Biological Health Hazard – Zika Virus Outbreak: Americas

Biological Health Hazard – Autochthonous Virus Transmission

ZIKA VIRUS – AMERICAS (03)
**************************
Published Date: 2015-12-05 22:42:46
Subject: PRO/EDR> Zika virus – Americas (03)
Archive Number: 20151205.3842908

[1] Cases in various countries
Brazil:
– National, Microcephaly
– Sergipe state, microcephaly
– Recife, Pernambuco state
– Neuropathology comment
– Virus in blood semen, milk in Brazil
Venezuela (Maracaibo, Zulia state)
Panama (Ustupu Island, Guna Yala comarca)
[2] World overview
[3] Neurological effects
————————————————————————-

[1] Cases in various countries

Brazil:
– National, Microcephaly. 30 Nov 2015. (susp.) 1248 microcephaly cases in 311 municipalities of 14 states according to the Official report from the Secretariat of Health Surveillance, Ministry of Health.
http://portalsaude.saude.gov.br/index.pp/o-ministerio/principal/secretarias/svs/noticias-svs/21020-ministerio-da-saude-divulga-novos-dados-de-microcefalia [in Portuguese]

[A HealthMap/ProMED-mail map of Brazil can be accessed at http://healthmap.org/promed/p/6. – Mod.TY]

As of 4 Dec 2015, the Brazil Ministry of Health has changed the criterion of microcephaly from 33 cm head circumference to 32 cm. This is expected to reduce the microcephaly case numbers considerably. (http://g1.globo.com/bemestar/noticia/2015/12/saude-muda-criterios-e-considera-menos-bebes-com-microcefalia.html in Portuguese) – Mod.TY]

– Sergipe state, microcephaly. 1 Dec 2015. (reported) 78 cases in 32 municipalities; Deaths 1 neonatal baby with microcephaly, 1st fatal case in the state; Health emergency declared.
http://g1.globo.com/se/sergipe/noticia/2015/12/governo-de-sergipe-decreta-emergencia-devido-microcefalia.html [in Portuguese]

– Recife, Pernambuco state. 29 Nov 2015. Health emergency declared due to numbers of cases of microcephaly and Zika virus infections.
http://noticias.uol.com.br/saude/ultimas-noticias/redacao/2015/11/29/pernambuco-e-recife-decretam-estado-de-emergencia-devido-ao-zika-virus.htm [in Portuguese]

– Neuropathology comment concerning Guillain-Barre syndrome from Dr. Marcelo Adriano da Cunha e Silva Vieira, neurologist, Institute of Tropical Diseases Natan Portella <macsvieira@superig.com.br> [in Portuguese, trans. – Mod.TY]. Sun 29 Nov 2015.

Viral detection in serum and / or cerebrospinal fluid confirms viremia and “penetration” of the central nervous system by the virus at the time of collection, but the principle is restricted to mere temporal relationship in cross-sectional study (or even number of cases); so what it indicates is that there is no cohort study or even case-control to check effective association between viral infection and the outbreak of the syndrome.

There was no evidence of the presence of viral particles, specific antibodies or cytokines with pathogenic effect on peripheral nerves (especially on the myelin sheath) – indicators arguing for causality.

Nothing ever prevents a patient in prodrome of the Guillain-Barre syndrome or even in the presence of the same, to suffer a ZIKAV infection, especially considering the high attack rate and the rate at which clinically evident infection (though not laboratory confirmed) affected the Pernambuco population (without even considering asymptomatic infections) this year [2015];

Guillain-Barre syndrome in its classical form is a post-infectious disease characterized by autoimmune damage (mediated by autoantibodies) to the myelin sheath of the roots and peripheral nerves, commencing within 6 weeks after the triggering event; therefore, the start of neurological symptoms hardly is seen in the patient in the viremia phase (it still is unknown how long the virus can remain viable in CSF), because the neurological tissue damage occurs precisely at the peak of antibody production; most previous infections demonstrated as triggers of Guillain-Barre symptoms published in the literature come from case-control studies that used serological markers (in serum) of recent infection rather than detection of viral infection or bacterial activity.

Guillain-Barre syndrome is a disease of the peripheral nervous system (segmental demyelination of peripheral nerves and roots), and not the central nervous system, in which despite the fact that the nerve roots being “bathed” by cerebrospinal fluid (hence the acute inflammatory demyelinating polyradiculoneuropathy terminology), virus detection in cerebrospinal fluid is not full proof of virus participation in the genesis of the disease, although is a very strong indicator of neuroinvasiveness.

