ZIKA VIRUS (04): AMERICAS, ASIA, EUROPE, RESEARCH, OBSERVATIONS

Posted on 20TH MAR 2017
tagged Zika Virus, Americas; Asia; Europe

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] PAHO/WHO update
[2] Cases in various countries:
Americas
Americas cumulative case numbers

Caribbean
---
Guadeloupe

South America
---
Argentina (Santa Fe province)
Venezuela

Asia
---
India (Ahmedabad, Gujarat state)

Imported cases with no possibility of ongoing mosquito transmission
---
United Kingdom
USA
- Case numbers mainland
- Utah
- Territories and Commonwealth

[3] Persistence in brain and placenta
[4] Cardiovascular complications
[5] Persistence in donated whole blood
[6] Virus in banked sperm
[7] _Culex quinquefasciatus_ and _Aedes taeniorhynchus_ refractory
[8] Virus diversity, Americas

******
[1] PAHO/WHO update
Date: Fri 10 Mar 2017
Source: PAHO/WHO Zika - Epidemiological Update [edited]
http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=...

Situation summary in the Americas
---------------------------------
Since epidemiological week (EW) 44 of 2016 [29 Oct-4 Nov 2016], no additional countries or territories of the Americas have confirmed autochthonous, vector-borne transmission of Zika virus. To date, 48 countries and territories in the Americas have confirmed autochthonous, vector-borne transmission of Zika virus since 2015 (Figure 1). In addition, 5 countries in the Americas have reported sexually transmitted Zika cases.

Figure 1 [map]. Countries and territories in the Americas with confirmed autochthonous (vector-borne) Zika virus cases, 2015 - 2017.
[Footnote to map:
(1) Anguilla; Antigua and Barbuda; Argentina; Aruba; the Bahamas; Barbados; Belize; Bolivia (Plurinational State of); Bonaire, Sint Eustatius, and Saba; Brazil; the British Virgin Islands; Cayman Islands; Colombia; Costa Rica; Cuba; Curaçao; Dominica; the Dominican Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico; Montserrat; Nicaragua; Panama; Paraguay; Peru; Puerto Rico; Saint Barthélemy; Saint Kitts and Nevis; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Sint Maarten; Suriname; Trinidad and Tobago; Turks and Caicos Islands; the United States of America; the United States Virgin Islands; and Venezuela (Bolivarian Republic of).
(2) Argentina, Canada, Chile, Peru, and the United States of America.

North America
In the United States of America, the Florida Department of Health reported isolated local transmission cases.

In Mexico, new cases continue to be reported, although they have been decreasing since EW 40 of 2016 [week ending 7 Oct 2016].

Central America
The number of reported cases in Central America continues to decrease, with a weekly average of 335 cases, 275 suspected, and 60 confirmed, in the last 4 weeks (EW 6 to EW 9 of 2017) [4 Feb-3 Mar 2017].

In Costa Rica a slight increase of suspected and confirmed cases was reported in EW 5 of 2017 [week ending 3 Feb 2017].

In Panama there was increasing trend of suspected and confirmed cases between EW 30 of 2016 and EW 1 of 2017 [23 Jul 2016-6 Jan 2017]. Although there was a decrease in EW 2 of 2017 [week ending 13 Jan 2017], suspected and confirmed cases continue to be reported at a weekly average of 229 suspected and confirmed cases in the last 4 weeks.

Caribbean
In Aruba an increasing trend in suspected and confirmed cases was reported between EW 29 of 2016 and EW 4 of 2017 [16 Jul 2016-27 Jan 2017]. In the last 4 weeks, there was a weekly average of 53 suspected and confirmed cases.

In Curaçao, there is an increasing trend in the number of suspected and confirmed cases between EW 31 and EW 47 of 2016 [30 Jul-25 Nov 2017].

In Guadeloupe and Martinique a low circulation of the virus continues to be reported with a few sporadic confirmed cases in the last five weeks (EW 1 of EW 5 of 2017) [1 Jan-3 Feb 2017].

While other countries and territories in the Caribbean continue to report cases, there is a decreasing trend in the sub-region with a weekly average of 340 cases in the last 4 weeks.

