GRAMMAR AND STRUCTURE III

OLEH :
ANDI HIDAYAT M
14-052-014-025

FAKULTAS SASTRA INGGRIS

UNIVERSITAS ISLAM MAKASSAR

2015

Zika Virus: What You Should Know

Birth defects linked to the mosquito-borne Zika virus represent an international public health
emergency, the World Health Organization declared.
There is an urgent need to do a lot more work, said Margaret Chan, MD, director-general of
the WHO. We need a coordinated international response to make sure we get to the bottom
of this.
The declaration will speed up research into the suspected connection between the virus and
cases of microcephaly in babies of infected pregnant women. Microcephaly causes
devastating, sometimes-fatal brain damage, and it can result in miscarriage or stillbirth. A
cause-and-effect link with the Zika virus hasnt been definitely established, though.
Meanwhile, officials in Dallas County, TX, reported Feb. 2 that one person caught Zika
through sexual activity.
The patient was infected with the virus after having sexual contact with an ill individual who
returned from a country where Zika virus is present, the Dallas County Health Human
Services department said in a statement.
The WHO on Jan. 28 said the virus was spreading explosively in the Americas. The level
of concern is high, as is the level of uncertainty, Chan told the organization's executive
board.
The agency predicts 3 million to 4 million people could be infected with the virus this year in
the Americas.
Experts previously warned the virus is likely to spread in the United States.
Doctors have seen cases of it in travelers coming back from the Caribbean and Central and
South America.
Zika has prompted a CDC travel warning for areas of those parts of the world, with the
agency cautioning pregnant women to "consider postponing travel" to more than 25 countries
and territories.
The virus has caused panic in Brazil since it first appeared there in May. More than 4,000
babies in Brazil have reportedly been born with microcephaly, and the Brazilian government
has taken the unprecedented step of advising women to avoid pregnancy until the crisis has
been solved. Since the virus has spread to other countries, several other nations have advised
women to put off getting pregnant.
Theres a lot of fear in Brazil. People are really scared of this virus, says Zika researcher
Scott Weaver, PhD, director of the Institute for Human Infections and Immunity at the
University of Texas Medical Branch at Galveston. I have colleagues working there who see
four to five births a day of infants with microcephaly.
To better understand the disease, its risks, and what it may mean for Americans, WebMD
turned to infectious disease researchers such as Weaver as well as experts at the CDC and
elsewhere.

What is the Zika virus? How do you catch it?

Zika virus, first identified in Uganda in 1947, is transmitted by the same type of mosquito
that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected
person and then passes those viruses to other people it bites. Outbreaks did not occur outside
of Africa until 2007, when it spread to the South Pacific.
The virus has been found in human semen, and one case of it possibly spreading person-toperson has been described, according to the WHO's Regional Office for the Americas.
Although the Dallas County case is not the first ever report of Zika spreading through sexual
activity, officials had said more evidence was needed to confirm whether it can be sexually
transmitted.
But this increases our awareness campaign in educating the public about protecting
themselves and others, Dallas County Health and Human Services Director Zachary
Thompson said. Next to abstinence, condoms are the best prevention method against any
sexually transmitted infections.
There has also been one report of possible spread of the virus through a blood transfusion,
according to the CDC.
What are the symptoms of Zika virus?
The disease can cause fever, rash, joint pain, and conjunctivitis, also called pinkeye. But most
people wont know they have it.
Only about 1 in 5 people with the virus will exhibit symptoms, says Amesh Adalja, MD, a
spokesman for the Infectious Diseases Society of America. The vast majority have no
symptoms at all.
Adalja also says the virus rarely causes major complications. Its never been thought of as a
severe infectious disease until now.
But in rare cases, Zika has been associated with Guillain-Barr syndrome, a disorder that can
cause partial or complete paralysis, most often temporary. An increase in that illness has been
seen in areas such as French Polynesia and Brazil, where a Zika epidemic has taken place, but
research hasn't established a direct relationship between the two, according to the WHOs
Regional Office for the Americas.
Is Zika similar to other mosquito-borne illnesses, such as dengue fever, chikungunya, or
West Nile virus?
All can cause a variety of flu-like symptoms that range in severity and can last from a few
days to more than a week. As with Zika, few people infected with dengue or West Nile will
show any symptoms.
How is Zika virus treated?