The FIOCRUZ report corrected some information, given at https://www.facebook.com/fiocruz.pernambuco?fref=ts

As an adjustment, you see the Institute exercising caution in endorsing categorical statements [attributing microcephaly to Zika virus infection] and the correction that there was no virus isolation, but rather detection of genetic material by molecular biology [RT-PCR].
—
Above Brazil reports above communicated by
ProMED-PORT
<promed-port@promedmail.org>

– Virus in blood, semen, milk in Brazil. 3 Dec 2015. FIOCRUZ detected presence of Zika virus in blood, semen and breast milk as announced by The Vice Director of Clinical Services of the National Institute of Infectious Diseases, Jose Serbino Neto.
http://www1.folha.uol.com.br/cotidiano/2015/12/1714312-fiocruz-estuda-se-virus-zika-e-passado-por-sangue-e-semen.shtml [in Portuguese]

[This report does not indicate if Zika virus presence in blood semen and breast milk was determined by PCR detection of non-infectious RNA fragments or by isolation of infectious virus that would be capable of transmission. Finding virus in blood is not surprising, since viremia is essential for acquisition by the vector mosquito. Interestingly, there was a case in the USA ex Senegal, with circumstantial evidence suggesting direct person-to-person, possibly sexual, transmission of the virus (see ProMED-mail archive no. 20150516.3367156). – Mod.TY]

Venezuela (Maracaibo, Zulia state). 29 Nov 2015. (susp.) 17 cases in the Maracaibo University Hospital.
http://www.laverdad.com/zulia/87663-registran-17-presuntos-casos-de-zika-en-el-hum.html [in Spanish]

[A 3 Dec 2015 WHO report indicated that 4 of these cases have been confirmed in the Venezuela reference laboratory (http://www.who.int/csr/don/03-december-2015-zika-venezuela/en/).

[A HealthMap/ProMED-mail map of Venezuela can be accessed at http://healthmap.org/promed/p/29. – Mod.TY]

Panama (Ustupu Island, Guna Yala comarca [administrative division with a substantial indigenous population]). 3 Dec 2015. (conf.) 3 cases
http://laestrella.com.pa/panama/nacional/minsa-detecta-tres-casos-virus-zika-panama/23907572

[A HealthMap/ProMED-mail map of Panama can be accessed at http://healthmap.org/promed/p/4563 and a map showing the location of Ustupu Island at http://mapcarta.com/19746206. – Mod.TY]
————————————————————————-
[2] World overview
Date: Fri 4 Dec 2015
Source: European Centre for Disease Prevention and Control Epidemiological Update [edited]
http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1336&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2FPages%2Fhome%2Easpx

Epidemiological summary

Americas

Brazil
In May 2015, the public health authorities of Brazil confirmed autochthonous transmission of Zika virus (ZIKV) infection in the northeastern part of the country. As of 8 Oct 2015, autochthonous virus transmission had been confirmed in 14 states [now up to 18 states. – Mod.TY]: Alagoas, Bahia, Ceara, Maranhao, Mato Grosso, Para, Paraiba, Parana, Pernambuco, Piaua, Rio de Janeiro, Rio Grande do Norte, Roraima and Sao Paulo. In addition, between January and July 2015, 121 cases with neurological symptoms or with Guillain-Barre were reported by states in the northeastern part of Brazil.

In October 2015, the Ministry of Health of Brazil reported an unusual increase in cases of microcephaly in the state of Pernambuco and at a lower level in other north-eastern states. On 17 Nov 2015, the Ministry of Health of Brazil confirmed in an international health regulation (IHR) message the molecular identification of ZIKV in amniotic fluid samples collected from 2 pregnant women in Paraiba state whose foetuses had been confirmed with microcephaly by ultrasound examinations.

On 17 Nov 2015, the Pan American Health Organization (PAHO) issued an epidemiological alert regarding an increase in microcephaly in the north-east of Brazil. In response to the situation, Brazil’s Ministry of Health had declared a national public health emergency on 11 Nov 2015. As of 28 Nov 2015, 1248 suspected cases of microcephaly have been identified in 311 municipalities across 14 states of Brazil. Pernambuco state has reported the highest number of cases (646) followed by the states of Paraiba (248), Rio Grande do Norte (79), Sergipe (77), Alagoas (59), Bahia (37), Piaui (36), Ceara (25), Rio de Janeiro (13), Maranhao (12), Tocantins (12), Goias (2), Distrito Federal (1) and Mato Grosso do Sul (1). Among these cases, 7 deaths were reported, and 5 additional deaths in Rio Grande do Norte and Piaui are currently being investigated.