South America
In Argentina in EW 8 of 2017 [week ending 24 Feb 2017], 2 autochthonous cases were confirmed for the 1st time in the province of Salta (one case) and in the province of Chaco (one case), the latter case had a history of having stayed in the province of Formosa during the probable period of infection. In 2016, autochthonous cases had been confirmed in the provinces of Córdoba and Tucumán.

In Paraguay, the trend of suspected cases increased between EW 42 of 2016 and EW 5 of 2017 [14 Oct 2016-3 Feb 2017].

In Peru, there was an increase in the number of cases reported between EW 1 and EW 3 of 2017 [1 Jan-20 Jan 2017]; the increase is related to an outbreak occurring in the department of Loreto. In 2017 cases were reported in new districts of the departments of Loreto, San Martín, and Ucayali.

In other countries of South America, the number of cases reported remains stable with a weekly average of 396 cases (353 suspected and 43 confirmed) in the last 4 weeks.

Trend in the Caribbean, Central America, and South America
Figure 2 shows the trend of suspected and confirmed cases in the Caribbean, Central America, and South America. Incidence rate peaked in EW 7 of 2016 [week ending 19 Feb 2016] for all 3 sub-regions; from that point onwards in Central America and South America a downward trend occurs. In contrast, in the Caribbean, a growing trend occurred with a peak observed in EW 23 of 2016 [week ending 10 Jun 2016]. Since EW 40 of 2016 [week ending 7 Oct 2016], the trend has remained stable in all 3 sub-regions.

Figure 2 [graph]. Distribution of incidence rate by EW and sub-region. Americas 2015-2017 (up to EW 7) [week ending 17 Feb 2017]
Source: Data provided by countries and territories and reproduced by PAHO/WHO

Congenital syndrome associated with Zika virus infection
To date, 24 countries and territories in the Americas have reported confirmed cases of congenital syndrome associated with Zika virus infection. In EW 5 of 2017 [week ending 3 Feb 2017], Saint Martin reported a confirmed case of congenital syndrome associated with Zika virus infection for the 1st time.

In the last 4 weeks, Argentina, Brazil, Colombia, the Dominican Republic, French Guyana, Guadeloupe, Guatemala, Martinique, Puerto Rico, Trinidad and Tobago, and the United States of America, updated their number of cases of congenital syndrome associated with Zika virus infection.

As of 1 Sep 2016, the table with the number of confirmed cases of congenital syndrome is published on a weekly basis on the PAHO/WHO website and is available at http://www.paho.org/hq/index.php?option=com_content&view=article&id=1239....

Guillain-Barré syndrome (GBS) and other neurological disorders
In EW 7 of 2017 [week ending 17 Feb 2017], Curaçao and Trinidad and Tobago reported cases of Guillain-Barré syndrome (GBS) associated with Zika virus infection for the 1st time.

The trend of Zika cases and associated GBS cases is shown in Figure 3. The declining Zika trend is accompanied by a similar trend for GBS cases.

Figure 3 [graph]. Distribution of Zika cases (suspected and confirmed) and GBS in the Region of the Americas. 2015-2017 (up to EW 7 of 2017) [week ending 17 Feb 2017]

The following is a list of countries and territories in the Americas reporting increased cases of Guillain-Barre syndrome (GBS) and/or laboratory confirmation of Zika virus in at least one GBS case.

Table 1. Countries and territories in the Americas with GBS in the context of Zika virus circulation.

Increase in GBS with Zika virus lab confirmation in at least one case of GBS:
Brazil
Colombia
Curacao
Dominican Republic
El Salvador
French Guiana
El Salvador
French Guiana
Guadeloupe
Guatemala
Honduras
Jamaica
Martinique
Puerto Rico
Suriname
Trinidad and Tobago
Venezuela

Zika virus infection laboratory confirmation in at least one case of GBS:
Bolivia
Costa Rica
Grenada
Haiti
Mexico
Panama
St Martin

Increase in GBS with no Zika virus lab confirmation in any of the cases:
Paraguay
Saint Vincent and the Grenadines

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

******
[2] Cases in various countries
Americas
---
Americas cumulative case numbers
As of 16 Mar 2017
http://www.paho.org/hq/index.php?option=com_content&view=article&id=1239...
Country / Locally acquired: suspected / Confirmed / Imported / Deaths / Conf. congenital syndrome
North America:
Bermuda / 0 / 0 / 6 / 0 / 0
Canada / 0 / 0 / 478 / 0 / 1
USA / 0 / 223 / 4842 / 0 / 52