Theres no treatment, but Adalja says most people with symptoms do well with over-thecounter medications for aches and pains. The disease usually runs its course within a week or
so.
What is the connection between Zika, microcephaly, and pregnancy?
Microcephaly stunts a babys head growth, causing it to be much smaller than normal. The
babys brain often will not grow properly.
Its sometimes fatal, Weaver says. Some fetuses are stillborn or [miscarried]. Of those that
survive, many die early in age or have very severe lifelong cognitive problems.
J. Erin Staples, MD, PhD, a medical epidemiologist with the Arboviral Diseases Branch of
the CDC, says it will take time to find the cause of microcephaly for the cases being reported
in Brazil. There are many causes of microcephaly in babies, including infections during
pregnancy, genetic problems, and exposure to toxic substances during pregnancy.
But Weaver says evidence is growing that many of the cases in Brazil are being caused or
triggered by Zika.
The CDC said in a Jan. 15 statement that it tested samples provided by Brazilian health
authorities from two pregnancies that ended in miscarriage and two infants with
microcephaly who died shortly after birth. In the two full-term infants, the Zika virus was
present in the brain. In all four cases, genetic testing showed the virus was the same as the
Zika strain circulating in Brazil. All four mothers reported having a fever and a rash
consistent with Zika virus during their pregnancies, the CDC says.
Health authorities in Brazil, with assistance from the Pan American Health Organization,
CDC, and other agencies, have been investigating the possible association between Zika virus
infection and microcephaly in infants," according to the CDC. Additional studies are needed,
the agency says, and more are planned.
Its possible that Zika has always triggered microcephaly, Weaver says. Before 2007, the
disease struck in such small numbers that the link simply may have been missed.
Or it may be that the virus has changed and has developed a different pattern of infection
and replication in people that leads to infection of the fetus, Weaver says.
What countries are in the CDC travel warning for pregnant women?
The CDC travel warning covers countries where Zika transmission is ongoing: Brazil,
Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico,
Panama, Paraguay, Suriname, Venezuela, and the U.S. territory of Puerto Rico.
On Jan. 22, the CDC added Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana,
Cape Verde, and Samoa to the warning. On Jan. 26, it added the U.S. Virgin Islands and the
Dominican Republic. On Feb. 1, it added American Samoa, Costa Rica, Curacao, and
Nicaragua. On Feb. 3, it added Jamaica and Tonga.

Pregnant women in any trimester are advised to avoid travel to those areas, the CDC says.
Those who must travel, as well as women who are thinking about becoming pregnant, should
talk to their doctor first and "strictly follow steps to avoid mosquito bites" during their trip.
What if I'm pregnant and I've traveled to these areas?
Talk to your doctor. She'll check on your baby's health, and you'll be screened for symptoms
of the virus. If you have symptoms, other diseases such as dengue or chikungunya can be
ruled out.
While there's no commercially available test for Zika, a blood test can be done by the CDC
and some state health departments if your symptoms have appeared in the past week, the
agency says. Testing of amniotic fluid can also be done, although it's not clear how sensitive
or specific this test would be for Zika, according to the CDC.
Pregnant women with Zika should get ultrasounds every 3 to 4 weeks to monitor the baby's
growth, the agency says.
Are we at risk of an outbreak in the U.S.?
Weaver earlier said Zika's arrival in the U.S. was likely, as it can be carried by travelers from
the Caribbean or Latin America. He also noted the tourist season has just begun. And Rio de
Janeiro, Brazils second largest city, will host the 2016 Summer Olympics in August, which
will draw people from around the globe.
But he saysits unlikely we will experience the same mass outbreaks, because we are not
exposed to mosquitoes on the same level as people in Latin America and the Caribbean are.
Staples agrees. We are not able to predict how much Zika virus will occur in the United
States, she writes. However, recent chikungunya and dengue outbreaks in the United States
suggest that Zika virus outbreaks in the U.S. mainland may be relatively small and local.
Aedes mosquitoes, which spread Zika, are found in every country in North, Central, and
South America except for two -- Canada and continental Chile, according to the WHO's
Regional Office for the Americas. The agency "anticipates that Zika virus will continue to
spread and will likely reach all countries and territories of the region where Aedes mosquitoes
are found."
What protective measures can be taken?
If you plan to travel in affected areas, avoid mosquito bites by using mosquito repellent
throughout the day. Also, wear long-sleeved shirts and long pants, both indoors and out. The
mosquitoes that spread Zika are aggressive daytime biters often found indoors, which were
not used to in the U.S., Weaver says. Mosquitoes here tend to feed at night outdoors.
You need to protect yourself all day long, Weaver says.
Weaver is particularly concerned about pregnant women travelers.