As of 1 Dec 2015, according to media quoting the Ministry of Health, 28 cases of Guillain-Barre syndrome (GBS) had been reported in Sergipe state. Last week, according to media, 7 cases of Guillain-Barre syndrome (GBS) were linked to ZIKV infections in Pernambuco state.

On 25 Nov 2015, according to media quoting the Flavivirus Laboratory at the Oswaldo Cruz Institute, 7 cases of Guillain-Barre syndrome (GBS) had been linked to ZIKV infections in Pernambuco state. The number of cases of GBS grew significantly in the north-east of the country between April and June 2015, shortly after the ZIKV epidemic started. In Rio Grande do Norte, there have been 24 cases of GBS, 4 times more than the historical average. In Pernambuco state, 130 cases have been reported, which is a significant increase on the most recent reports. There have also been increases in the states of Maranhao (14 cases) and Paraiba (6 cases). Investigations are ongoing regarding a possible association with ZIKV infection.

Chile (Easter Island)
According to WHO-PAHO, autochthonous circulation of ZIKV was reported in Easter Island from February to June 2014. Chile did not report any cases of ZIKV in 2015.

Colombia
On 16 Oct 2015, the 1st cases of ZIKV infections were reported in Colombia, with 9 confirmed cases in the Bolivar department. From 16 Oct – 21 Nov [2015], Colombian authorities reported 578 confirmed cases and 2635 suspected cases.

El Salvador
On 24 Nov 2015, the El Salvador IHR National Focal Point (NFP) gave notification of 3 confirmed autochthonous cases of ZIKV infection. On 3 Dec [2015], media reported 240 ZIKV cases across the country.

Guatemala
On 1 Dec 2015, media, quoting authorities, reported 17 suspected cases of ZIKV infection, 14 of which were among hospital employees. Blood samples have been collected and sent to the US for analysis.

Mexico
On 26 Nov 2015, authorities acknowledged 3 ZIKV cases, including 2 autochthonous cases reported from Nuevo Leon and Chiapas. The imported cases had recently travelled to Colombia.

Panama
On 3 Dec 2015, the Ministry of Health of Panama reported 3 autochthonous cases of Zika virus infection. All 3 cases are residents of the district of Ailigandi, Guna Yala (north-east).

Paraguay
On 27 Nov 2015, the Paraguay IHR National Focal Point (NFP) reported the confirmation of 6 ZIKV cases in the city of Pedro Caballero, close to the border with Brazil.

Suriname
On 12 Nov 2015, the authorities reported 5 cases of ZIKV through IHR.

Venezuela
On 27 Nov 2015, the Venezuela IHR National Focal Point (NFP) gave notification of 7 ZIKV autochthonous suspected cases.

Pacific region

French Polynesia
On 24 Nov 2015, the health authorities of French Polynesia reported an unusual increase of at least 17 cases of central nervous system malformations in foetuses and infants during 2014-2015. The cases are reported from pregnancies that occurred during the ZIKV infection outbreak in French Polynesia (September 2013 – March 2014) at a gestational age of less than 6 months. None of the pregnant women described clinical signs of ZIKV infection, but the 4 tested were found positive by IgG serology assays for flavivirus, suggesting a possible asymptomatic ZIKV infection. Further serological investigations are ongoing. Based on the temporal correlation of these cases with the ZIKV epidemic, the health authorities of French Polynesia hypothesise that ZIKV infection may be associated with these abnormalities if mothers are infected during the 1st or 2nd trimester of pregnancy.

Other countries
Since the beginning of [2015], sporadic autochthonous cases have been reported in Samoa, Fiji, New Caledonia, the Solomon Islands, Vanuatu and New Zealand (2 imported cases from Samoa).

Asia

Indonesia
On 15 Nov 2015, media reported the 1st ZIKV case in the country. There was no information available about the travel history of this case.

