Date: Tue 9 Jun 2015
Source: Outbreak News Today [edited]
Less than 2 months after issuing a travel notice for Brazil because of the dengue fever outbreak, the Centers for Disease Control and Prevention (CDC) today [9 Jun 2015] issued another one because of a different mosquito borne virus, Zika virus.
This follows a report last month [May 2015] of 16 confirmed, locally transmitted cases of Zika [virus infection]. Cases have been reported in the states of Bahia and Rio Grande do Norte.
Zika is an illness caused by a virus that is spread to humans through mosquito bites, specifically the _Aedes mosquito_, the same one that transmits dengue fever, chikungunya, and yellow fever [viruses], all found in Brazil.
Symptoms of Zika may include fever, headache, red eyes, rash, muscle aches, and joint pains. The illness is usually mild, lasting 4-7 days.
There is currently no vaccine or medicine to prevent Zika. Travelers can protect themselves by preventing mosquito bites.
[Byline: Robert Herriman]
–
Communicated by:
ProMED-mail from HealthMap Alerts
[Zika virus continues to spread in Brazil. In addition to the cases in Bahia and Rio Grande do Norte states mentioned in the report above, 3 cases have been identified retrospectively in Alagoas state, with onset at the beginning of 2015 in Mata Grande, which is on the border with Bahia state. There is also one confirmed case in Dom Eliseu, in the northwestern part of Para state and one confirmed locally acquired case in Rio de Janeiro state.
Some South and Central American countries have heeded PAHO advice and officially are on alert for cases of Zika virus infections. However, no mention is made of whether they have the laboratory capability to diagnose Zika virus infections, which is essential to differentiate them from cases of dengue and chikungunya virus infections, which are clinically and epidemiologically similar to each other.
Maps of Brazil showing the location of the states mentioned can be accessed at <http://www.lib.utexas.edu/maps/americas/brazil.jpg> and <http://healthmap.org/promed/p/6>. – Mod.TY]
[On 11 Jun 2015, Brazil news media reported 34 confirmed cases of Zika virus infection up to 10 Jun 2015 in 8 states: Bahia, Rio Grande do Norte, Sao Paulo, Alagoas, Para, Roraima, Rio de Janeiro and Maranhao,
see:
<http://www.promedmail.org/direct.php?id=3431199> (in Portuguese). – Mod.JW]
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Italian tourist returns to Italy with Zika virus
[2] Italy ex Brazil
Date: Thu 11 Jun 2015
Source: Eurosurveillance 20 (23) [summarized, edited] <http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21153>
Zammarchi L, Tappe D, Fortuna C, Remoli ME, Gunther S, Venturi G, Bartoloni A, Schmidt-Chanasit J. Zika virus infection in a traveller returning to Europe from Brazil, March 2015.
Abstract:
We report a case of laboratory-confirmed Zika virus infection imported into Europe from the Americas. The patient developed fever, rash, and oedema of hands and feet after returning to Italy from Brazil in late March 2015.
The case highlights that, together with chikungunya virus and dengue virus, 3 major arboviruses are now co-circulating in Brazil. These arboviruses represent a burden for the healthcare systems in Brazil and other countries where competent mosquito vectors are present.
The case: A male Italian traveller in his early 60s presented to the Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence (Italy) 4 days after his return from a 12-day holiday in Salvador de Bahia, Brazil at the end of March 2015.
Results of the serological tests for the other viruses tested were negative. A follow up sample, taken 26 days after symptoms onset, showed a 3-fold increase of the anti-ZIKV-IgM and -IgG antibody titres. In addition, a low-titre DENV IgG was now observed, most likely representing a serological cross-reaction of the anti-ZIKV-IgG antibodies. ZIKV-specific real-time reverse transcription-PCR was negative from both samples. Generic flavivirus and alphavirus RT-PCR were also negative. The presence of ZIKV-specific neutralising antibodies in the 2nd serum sample was confirmed by a virus neutralisation assay. The patient was discharged, managed, and followed up in the outpatient department. The patient was recommended symptomatic treatment with paracetamol. The symptoms rapidly resolved in the following week (fever and rash lasted for only 4 days).
—
Communicated by:
ProMED-mail
[This is an example of long-distance travel of a viremic individual to a country where a given virus, Zika virus in this instance, is not present. A similar situation occurred when chikungunya virus was introduced into Italy from India in 2007 and transmitted by _Aedes albopictus_.
A map of Italy, showing the location of Venice in the northwest, can be accessed at <http://www.mapsofworld.com/italy/>. – Mod.TY
A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/6>.]
There is an additional mosquito borne virus in the news. It is the Zika virus.
Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease (Zika) are fever, rash, joint pain, and red eye. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.
Outbreaks of Zika have occurred in Africa, Southeast Asia, and the Pacific Islands. Because the Aedes species mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will spread to new countries. Zika virus is not currently found in the United States. However, cases of Zika have been reported in returning travelers.
