Health officials probe tie between Zika, paralyzing syndrome

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CDC Expands Zika Travel Alert

SAN SALVADOR, El Salvador (AP) -- Health officials say they're trying to determine if an unusual jump in cases of a rare nerve condition sometimes severe enough to cause paralysis is related to the spread of the mosquito-borne Zika virus in at least two Latin American countries.

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Fears the illness might be causing thousands of birth defects already has led authorities in Brazil, Colombia and El Salvador to take the drastic step of warning women against becoming pregnant. The U.S. Centers for Disease Control and Prevention on Friday expanded its warning for pregnant women thinking of visiting 22 destinations, most in Latin America and the Caribbean.

But concern also has been rising about a potential link to Guillain-Barre syndrome, a nerve disorder than can affect anyone. It causes muscle weakness, tingling in the arms and legs and sometimes temporary paralysis. Most people recover fully, but severe cases that affect muscles used to breathe can be life-threatening.

It's thought to occur when someone's immune system overreacts and attacks its own nervous system cells, often after various types of infections.

See birth defects linked to the Zika virus:

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Zika, Mosquito borne illness causing birth defects in Brazil
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Health officials probe tie between Zika, paralyzing syndrome
In this Jan. 29, 2016 photo, Tainara Lourenco, who is five months pregnant, sits inside her house at a slum in Recife, Brazil. Like many of the estimated 400,000 women currently pregnant in Brazil, she canât afford mosquito repellent. The government has pledged to start providing repellent to low-income women and promises to deploy the Armed Forces to help eliminate Aedesâ breeding places. (AP Photo/Felipe Dana)
RECIFE, BRAZIL - JANUARY 29: Dr. Valeria Barros treats a 6-week old baby born with microcephaly at the Lessa de Andrade polyclinic during a physical therapy session on January 29, 2016 in Recife, Pernambuco state, Brazil. Health officials believe as many as 100,000 people have been exposed to the Zika virus in Recife, although most never develop symptoms. In the last four months, authorities have recorded around 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. (Photo by Mario Tama/Getty Images)
RECIFE, BRAZIL - JANUARY 31: Alice Vitoria Gomes Bezerra, 3-months-old, who has microcephaly, is held by her mother Nadja Cristina Gomes Bezerra on January 31, 2016 in Recife, Brazil. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. (Photo by Mario Tama/Getty Images)
RECIFE, BRAZIL - JANUARY 29: David Henrique Ferreira, 5 months, who was born with microcephaly, is kissed by his mother Mylene Helena Ferreira on January 29, 2016 in Recife, Pernambuco state, Brazil. In the last four months, authorities have recorded around 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. (Photo by Mario Tama/Getty Images)
RECIFE, BRAZIL - JANUARY 29: David Henrique Ferreira, 5 months, who was born with microcephaly, is held by his grandmother Maria Elisabeth as his mother stands at right on January 29, 2016 in Recife, Pernambuco state, Brazil. In the last four months, authorities have recorded around 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. (Photo by Mario Tama/Getty Images)
Pregnant woman Angelica Prato, infected by the Zika virus, is attended at the Erasmo Meoz University Hospital in Cucuta, Colombia, on January 25, 2016. Authorities in Brazil, Colombia, Ecuador, El Salvador and Jamaica have advised couples to avoid pregnancy for the time being due to the presence of the Zika virus because if a pregnant woman is infected by the virus, the baby could be born with microcephaly. The Zika virus, a mosquito-borne disease suspected of causing serious birth defects, is expected to spread to all countries in the Americas except Canada and Chile, the World Health Organization said. AFP PHOTO/Schneyder Mendoza / AFP / SCHNEYDER MENDOZA (Photo credit should read SCHNEYDER MENDOZA/AFP/Getty Images)
In this Jan. 29, 2016 photo, Tainara Lourenco smiles as she chats with neighbors from the entrance of home at a slum in Recife, Brazil. Unemployed and five months pregnant, 21-year-old Lourenco lives in a slum at the epicenter of Brazilâs tandem Zika and microcephaly outbreaks, the state of Pernambuco. (AP Photo/Felipe Dana)
RECIFE, BRAZIL - JANUARY 27: Alice Vitoria Gomes Bezerra, 3-months-old, who has microcephaly, is placed in her crib by her father Joao Batista Bezerra on January 27, 2016 in Recife, Brazil. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. At least twelve cases in the United States have now been confirmed by the CDC. (Photo by Mario Tama/Getty Images)
Gleyse Kelly da Silva holds her daughter Maria Giovanna as she sleeps in their house in Recife, Pernambuco state, Brazil, Wednesday, Jan. 27, 2016. Brazilian officials still say they believe there's a sharp increase in cases of microcephaly and strongly suspect the Zika virus, which first appeared in the country last year, is to blame. The concern is strong enough that the U.S. Centers for Disease Control and Prevention this month warned pregnant women to reconsider visits to areas where Zika is present. (AP Photo/Felipe Dana)