Especially in the first trimester or early second trimester, going to an area with Zika virus
circulating is pretty risky, he says. Even though the link between Zika and microcephaly is
not completely solid, its very likely that Zika is involved, and I certainly would not
recommend that pregnant women travel to areas where epidemics are ongoing.
Even those who dont know they have Zika can spread the disease. Weaver advises people
who have traveled to affected regions to be extremely vigilant against mosquito bites when
they return home, especially during the first 10 days.

Zika and Microcephaly: How Doctors Made the Link

The first ultrasound scans were devastating.

In grainy black and white, doctors peeking into the wombs of pregnant women in Brazil
could see trouble.

The brains of their tiny patients werent keeping pace with the rest of their growth. And
something was badly wrong. The brains inner chambers seemed enlarged and deformed, and
other key structures were altered -- a condition known as microcephaly.
Most puzzling to Adriana Melo, MD, PhD, an obstetrician and fetal medicine specialist in
Campina Grande, Brazil, were the bright spots called calcifications that dotted the brain
tissue.
Since the first exams, when I started to see a strange pattern, I thought that this was
something different, something new in Brazil, Melo says. She says when the brains inner
chambers are enlarged, it usually points to a genetic problem, but ...calcification suggests
infection. So the combination of these findings was confusing.
In an average year, a doctor in Brazil might see one or two pregnancies with birth defects like
these. But by October, Melo had heard about more than 60 of these babies.
Fear took hold.
There was a terrible rumor that vaccines were the cause, Melo says. And that was very
hard for us, because people would talk about microcephaly and then someone would say,
Oh, just dont get any vaccines, she says. People started to believe that it was related.
But Melo knew it had to be something else, and she raced to find it.
We couldnt just sit here, she says. I knew what I was seeing was something different,
something new that we hadnt seen before.
Her first patient was a 34-year-old first-time mom. Melo had been her doctor from the
beginning of her pregnancy. The woman had no risk factors for microcephaly. She didnt
smoke, didnt drink, didnt use drugs, and had no family history of genetic problems that
might cause the condition.
What she did have was a rash and achy joints when she was about 8 weeks pregnant. Her
symptoms had faded and she had seemingly recovered without a problem.
Nobody suspected Zika virus.

Weve had dengue here for years, and we just havent been that worried about that virus, and
we thought this was going to be same, Melo says.
The virus was first discovered in a monkey in Uganda in 1947. It was only reported in
humans about a dozen times for the next 50 years. Then in 2007, Zika infected about threequarters of the population on the tiny island of Yap, between the Philippines and Papua New
Guinea in the western Pacific Ocean. In 2013 the virus skipped east, where it caused another
major outbreak on the islands of French Polynesia.
The virus seemed mild. About 80% of people who are infected never even know it. Those
who do have mild symptoms, like a rash, joint pain, fever and red eyes, and they tend to
recover quickly.
Melo says she first started hearing about Zika infections in Campina Grande in July. She and
other doctors shrugged. It was a nuisance, but hardly unexpected in a tropical climate.
But as she tried to figure out what was affecting so many pregnant women at the same time,
she remembered her patients rash and achy joints. Could it be Zika?
She read as much as she could about the virus. She learned it was neurotropic, meaning it
likes to infect the nervous system. She also found two scientific reports that showed the same
kind of brain damage in fetal cows and sheep after their mothers had been experimentally
infected with viruses in the same family as Zika.
Melo knew she was on to something.
On Nov. 10, she used a long needle to draw samples of the pale amniotic fluid from two of
her patients whose babies were showing signs of microcephaly. She sent them off for
analysis.
On Thursday, as luck would have it, she had registered to attend a medical meeting in Sao
Paulo --about 1,600 miles south of Campina Grande -- on the development of the fetal brain.
She took her patients medical records and their ultrasound scans so other doctors could see
them and weigh in.