There is no vaccine to prevent or medicine to treat Zika. Travelers can protect themselves from this disease by taking steps to prevent mosquito bites. When traveling to countries where Zika virus (see map) or other viruses spread by mosquitoes have been reported, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens. CDC.
Origins
Zika was first identified in 1947 when a rhesus monkey living in the Zika forest in Uganda developed an unknown febrile illness. One year later the virus was found in the Aedes Africanus mosquito and then in Aedes Aegypti, both captured in the Zika forest.
The first outbreak outside of Africa occurred in 2007 when cases were confirmed in Yap Island in the southwestern Pacific Ocean.
In 2009, it was discovered that Zika virus can be sexually transmitted between humans. Professor Brian Foy, a university biologist from Colorado State University, visited Senegal to study mosquitoes and was bitten on a number of occasions during his research. A few days after returning to the United States, he fell ill with Zika, and his wife subsequently showed symptoms, along with extreme sensitivity to light.
Foy and research assistant Kevin Kobylinsky released a study in the May 2011 journal of Emerging Infectious Diseases that detailed those events and provided evidence that Foy’s might have been the first case of the sexual transmission of an insect-borne disease.
The findings were validated by the U.S. National Institutes of Health, which considers Foy the first person known to have passed on an insect-borne virus to another human by sexual contact.
Date: Wed 3 Jun 2015
Source: El Nuevo Diario [in Spanish, trans. Mod.JW, edited] <http://www.elnuevodiario.com.do/app/article.aspx?id=428858
The 1st case of Zika virus registered in Puerto Plata province
————————————————————–
In this city of Puerto Plata [Puerto Plata province, Dominican Republic] the 1st case of Zika virus has been recorded, which, like dengue and chikungunya, is transmitted by the bite of the _Aedes aegypti_ mosquito. The patient is a 12 year old girl, [daughter of] a young lawyer resident in one of the southern sectors of Puerto Plata, hospitalized in a private clinic in Puerto Plata, where a medical team told her family that Zika virus is transmitted by the same mosquito as dengue and chikungunya, and the symptoms are similar to those of the above-mentioned epidemics but milder.
According to epidemiologists, the symptoms of Zika virus are fever, non-purulent conjunctivitis (without pus), headache, joint pain, rash, weakness, and sometimes, pain behind the eyes, swelling of the legs, loss of appetite, vomiting, diarrhea or abdominal pain, which lasts 4-7 days, and so far there are no reports of any deaths. If confirmed, this would be the 1st Zika case outside of Brazil in the Americas, indicating spread. – Mod.TY
[byline: Antonio Heredia]-
communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
<roland.hubner@sante.belgique.be>
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ZIKA VIRUS – BRAZIL (02): (SAO PAULO)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases <http://www.isid.org>
Date: Wed 20 May 2015
Source: Centro de Vigilancia Epidemiologica, Secretaria de Sao Paulo [in Portuguese, trans. Mod.TY, edited] <http://www.cve.saude.sp.gov.br/htm/zoo/pdf/ZIKA15_SP_INFORMACAO.pdf>
Information on the 1st case of Zika fever virus in Sao Paulo state
——————————————————————
On 19 May [2015] the Instituto Adolfo Lutz announced the results of an RT-PCR test positive for Zika [virus]. The patient is a 52 year old male resident of Sumare [Sao Paulo state] without a travel history [outside of the area] during the 15 days before the onset of symptoms on 10 Mar 2015.
To date, the Ministry of Health has confirmed, based on laboratory criteria, 16 cases of Zika [virus infection] in the country — 8 cases in Bahia and 8 in Rio Grande do Norte.
Zika fever is a disease caused by Zika virus (ZIKAV), an arbovirus of the Flavivirus genus (Flaviviridae family); phylogenetically related to the viruses: dengue (DENV), yellow fever (YFV), St Louis encephalitis (SLEV), and West Nile virus (WNV). This virus [Zika] was isolated in 1947 in the Zika Forest in Uganda (hence the reason for naming the virus).
The principal means of transmission is via vectors, through bite of mosquitoes of the genus _Aedes_. In urban areas the main vector is _Ae. aegypti.
Currently, Sao Paulo state has DENV circulating and imported cases of chikungunya, both [viruses] transmitted by _Aedes aegypti_. Therefore, it is important that health services remain aware and attentive to cases of suspected dengue, carrying out recommended clinical management. Until there is decentralization of laboratory diagnosis at the state level, the Epidemiological Surveillance Center will carry out monitoring suspected cases of Zika based on the existing system of surveillance for dengue and chikungunya.
communicated by:
ProMED-PORT
<http://www.promedmail.org/pt>
[The case reported here is the 1st locally acquired one to be confirmed in Sao Paulo state. Surprised? Anyway, in this context in that the introduction of the virus [Zika] now is confirmed (see below), and given the high rates of vector infestation in Brazil as well as the high degree of mobility of people, it was just a matter of time — [only] a little time. But very, very probably this is not the only, much less the 1st, case [of Zika virus infection].