Latin America:
Mexico / 0 / 8127 / 15 / 0 / 5

Central American Isthmus:
Belize / 816 / 73 / 0 / 0 / 0
Costa Rica / 6131 / 1743 / 32 / 0 / 2
El Salvador / 11 535 / 51 / 0 / 0 / 4
Guatemala / 3464 / 890 / 0 / 0 / 37
Honduras / 32 105 / 298 / 0 / 0 / 2
Nicaragua / 0 / 2060 / 3 / 0 / 2
Panama / 3962 / 869 / 42 / 0 / 5

Latin Caribbean:
Cuba / 0 / 187 / 58 / 0 / 0
Dominican Republic / 4900 / 345 / 0 / 0 / 54
French Guiana / 10 320 / 483 / 10 / 0 / 17
Guadeloupe / 30 845 / 382 / 0 / 0 / 14
Haiti / 2955 / 5 / 0 / 0 / 1
Martinique / 36 680 / 21 / 0 / 0 /22
Puerto Rico / 0 / 39 529 / 137 / 5 / 12
Saint Barthélemy / 990 / 61 / 0 / 0 / 0
Saint Martin / 3215 / 200 / 0 / 0 / 1

Non-Latin Caribbean:
Anguilla / 28 / 22 / 1/ 0 / 0
Antigua and Barbuda / 465 / 14 / 2 / 0 / 0
Aruba / 880 / 34 / 7 / 0 / 0
Bahamas / 0 / 25 / 3 / 0 / 0
Barbados / 699 / 46 / 0 / 0 / 0
Bonaire, St Eustatius and Saba / 0 / 343 / 0 / 0 / 0
Caymans / 217 / 31 / 10 / 0 / 0
Curacao / 0 / 2589 / 1259 / 0 / 0
Dominica / 1150 / 79 / 0 / 0 / 0
Grenada / 335 / 112 / 0 / 0 / 1
Guyana / 0 / 37 / 0 / 0 / 0
Jamaica / 7371 / 203 / 0 / 0 / 0
Montserrat / 18 / 5 / 0 / 0 / 0
Saint Kits and Nevis / 549 / 33 / 0 / 0 / 0
Saint Lucia / 822 / 50 / 0 / 0 / 0
Saint Vincent and the Grenadines / 508 / 83 / 0 / 0 / 0
Sint Maarten / 247 / 147 / 0 / 0 / 0
Suriname / 2767 / 723 / 0 / 4 / 4
Trinidad and Tobago / 0 / 718 / 1 / 0 / 3
Turks and Caicos / 175 / 25 / 3 / 0 / 0
Virgin Islands (UK) / 74 / 52 / 0 / 0 / 0
Virgin Islands (USA) / 1072 / 995 / 2 / 0 / 0

Andean Area:
Bolivia / 837 / 192 / 4 / 0 / 14
Colombia / 97 586 / 9802 / 0 / 0 / 131
Ecuador / 2797 / 1024 / 15 / 0 / 0
Peru / 1957 / 903 / 22 / 0 / 0
Venezuela / 59 787 / 2413 / 0 / 0 / 0

[Brazil and] Southern Cone:
Brazil / 216 972 / 130 976 / 0 / 11 / 2386
Argentina / 2251 / 26 / 29 / 0 / 2
Chile / 0 / 0 / 33 / 0 / 0
Paraguay / 650 / 14 / 0 / 0 / 2
Uruguay / 0 / 0 / 1 / 0 / 0

Totals, Americas / 550 721 / 205 942 / 5759 / 20 / 2774

[Maps showing the location of the affected islands and countries in the Americas mentioned above and below can be accessed at
http://healthmap.org/promed/p/35574;
North America at http://healthmap.org/promed/p/106;
Central America http://healthmap.org/promed/p/39455;
Caribbean http://www.mapsofworld.com/caribbean-islands/, and
South America at http://healthmap.org/promed/p/6186. - Mod.TY]

Caribbean
---
Guadeloupe. April 2017 ahead of print. (conf.) 7 cases of severe thrombocytopenia and hemorrhagic signs and symptoms after infection with Zika virus. Clinical course and laboratory findings strongly suggest a causal link between Zika virus infection and immune-mediated thrombocytopenia.
https://wwwnc.cdc.gov/eid/article/23/4/16-1967_article