There she met Gustavo Malinger, MD, director of the obstetrical ultrasound unit at the Tel
Aviv Sourasky Medical Center in Israel. She knew Malinger to be one of the greatest fetal
brain experts in the world.
He thought it was virtually impossible that this could be caused by a virus, she says. But I
insisted we were seeing a pattern. That made an impression on him.
He asked her if she could bring the patients to him so he could repeat the scans. She told him
that no, the patients lived thousands of miles to the north, and it wouldnt be possible.
But she knew this was a critical piece of evidence. She left Malinger and quickly called
Brazils Ministry of Health -- an agency thats a bit like the Department of Health and Human
Services in the U.S. -- and convinced them to pay for plane tickets for the women to travel to
Sao Paulo the next day.
I performed the examinations in Sao Paulo, Malinger says, after the doctors found a private
hospital that allowed them to do ultrasounds and MRIs.
The findings were very surprising, he says. Most of the brain structures were destroyed.
Also the eyes were destroyed. They were, he says, without hope.
Malinger did the exams on Nov. 14. By the following Monday, Melo had her lab results back.
The amniotic fluid around the babies was teeming with Zika virus.
On Monday, when I gave him the results, he was truly taken aback. This was something,
Melo says. It was the first time in the world that we had been able to detect Zika virus in
amniotic fluid. And we had documented just how aggressive the virus was.
The two later published their findings as a Physician Alert in the journal Ultrasound in
Obstetrics and Gynecology.
'We Needed to Say Something to Women'
Though local doctors had suspected Zika might be causing microcephaly since September,
every time we tried to broach the subject, we were criticized because we didnt have any
evidence, Melo says.

Evidence in hand, Melo alerted the Ministry of Health. After laboratory tests found Zika virus
in the amniotic fluid around a third baby, stillborn in the neighboring state of Ceara, the
agency sounded the alarm.
A week later, the European Centre for Disease Prevention and Control put out the first
international alert that the microcephaly cases in Brazil might be linked to Zika.
The Brazilian doctors were criticized for the warning. Even with Zika in the amniotic fluid,
the virus has still never been found in the blood from a babys umbilical cord. And right now,
theres no biological theory to explain how the virus might be doing its dirty work.
For this, you need long-term studies, Melo says. We all know that. But my concern was -why I wanted to get clarification of these cases -- is because we needed to say something to
women who are pregnant now, she says.
This is very serious. They have to have a chance.
For many of her patients, the discovery was simply too late. After learning of the
microcephaly, many women wanted to abort their pregnancies, but abortion is against the law
in Brazil.
But at least the government started to advise pregnant women to protect themselves with long
pants, long sleeves, and socks, and to put screens on their windows -- something thats rarely
done in Brazil. Health officials have also started a campaign called Sabado da Faxina, or
Cleaning Saturday, to get people to walk around their houses to check for trash and small
pools of still water, even water that might collect in sidewalk cracks.
Theres no such thing as enough protection, Melo says.
Besides the infants who are obviously affected, Malinger predicts something worse.
First they will diagnose the children who are most severely affected. In time, after 2 or 3
years, they will find other children who are sick -- they will be blind, they will have hearing
problems, they will have cardiac problems. It wont only affect the brain. It will be a multiorgan disease. Melo stays in touch with mothers who have given birth to babies with
microcephaly, privately, on social media.

These mothers situations are very hard right now, she says. Its the uncertainty. Because
theres nothing we can tell them about the prognosis of these children, so its very difficult for
a mother who doesnt know if her child is going to sit up, if her child is going to walk.
The Brazilian Ministry of Health has pledged to follow the microcephaly babies. They are
offering families physical therapy and other programs to help the children and try to
minimize the consequences.
These services are going to be overloaded. And this isnt [just] a problem with Brazil.
Nobody can say Oh, Brazil isnt prepared for this. No country is prepared for this, Melo
says.