Africa

Cape Verde
On 3 Nov 2015, the Cape Verde Ministry of Health reported that 17 out of 64 blood samples sent for confirmation at the Pasteur Institute in Dakar were positive for ZIKV and there were approximately 1000 suspected cases showing symptoms consistent with ZIKV infection as of 1 Nov 2015.
—
Communicated by:
ProMED-mail
promed@promedmail.org

[The above report provides a good overview of the spread of ZIKV as of the dates indicated. There is a map in the report of countries with locally acquired ZIKV infections and a graph showing the occurrence of microcephaly by state in Brazil. – Mod.TY]

————————————————————————-
[3] Neurological effects
Date: Tue 1 Dec 2015
Source: OPAS/PAHO Epidemiological Alert [summ. & edited]
http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32405&lang=en

Neurological syndrome, congenital malformations, and Zika virus infection. Implications for public health in the Americas
———–

Given the increase of congenital anomalies, Guillain-Barre syndrome, and other neurological and autoimmune syndromes in areas where Zika virus is circulating and their possible relation to the virus, the Pan American Health Organization / World Health Organization (PAHO/WHO) recommends its Member States establish and maintain the capacity to detect and confirm Zika virus cases, prepare healthcare facilities for the possible increase in demand at all healthcare levels and specialized care for neurological syndromes, and to strengthen antenatal care. In addition, Member States should continue efforts to reduce the presence of mosquito vectors through an effective vector control strategy and public communication.

Transplacental transmission
———-
On 28 Nov 2015, the Brazil Ministry of Health established the relationship between the increase in occurrence of microcephaly and Zika virus infection through the detection of Zika virus genome in the blood and tissue samples of a baby from the state of Para. The newborn presented microcephaly and other congenital anomalies and died within 5 minutes of being born. The confirmation of the presence of the viral genome was provided by the Evandro Chagas Institute, national reference laboratory for arboviruses in Belem, Para. According to the preliminary analysis of the investigation conducted by the Brazil health authorities, the greatest risk of microcephaly or congenital anomalies in newborns is associated with Zika virus infection in the first trimester of pregnancy.

Zika virus-related deaths
———-
As of 28 Nov 2015, the Brazil Ministry of Health has notified 3 deaths associated with Zika virus infection. The fatal cases are 2 adults and 1 newborn. The 1st fatal case is a male adult with no neurological disorders, with history of lupus erythematosus, chronic use of corticosteroid drugs, rheumatoid arthritis, and alcoholism. He was admitted as a suspected dengue case, however dengue was discarded and the final laboratory diagnosis by RTp-PCR technique was Zika virus infection. Zika virus genome was detected by RT- PCR in the blood and organ samples (brain, liver, spleen, kidney, lung, and heart). Additionally, Zika virus was identified through partial sequencing of the virus.

The 2nd fatal case is a 16-year-old female from the Benevides municipality in the state of Para. She had no neurological disorder, and was admitted to the hospital as a suspected dengue case. The onset of her symptoms (headache, nausea, and petechiae) was on 29 Sep 2015 and she died in late October 2015. Zika virus infection was confirmed by RTp-PCR. The 3rd fatal case is the newborn described above.
—
Comunicated by:
ProMED-PORT
<promed-port@promedmail.org>

[The Zika virus panorama is changing almost daily, both in terms of its geographical distribution in the Americas as well as it pathogenesis. It is not surprising that the geographic range of the virus is increasing, given the movement of infected, viremic individuals and the presence of abundant mosquito vectors. If the observed cases of microcephaly and Guillain-Barre syndrome are shown conclusively to be caused by Zika virus infections, it can no longer be considered just a benign febrile infection. – Mod.TY]

See Also

Zika virus – Americas (02) 20151127.3824009
Zika virus – Colombia (08) 20151121.3808431
Zika virus – Brazil (08) 20150716.3513770
Zika virus – Brazil (07) 20150630.3473420
Zika virus – Brazil (06): (BA) 20150619.3449500
Zika virus – Brazil (05) 20150612.3431148
Zika virus – Americas: PAHO alert, country alerts, Brazil update 20150609.3422423
Zika virus – Brazil (04): (RJ) 20150608.3420363
Zika virus – Americas: PAHO alert, country alerts, Brazil update 20150609.3422423
Zika virus – Brazil (03): (RR) 20150604.3408349
Zika virus – Brazil (02): (SP) 20150524.3382529
Zika virus – Brazil: confirmed 20150519.3370768
Zika virus: possible sexual transmission 20150516.3367156
Undiagnosed illness – Brazil (02): Zika virus conf 20150515.3364149
Undiagnosed illness – Brazil: (Northeast, RJ) Zika virus susp, RFI 20150501.3334749
2014
—-
Zika virus – Pacific (06): French Polynesia, New Caledonia 20140303.2309965
………………………………………….sb/lm/jw/mpp/ty/pg/mpp

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

—————–
Related

Panama reports first Zika virus cases