[This report provides some clinical support for antibody-dependent enhancement of Zika virus infection. A recently published review emphasizes the critical role for epidemiologic studies (retrospective and prospective) in combination with the studies to identify specific sites of Zika virus infection in humans that are needed to establish antibody-dependent enhancement as a possibility or a reality. (https://wwwnc.cdc.gov/eid/article/23/4/16-1879_article) - Mod.TY]

South America
---
Argentina (Santa Fe province). 19 Mar 2017. (reported) 2nd autochthonous case of microcephaly.
http://equilibrioinformativo.com/2017/03/confirman-un-reci-n-nacido-con-... [in Spanish]

Venezuela. 13 Mar 2017. (reported) 9 patients, ages 30-64, treated at the Institute of Tropical Medicine in Caracas developed heart symptoms such as palpitations, shortness of breath, and fatigue an average of 10 days after typical Zika symptoms began. Only one had any prior heart-related problem. Over 6 months, 8 of the 9 developed a dangerous heart rhythm problem, and 6 of the 9 developed heart failure.
http://whnt.com/2017/03/13/doctors-tie-zika-virus-to-heart-problems-in-s...

[See the full report in item [4] below. - Mod.TY]

Asia
---
India (Ahmedabad, Gujarat state). 17 Mar 2017. (reported) 1 case.
http://www.dnaindia.com/india/report-one-case-of-zika-virus-detected-in-...

Imported cases with no possibility of ongoing mosquito transmission (except USA, Florida and Texas)
---
United Kingdom. April 2017 ahead of print. (conf.) presence of Zika virus RNA in semen in 13 of 23 Zika virus infected men, highly variable within 10-91 days following onset of symptoms. Virus isolated from one on day 13.
https://wwwnc.cdc.gov/eid/article/23/4/16-1692_article

USA
- Case numbers mainland. Zika virus disease in the United States, 2015-2017 as of 15 Mar 2017
http://www.cdc.gov/zika/geo/united-states.html
State / Symptomatic cases / Viremic blood donors
Alabama 40 / 0
Arizona 54 / 1
Arkansas 15 / 0
California 433 / 5
Colorado 56 / 0
Connecticut 58 / 0
Delaware 17 / 0
District of Columbia 31 / 0
Florida 1104 / 24
Georgia 109 / 0
Hawaii 16 / 0
Idaho 5 / 0
Illinois 94 / 0
Indiana 53 / 0
Iowa 27 / 1
Kansas 22 / 0
Kentucky 33 / 0
Louisiana 39 / 0
Maine 14 / 0
Maryland 134 / 0
Massachusetts 123 / 0
Michigan 69 / 0
Minnesota 64 / 0
Mississippi 25 / 0
Missouri 36 / 0
Montana 9 / 0
Nebraska 13 / 0
Nevada 22 / 2
New Hampshire 12 / 0
New Jersey 182 / 0
New Mexico 10 / 0
New York 1009 / 3
North Carolina 98 / 0
North Dakota 3 / 0
Ohio 85 / 0
Oklahoma 29 / 0
Oregon 48 / 0
Pennsylvania 177 / 0
Rhode Island 54 / 0
South Carolina 54 / 0
South Dakota 2 / 0
Tennessee 61 / 0
Texas 317 / 3
Utah 22 / 0
Vermont 11 / 0
Virginia 114 / 0
Washington 71 / 0
West Virginia 11 / 0
Wisconsin 52 / 0
Wyoming 2 / 0
Total 5139 / 39

- Utah. 15 Mar 2017. (conf.) in the past 5 months 2 pregnancies lost in 1st trimester due to Zika virus infection.
http://www.heraldextra.com/news/local/report-pregnant-utah-women-with-zi...