Kleisse Marcelina ,24, bathes her son Pietro, 2 month, suffering from microcephalia caught through an Aedes Aegypti mosquito bite, in Salvador, Brazil on January 28 , 2016. AFP PHOTO / Christophe SIMON / AFP / CHRISTOPHE SIMON (Photo credit should read CHRISTOPHE SIMON/AFP/Getty Images)
RECIFE, BRAZIL - JANUARY 26: Grandmother Ivalda Caetano holds Ludmilla Hadassa Dias de Vasconcelos (2 months), who has microcephaly, at Oswald Cruz hospital on January 26, 2016 in Recife, Brazil. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. At least twelve cases in the United States have now been confirmed by the CDC. The Brazilian government announced it will deploy more than 200,000 troops to combat the mosquitos which are spreading the Zika virus. (Photo by Mario Tama/Getty Images)
RECIFE, BRAZIL - JANUARY 27: Dr. Vanessa Van Der Linden, the neuro-pediatrician who first recognized and alerted authorities over the microcephaly crisis in Brazil, measures the head of a 2-month-old baby with microcephaly on January 27, 2016 in Recife, Brazil. The baby's mother was diagnosed with having the Zika virus during her pregnancy. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. At least twelve cases in the United States have now been confirmed by the CDC. (Photo by Mario Tama/Getty Images)
RECIFE, BRAZIL - JANUARY 31: Alice Vitoria Gomes Bezerra, 3-months-old, who has microcephaly, is held by her mother Nadja Cristina Gomes Bezerra on January 31, 2016 in Recife, Brazil. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. (Photo by Mario Tama/Getty Images)
Physical therapist Isana Santana treats Ruan Hentique dos Santos, suffering from microcephalia caught through an Aedes Aegypti mosquito bite, at Obras Socias irma dulce hospital in Salvador, Brazil on January 28 , 2016. AFP PHOTO / Christophe SIMON / AFP / CHRISTOPHE SIMON (Photo credit should read CHRISTOPHE SIMON/AFP/Getty Images)
The parents of Icaro Luis , 2 month, suffering from microcephalia caught through an Aedes Aegypti mosquito bite, Physical therapist Isana Santan at the Obras socias irma dulce hospital in Salvador, Brazil on January 28, 2016. AFP PHOTO / Christophe SIMON / AFP / CHRISTOPHE SIMON (Photo credit should read CHRISTOPHE SIMON/AFP/Getty Images)
Physical therapist Isana Santana treats Ruan Hentique dos Santos, suffering from microcephalia caught through an Aedes Aegypti mosquito bite, at Obras Socias irma dulce hospital in Salvador, Brazil on January 28 , 2016. AFP PHOTO / Christophe SIMON / AFP / CHRISTOPHE SIMON (Photo credit should read CHRISTOPHE SIMON/AFP/Getty Images)
Ana Paula Santos, 34, holds her 45-day-old daughter Flavia Alessandra suffering from microcephalia supposedly caught through an Aedes aegypti mosquito bite, at the Obras Sociais Irma Dulce hospital in Salvador, Brazil on January 27, 2016. AFP PHOTO / Christophe SIMON / AFP / CHRISTOPHE SIMON (Photo credit should read CHRISTOPHE SIMON/AFP/Getty Images)
RECIFE, BRAZIL - JANUARY 25: Estafany Perreira holds her nephew David Henrique Ferreira, 5 months, who has microcephaly, on January 25, 2016 in Recife, Brazil. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. Microcephaly results in newborns with abnormally small heads and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to further spread in South, Central and North America. At least twelve cases of Zika in the United States have now been confirmed by the CDC. (Photo by Mario Tama/Getty Images)
RECIFE, BRAZIL - JANUARY 25: Mother Mylene Helena Ferreira cares for her son David Henrique Ferreira, 5 months, who has microcephaly, on January 25, 2016 in Recife, Brazil. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. Microcephaly results in newborns with abnormally small heads and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to further spread in South, Central and North America. At least twelve cases of Zika in the United States have now been confirmed by the CDC. (Photo by Mario Tama/Getty Images)
In this Dec. 23, 2015 photo, Solange Ferreira bathes her son Jose Wesley in a bucket at their house in Poco Fundo, Pernambuco state, Brazil. Ferreira says her son enjoys being in the water, she places him in the bucket several times a day to calm him. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, 10-year-old Elison nurses his 2-month-old brother Jose Wesley at their house in Poco Fundo, Pernambuco state, Brazil. Suspicion of the link between microcephaly and the Zika virus arose after officials recorded 17 cases of central nervous system malformations among fetuses and newborns after a Zika outbreak began last year in French Polynesia, according to the European Center for Disease Prevention and Control. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, plastic bags and trash lay on the ground in Santa Cruz do Capibaribe, where many cases of Zika where reported in Pernambuco state, Brazil, Wednesday. The Zika virus, first detected about 40 years ago in Uganda, has long seen as a less-painful cousin to dengue and chikunguya, which are spread by the same Aedes mosquito. