Abstract INTRODUCTION: Newborn who had Zika vírus but did not show microcephaly at birth may have neuropsychomotor development problems. We aimed to evaluate the developmental and anthropometric milestones of asymptomatic children whose mothers had Zika during pregnancy in Northeastern Brazil in 2015 and 2016. METHODS: We conducted a descriptive cross-sectional case series study of children in Fortaleza born without microcephaly whose mothers had Zika during pregnancy. Home visits were undertaken to evaluate the developmental milestones and gather anthropometric data of the children and to conduct semi-structured interviews with the mothers to identify their socioeconomic and gestational profiles and assess the newborns after birth. RESULTS: In total, 30 cases were identified. Of these, 17 children and their mothers participated in the study. The median age of the mothers at the time of delivery was 26 years. All were symptomatic, and TORCH was negative. At the time of the home visit, all had growth profiles suitable for their age. However, nearly all children (15/17, 88.2%) presented at least one developmental delay, considering their age group. CONCLUSIONS: There were late changes in the neuropsychomotor development of children born to mothers who had Zika during pregnancy, suggesting the need for specialized medical follow-ups.

Abstract INTRODUCTION Chikungunya causes fever and severe and persistent joint pain. METHODS We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. RESULTS: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. CONCLUSIONS: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

Resumo Objetivo: descrever a experiência e os resultados preliminares do Comitê de Investigação de Óbitos por Arboviroses no Ceará, Brasil, em 2017. Métodos: o Comitê investiga e discute todos os casos suspeitos de óbitos por arboviroses notificados pela vigilância epidemiológica. Resultados: foram notificados 443 óbitos suspeitos de arboviroses e 220 (49,7%) foram confirmados; destes, 88,2% por chikungunya e 11,8% por dengue; a mediana de idade dos óbitos por chikungunya foi mais elevada, quando comparada à da dengue (77 versus 56 anos), e o tempo de evolução até o óbito também foi mais prolongado, quando comparado ao da dengue (38 versus 12 dias); para o encerramento dos casos, a mediana foi de 54,5 dias; em 2017, o Ceará confirmou 80,4% dos óbitos por chikungunya no Brasil. Conclusão: a análise dos óbitos mostrou que o CHIKV foi o responsável pela maior parte dos óbitos por arboviroses no estado do Ceará, em 2017.

Abstract Objective: to describe the experience and preliminary results of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017. Methods: the Committee investigates and discusses all suspected cases of arbovirus deaths reported by the epidemiological surveillance service. Results: a total of 443 suspected arbovirus deaths were reported, 220 (49.7%) of which were confirmed; of these, 88.2% were from chikungunya and 11.8% from dengue; the median age of chikungunya deaths was higher when compared to dengue (77 versus 56 years) and the time until death was also longer when compared to dengue (38 versus 12 days); median time for case closure was 54.5 days; in 2017, Ceará confirmed 80.4% of Brazilian chikungunya deaths. Conclusion: the investigation of deaths showed that CHIK viruses were responsible for the majority of arboviral deaths in the state of Ceará, in 2017.

Resumen Objetivo: describir la experiencia y los resultados preliminares del Comité de Investigación de Óbitos por Arbovirus desarrollada en Ceará, Brasil, en 2017. Métodos: el comité discute los casos sospechosos de muertes por arbovirus notificados por la vigilancia epidemiológica. Resultados: se notificaron 443 óbitos sospechosos y 220 (49,7%) fueron confirmados; de estos, 88,2% por chikungunya y 11,8% por dengue; el promedio de edad de los fallecimientos por chikungunya fue más elevado (77 versus 56 años) y el tiempo de evolución hasta el óbito más prolongado, en comparación con el dengue (38 versus 12 días); para el cierre de los casos el promedio fue de 54,5 días; en 2017, Ceará confirmó 80,4% de las muertes por chikungunya en Brasil. Conclusión: El análisis de muertes mostró que CHIKV fue responsable de la mayoría de las muertes por arbovirus en el estado de Ceará, en 2017.

Resumo Objetivo: descrever a experiência e os resultados preliminares do Comitê de Investigação de Óbitos por Arboviroses no Ceará, Brasil, em 2017. Métodos: o Comitê investiga e discute todos os casos suspeitos de óbitos por arboviroses notificados pela vigilância epidemiológica. Resultados: foram notificados 443 óbitos suspeitos de arboviroses e 220 (49,7%) foram confirmados; destes, 88,2% por chikungunya e 11,8% por dengue; a mediana de idade dos óbitos por chikungunya foi mais elevada, quando comparada à da dengue (77 versus 56 anos), e o tempo de evolução até o óbito também foi mais prolongado, quando comparado ao da dengue (38 versus 12 dias); para o encerramento dos casos, a mediana foi de 54,5 dias; em 2017, o Ceará confirmou 80,4% dos óbitos por chikungunya no Brasil. Conclusão: a análise dos óbitos mostrou que o CHIKV foi o responsável pela maior parte dos óbitos por arboviroses no estado do Ceará, em 2017.

Abstract Objective: to describe the experience and preliminary results of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017. Methods: the Committee investigates and discusses all suspected cases of arbovirus deaths reported by the epidemiological surveillance service. Results: a total of 443 suspected arbovirus deaths were reported, 220 (49.7%) of which were confirmed; of these, 88.2% were from chikungunya and 11.8% from dengue; the median age of chikungunya deaths was higher when compared to dengue (77 versus 56 years) and the time until death was also longer when compared to dengue (38 versus 12 days); median time for case closure was 54.5 days; in 2017, Ceará confirmed 80.4% of Brazilian chikungunya deaths. Conclusion: the investigation of deaths showed that CHIK viruses were responsible for the majority of arboviral deaths in the state of Ceará, in 2017.

Resumen Objetivo: describir la experiencia y los resultados preliminares del Comité de Investigación de Óbitos por Arbovirus desarrollada en Ceará, Brasil, en 2017. Métodos: el comité discute los casos sospechosos de muertes por arbovirus notificados por la vigilancia epidemiológica. Resultados: se notificaron 443 óbitos sospechosos y 220 (49,7%) fueron confirmados; de estos, 88,2% por chikungunya y 11,8% por dengue; el promedio de edad de los fallecimientos por chikungunya fue más elevado (77 versus 56 años) y el tiempo de evolución hasta el óbito más prolongado, en comparación con el dengue (38 versus 12 días); para el cierre de los casos el promedio fue de 54,5 días; en 2017, Ceará confirmó 80,4% de las muertes por chikungunya en Brasil. Conclusión: El análisis de muertes mostró que CHIKV fue responsable de la mayoría de las muertes por arbovirus en el estado de Ceará, en 2017.

Abstract INTRODUCTION: Chikungunya virus (CHIKV) can negatively influence outcomes in patients with pre-existing conditions. We investigated the association between the recent CHIKV outbreak and increased type 2 diabetes (T2D)-attributable deaths. METHODS: Monthly averages of T2D-attributable deaths between 2001 and 2016 were determined and compared to the equivalent data for 2017 and the recent CHIKV outbreak. RESULTS: CHKV outbreak peaked in April 2017 with 4,394.4 cases/100,000 inhabitants, while T2D-attributable deaths in the same period increased by 35.2%. CONCLUSIONS: T2D-attributable deaths significantly increased compared to the previous data, which overlapped with CHIKV incidence. The pathophysiology of this association warrants further investigations.