesser extent, over southern Europe during the boreal summer season.


Assuntos
El Niño Oscilação Sul , Modelos Estatísticos , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/transmissão , Zika virus , Aedes , Animais , Haplorrinos , Humanos , Mosquitos Vetores , Risco , Uganda , Infecção por Zika virus/mortalidade
15.
J Virol ; 91(1)2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27795432

RESUMO

Zika virus (ZIKV; family Flaviviridae, genus Flavivirus) is a rapidly expanding global pathogen that has been associated with severe clinical manifestations, including devastating neurological disease in infants. There are currently no molecular clones of a New World ZIKV available that lack significant attenuation, hindering progress toward understanding determinants of transmission and pathogenesis. Here we report the development and characterization of a novel ZIKV reverse genetics system based on a 2015 isolate from Puerto Rico (PRVABC59). We generated a two-plasmid infectious clone system from which infectious virus was rescued that replicates in human and mosquito cells with growth kinetics representative of wild-type ZIKV. Infectious clone-derived virus initiated infection and transmission rates in Aedes aegypti mosquitoes comparable to those of the primary isolate and displayed similar pathogenesis in AG129 mice. This infectious clone system provides a valuable resource to the research community to explore ZIKV molecular biology, vaccine development, antiviral development, diagnostics, vector competence, and disease pathogenesis. IMPORTANCE: ZIKV is a rapidly spreading mosquito-borne pathogen that has been linked to Guillain-Barré syndrome in adults and congenital microcephaly in developing fetuses and infants. ZIKV can also be sexually transmitted. The viral molecular determinants of any of these phenotypes are not well understood. There is no reverse genetics system available for the current epidemic virus that will allow researchers to study ZIKV immunity, develop novel vaccines, or develop antiviral drugs. Here we provide a novel infectious clone system generated from a recent ZIKV isolated from a patient infected in Puerto Rico. This infectious clone produces virus with in vitro and in vivo characteristics similar to those of the primary isolate, providing a critical tool to study ZIKV infection and disease.


Assuntos
Aedes/virologia , Insetos Vetores/virologia , Plasmídeos/metabolismo , Genética Reversa/métodos , Infecção por Zika virus/virologia , Zika virus/genética , Animais , Linhagem Celular Tumoral , Chlorocebus aethiops , Células Clonais , Clonagem Molecular , RNA Polimerases Dirigidas por DNA/genética , RNA Polimerases Dirigidas por DNA/metabolismo , Células Epiteliais/virologia , Engenharia Genética , Vírus Delta da Hepatite/química , Hepatócitos/virologia , Humanos , Camundongos , Plasmídeos/química , RNA Catalítico/genética , RNA Catalítico/metabolismo , Análise de Sobrevida , Células Vero , Carga Viral , Proteínas Virais/genética , Proteínas Virais/metabolismo , Replicação Viral , Zika virus/crescimento & desenvolvimento , Infecção por Zika virus/mortalidade
16.
s.l; s.n; 2017. 2 p. maps, tab, ilus.
Não convencional em Inglês | MedCarib | ID: biblio-906780

RESUMO

Zika has been spreading in Suriname since November 2015 when the first ZIKV cases were confirmed and have been seen in all 10 districts in Suriname.


Assuntos
Humanos , Masculino , Feminino , Infecção por Zika virus/epidemiologia , Síndrome de Guillain-Barré/etiologia , Medidas de Ocorrência de Doenças , Suriname/epidemiologia , Infecção por Zika virus/mortalidade
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