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, 10-year-old Elison, left, watches as his mother Solange Ferreira bathes Jose Wesley in a bucket at their house in Poco Fundo, Pernambuco state, Brazil. Ferreira says Jose Wesley enjoys being in the water, she places him in the bucket several times a day to calm him. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, Dejailson Arruda holds his daughter Luiza at their house in Santa Cruz do Capibaribe, Pernambuco state, Brazil. More than 2,700 babies have been born in Brazil with microcephaly this year, up from fewer than 150 in 2014. Brazilâs health officials say theyâre convinced the jump is linked to a sudden outbreak of the Zika virus that infected Pereira, though international experts caution itâs far too early to be sure. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, 10-year-old Elison carries his 2-month-old brother Jose Wesley at their house in Poco Fundo, Pernambuco state, Brazil. More than 2,700 babies have been born in Brazil with microcephaly this year, up from fewer than 150 in 2014. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, Jose Wesley sleeps covered by a mosquito net in Poco Fundo, Pernambuco state, Brazil. Jose Wesleyâs mother Solange Ferreira had never heard of microcephaly before her youngest son was diagnosed a couple of days after his birth. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, 5-year-old Elenilson, left, holds a notebook as he plays next to his 2-month-old brother Jose Wesley at their house in Poco Fundo, Pernambuco state, Brazil. Their mother, Solange Ferreira had never heard of microcephaly before her youngest son was diagnosed a couple of days after his birth. (AP Photo/Felipe Dana)
In this Dec. 22, 2015 photo, Angelica Pereira applies perfume on Luiza as her father Dejailson Arruda holds her at their house in Santa Cruz do Capibaribe, Pernambuco state, Brazil. While thereâs never before been a detected link between the virus and microcephaly, âthere has never been an epidemic of Zika in the proportions that we are looking at now in Brazil,â said Pedro Fernando Vasconcelos, a researcher at Evandro Chagas Institute investigating an association between the virus and the birth defects. (AP Photo/Felipe Dana)
In this Dec. 23, 2015 photo, Dejailson Arruda holds his daughter Luiza at their house in Santa Cruz do Capibaribe, Pernambuco state, Brazil. Luiza was born in October with a rare condition, known as microcephaly. Luiza's mother Angelica Pereira was infected with the Zika virus after a mosquito bite. Brazilian health authorities are convinced that Luiza's condition is related to the Zika virus that infected her mother during pregnancy. (AP Photo/Felipe Dana)
In this Dec. 22, 2015 photo, Angelica Pereira holds Luiza outside their house in Santa Cruz do Capibaribe, Pernambuco state, Brazil. Luiza was born in October with a rare condition, known as microcephaly. The Zika virus, first detected in humans about 40 years ago in Uganda, has long seen as a less-painful cousin to dengue and chikunguya, which are spread by the same Aedes mosquito. Until a few months ago, investigators had no reported evidence it might be related to microcephaly. (AP Photo/Felipe Dana)
In this Dec. 22, 2015 photo, Angelica Pereira, right, holds her daughter Luiza as she waits for their appointment with a neurologist at the Mestre Vitalino Hospital in Caruaru, Pernambuco state, Brazil. In November, Brazilian researchers detected the Zika virus genome in amniotic fluid samples from two women whose fetuses were been diagnosed with microcephaly by ultrasound exams, the Pan American Health Organization reported. (AP Photo/Felipe Dana)
In this Dec. 22, 2015 photo, Luiza has her head measured by a neurologist at the Mestre Vitalino Hospital in Caruaru, Pernambuco state, Brazil. Luiza was born in October with a head that was just 11.4 inches (29 centimeters) in diameter, more than an inch (3 centimeters) below the range defined as healthy by doctors. Her rare condition, known as microcephaly, often results in mental retardation. (AP Photo/Felipe Dana)
In this Dec. 22, 2015 photo, Angelica Pereira holds her daughter Luiza as she waits for her husband at their house in Santa Cruz do Capibaribe, Pernambuco state, Brazil. In the early weeks of Angelica Pereiraâs pregnancy, a mosquito bite began bothering her. At first it seemed a small thing. But the next day she awoke with a rash all over her body, a headache, a fever and a burning in her eyes. The symptoms disappeared within four days, but she fears the virus has left lasting consequences. (AP Photo/Felipe Dana)
In this Dec. 22, 2015 photo, Dejailson Arruda holds his daughter Luiza at their house in Santa Cruz do Capibaribe, Pernambuco state, Brazil. Luiza was born in October with a head that was just 11.4 inches (29 centimeters) in diameter, more than an inch (3 centimeters) below the range defined as healthy by doctors. Her rare condition, known as microcephaly, often results in mental retardation. (AP Photo/Felipe Dana)
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Researchers have been suspicious of the virus since French Polynesia noted a jump in cases of Guillain-Barre and microcephaly, in which a child is born with a small head, that accompanied a wave of Zika cases, though the populations were far smaller than in the recent outbreaks

