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Dear Editor of JVATiTD, A little more than a year ago, physicians and researchers from the northeastern region of Brazil raised the hypothesis of an association between microcephaly cases in newborns and a possible Zika virus infection in their mothers during pregnancy. Common phenotypic features called the attention of the discerning eyes of geneticists, already used to this type of observation [1]. In those cases, records of exanthematous disease during pregnancy were found in the anamnesis. Moreover, radiology images revealed findings that although resembled some other TORCH, they had their particularities in common. Initially, a recurrent pattern in computerized tomography of the skulls was described, which led physicians to classify the set of findings as the emergence of a new disease [2]. For professionals who were experiencing this reality in the Northeast, there was no doubt that the puzzle was being solved. Chronology, clinical history and findings, all of these suggested that the exanthematous disease reported by those women during pregnancy was related to the microcephaly of their babies [3]. Although there was a strong distrust concerning causal relationship and at that time no scientific basis to corroborate the hypothesis, for many physicians Zika virus was underestimated, an apparently self-limited disease with discrete symptoms that people often overlooked. Despite emerging evidence, several researchers were skeptical. They did not even consider the possibility of teratogeny provoked by an epidemic of Zika virus disease. In this scenario of panic and uncertainties – permeated by mismatched information among physicians, researchers, journalists and the general population – the scientific community was divided, living moments of collective hysteria. Misleading information on social networks and sensationalist news made this moment even more complicated and moving. It also should be noted that it all occurred in a very troubled political and economic moment in Brazil. At this first moment, there were no sources in the literature to provide information on necessary measures or even follow-up protocols. Nothing could backed up the physicians and guide them in the investigation. There were distressed parents waiting for a diagnosis or explanation, full of doubts that health professionals could not clarify. At that moment, several questions were repeated: “What is the problem of our baby?”, “Will he be fine?”, “Will he survive?”, “Are you sure it was Zika?” and “What do I do to make him better?”. Despite the feeling of powerlessness in face of the unknown, physicians in charge had to be sincere and to use their experiences with similar pathologies to manage the cases of these babies. They requested many tests to rule out other possible causes and referred children to many specialists [4, 5]. As therapeutic management, they indicated early stimulation with physiotherapy, speech therapy and occupational therapy in order to avoid complications that could lead to death. They did so in the hope that this work would stimulate the incredible intrinsic neuronal plasticity of children and could bring to these patients a better perspective of development, despite the severe neurological damage already established. * Correspondence: pamplona.luciano@gmail.com Department of Community Health, School of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes, 1608, 5 andar, Fortaleza, CE CEP 60430-140, Brazil Full list of author information is available at the end of the article

the journal of venomous animals and toxins including tropical diseases

From the perception of a cluster of cases of children with microcephaly to congenital Zika syndrome in Brazil: the lessons we have learned and the challenges that lie ahead of us