In a dengue epidemic of current proportions, where 10s of thousands of cases have been reported (as dengue) and confirmed by clinical and epidemiological criteria (such as dengue), it is impossible to estimate how many cases of Zika virus [infections] there are and where they would be taking place [in the absence of laboratory confirmation.
– Mod.TY]. Given current knowledge, Zika virus infections [like dengue and chikungunya virus infections] present as an acute febrile syndrome with rash, in general, self-limited and possibly with rare complications. It is difficult to clinically differentiate suspected cases of Zika [virus infections] among the thousands of suspected dengue cases. It is the same with chikungunya, which has not occurred in most states of Brazil (or perhaps the cases that may exist have not been identified …) during the current epidemic of dengue, even when exhibiting clinical elements that allow suspicion of the less complicated [chikungunya virus infection] (with the presence of articular manifestations in a significant proportion of cases) that can perfectly well have already landed in states that are not [currently] on the list of states with locally acquired cases.
The recent identification of Zika virus [in Brazil] makes the current epidemiological scenario of arbovirus diseases become even more complex, and brings numerous questions and challenges about which is the best model, the best surveillance strategy [to use]. As for control there are no innovations, even with the ever closer prospect of one or more vaccines against dengue, so a more efficient control of _Aedes_ is mandatory — is the “backbone”, not only for control of dengue, but for chikungunya and now for the “debutante” Zika [viruses]. – Mod.RNA]
[The arrival of Zika virus in Brazil, in areas of active transmission of dengue and chikungunya, complicates surveillance and the need for adequate laboratory support to make differential diagnoses, as Mod.RNA notes. I suppose that one might argue that the cost of decentralization of diagnostic laboratory capability to the state or municipal level is not justified, since treatment of patients is supportive and essentially the same. This argument changes as soon as an effective dengue virus vaccine becomes available and is applied broadly in the population. Epidemiologists will contend that it is essential to know which viruses are being transmitted in the field.
Maps of Brazil showing the location of the states mentioned can be accessed at <http://www.lib.utexas.edu/maps/americas/brazil.jpg> and <http://healthmap.org/promed/p/33007>. – Mod.TY]
Zika virus: following the path of dengue and chikungunya?
On May 7, 2015, the Pan American
Health Organization issued an alert
about potential Zika virus (ZIKV)
transmission in northeast Brazil.1
This has now been confirmed with wide
spread of the disease, underscoring
the potential for ZIKV to spread
globally, similar to dengue (DENV)
and chikungunya (CHIKV) viruses.
ZIKV is an emerging arthropod borne
virus (arbovirus) that was first
isolated from a Rhesus monkey in
Uganda, in 1947. This arbovirus is
related to DENV and they have similar
epidemiology and transmission cycle
in urban environments. Until recently,
only sporadic human ZIKV infections
were reported.
In 2007, ZIKV emerged outside of Asia
and Africa for the first time and
caused an epidemic on
Yap Island in the Federated States of
Micronesia,2 which was followed by
a large epidemic in French Polynesia
in 2013–14.3 Subsequently, ZIKV
spread to several countries in Oceania
The clinical presentation of ZIKV
infection is not specific (mild fever,
rash, arthralgia, and conjunctivitis)
and can be confused with other
diseases, especially dengue and chikungunya.
Prior to the French Polynesian epidemic,
during which severe neurological complications
(Guillain-Barre syndrome) were
confirmed, ZIKV was believed to cause
only mild diseases.
The history of ZIKV resembles
that of CHIKV, an alphavirus.5 First
described in Africa in 1952, CHIKV
emerged in Asia and caused major
epidemics in India and southeast Asia
between the 1950s and 1980s, before
it disappeared epidemiologically.
In 2004, CHIKV re-emerged in east
Africa and spread to Asia again
before spreading worldwide. CHIKV,
similar to DENV, now circulates in all
inhabited continents, evolving to a
global public health problem in the
past decade.
The adaptation of ZIKV to an
urban or peri-urban cycle, involving
Aedes aegypti and other mosquitoes
of the Stegomyia subgenus as vectors
and humans as amplification hosts,
should be of great concern to public
health officials. With more than half
of the world’s human population
living in areas infested with these
mosquitoes, the potential for major
urban epidemics of ZIKV, DENV, CHIKV,
yellow fever, epidemic polyarthritis,
and other as yet unknown mosquitoborne
viruses that might emerge,
is overwhelming, and underscores
the desperate need to develop more
effective mosquito control as well as
vaccines and drugs.
The future of ZIKV is unpredictable,
but the worldwide spread of DENV
and CHIKV—closely tied to the trends
of urbanisation and globalisation,
suggests that ZIKV has the potential to
follow in their path.
We declare no competing interests.
*Didier Musso, Van Mai Cao-Lormeau,
Duane J Gubler
dmusso@ilm.pf Unit of Emerging Infectious Diseases, Institute
Louis Malardé, Tahiti, French Polynesia (DM,
VMC-L); Program in Emerging Infectious Diseases,
Duke-NUS Graduate Medical School, Singapore
(DJG); and Partnership for Dengue Control, Lyon,
France (DJG)