The World Health Organization said Salvadoran authorities reported 46 cases of Guillain-Barre in just five weeks, from Dec. 1 to Jan. 6. The full-year average for the country is 169 cases. It said that of 22 patients on which there was information, at least 12 patients had experienced a rash-fever illness in the 15 days before developing Guillain-Barre.

Brazilian officials too have said they're investigating a link between Guillain-Barre and Zika.

Dr. Antonio Bandeira, an infectologist with the Couto Maia Hospital in the northeastern city of Salvador, said that during last year's rainy season, when a Zika outbreak was at its peak, he had an unusual spate of patients with Guillain-Barre.

"Zika was really bad here from February to July and then all but disappeared in August. In May, June and July, we had 24 patients come in with Guillain-Barre, and none since August," he said, adding that in previous years he generally only saw two or three patients with the condition per year.

Nationwide, Guillain-Barre had been so rare that the Health Ministry doesn't track the exact number of cases. Still, officials here acknowledge the rise.

"For sure, throughout the northeast we've quite a significant spike in cases of Guillain-Barre," said Pedro Fernando Vasconcelos, director of the Instituto Evandro Chagas health research institute, in the Amazonian city of Belem. "And that rise is closely associated to the rise in cases of Zika virus."

Local transmission of the virus was first formally confirmed in the Americas only nine months ago in Brazil, where officials became alarmed by a sudden rise in cases of microcephaly.

Since the start of October, the country has recorded 3,893 cases of microcephaly, compared with 150 cases for all of 2014.

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Brazilian officials say they're convinced of a link. International health bodies have said that's not yet scientifically established, but they are on the alert.

The CDC said Friday it had acted "out of an abundance of caution" in issuing its call for pregnant women "to consider postponing travel to any area where Zika virus transmission was ongoing."

Experts said microcephaly may not have been seen in other Zika outbreaks because until now, they've occurred in much smaller populations. Brazil, a nation of about 205 million, estimates that 440,000 to 1.3 million people there have been infected, though the numbers are difficult to pin down because there are no commercial tests and most people show no symptoms.

"We're just seeing the sheer size, the magnitude brings those rare cases above the radar whereas in the past the outbreaks didn't involve nearly as many people," said Scott Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch in Galveston.

Guillain-Barre is very rare, too, and investigators will have the same question.

El Salvador's government this week suggested that women avoid getting pregnant for the next two years, and some say they're taking that advice.

"We were very lucky. My son was born before this," said 19-year-old Fatima Mejia, who was visiting a clinic in Santa Tecla, just outside the Salvadoran capital, for a checkup on her 17-day-old infant.

"I'm not going to get pregnant until this passes. I'm not going to risk a child," she said.

Another woman in for a checkup at the clinic, 22-year-old Sandra Barrios, also said she might avoid having more children.

"If this continues I'm going to speak with my husband about an operation on myself. I already have three children and I don't want problems."

In Colombia, Deputy Health Minister Fernando Ruiz told The Associated Press the country has recorded 13,531 suspected cases of Zika and said the number could rise to half a million this year.

He said at least 560 cases involve pregnant women, though there have been no detected cases of microcephaly. The Health Ministry recently urged all women in the country to avoid getting pregnant while the virus is spreading, saying that could extend until July.

Ruiz said there have been 12 cases of people with Guillain-Barre who had earlier had symptoms similar to those of Zika.

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