- Territories and Commonwealth
Symptomatic / Blood donors
American Samoa 139 / 0
Puerto Rico 37 056 / 325
US Virgin Islands 993 / 0
Total 38 188 / 325
[A map of the USA showing the states and territories mentioned above can be accessed athttp://www.mapsofworld.com/usa/]

--
Communicated by:
ProMED-mail

and
Roland Hübner
Superior Health Council
Brussels
Belgium

******
[3] Persistence in brain and placenta
Date: March 2017 [ahead of print]
Source: Emerging Infectious Diseases journal [edited] https://wwwnc.cdc.gov/eid/article/23/3/16-1499_article

Ref: Bhatnagar J, Rabeneck DB, Martines RB, et al: Zika virus RNA replication and persistence in brain and placental tissue. Emerg Infect Dis. 2017; 23(3): 405-14. doi: 10.3201/eid2303.161499
----------------------------------------------------------------------
Abstract
--------
Zika virus is causally linked with congenital microcephaly and may be associated with pregnancy loss. However, the mechanisms of Zika virus intrauterine transmission and replication and its tropism and persistence in tissues are poorly understood. We tested tissues from 52 case-patients: 8 infants with microcephaly who died and 44 women suspected of being infected with Zika virus during pregnancy. By reverse transcription PCR, tissues from 32 (62 percent) case-patients (brains from 8 infants with microcephaly and placental/fetal tissues from 24 women) were positive for Zika virus. In situ hybridization localized replicative Zika virus RNA in brains of 7 infants and in placentas of 9 women who had pregnancy losses during the 1st or 2nd trimester. These findings demonstrate that Zika virus replicates and persists in fetal brains and placentas, providing direct evidence of its association with microcephaly. Tissue-based reverse transcription PCR extends the time frame of Zika virus detection in congenital and pregnancy-associated infections.

--
Communicated by:
ProMED-mail

[The evidence of Zika virus infection of and persistence in fetal tissues and the placenta continue to accumulate. This study adds to those observations.

A 9 Mar 2017 report indicates that a new study shows the human fetus may be most vulnerable to Zika infection very early in pregnancy. In addition, the lesser-known African strain of Zika might possibly cause nearly immediate death of the placenta. (http://www.futurity.org/zika-miscarriage-placenta-1376622-2/). - Mod.TY]

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[4] Cardiovascular complications
Date: Thu 9 Mar 2017
Source: American College of Cardiology [edited]
http://www.acc.org/about-acc/press-releases/2017/03/09/13/25/researchers...

As the Zika virus continues to spread globally, new evidence has emerged about the virus's potentially detrimental effects on the heart, according to data scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session [17-19 Mar 2017].

The study -- the 1st to report Zika-related heart troubles following infection -- included adult patients with no prior history of cardiovascular disease who were treated at the Institute of Tropical Medicine in Caracas, Venezuela, one of the epicenters of the Zika virus outbreak. All but one patient developed a dangerous heart rhythm problem and 2/3 had evidence of heart failure, a condition in which the heart can't pump enough blood to meet the body's needs.

"Our report provides clear evidence that there is a relationship between the Zika virus infection and cardiovascular complications," said Karina Gonzalez Carta, MD, cardiologist and research fellow at the department of cardiovascular diseases at Mayo Clinic and the study's lead author. "Based on these initial results, people need to be aware that if they travel to or live in a place with known Zika virus and develop a rash, fever or conjunctivitis, and within a short timeframe also feel other symptoms such as fatigue, shortness of breath or their heart skipping beats, they should see their doctor."

Carta and her team were not entirely surprised by their findings as they follow trends seen with other mosquito-borne diseases known to affect the heart, including the dengue and chikungunya virus [infections]. However, she noted that the burden and severity of heart problems, including rapidly progressive heart failure and potentially life-threatening arrhythmias, among these patients was unexpected.

The 9 patients who were seen in the clinic in Caracas within one week of having Zika-type symptoms and who subsequently reported common symptoms of heart problems, most commonly palpitations followed by shortness of breath and fatigue, were included in this small, prospective case report. Only one patient had any previous cardiovascular problems (well-controlled high blood pressure), and lab tests confirmed that all had active Zika infection. Patients were asked to fill out a form to record their symptoms and underwent an initial electrocardiogram, a test that displays the electrical activity of the heart, which in 8 cases was suggestive of a problem with the rate or rhythm of their heartbeat. These findings prompted researchers to perform a full cardiovascular work up using an echocardiogram, (24-hour) Holter monitor, and a cardiac magnetic resonance imaging study. Of the 9 patients, 6 were female with a mean age of 47 ± 17 years. They were followed for an average of 6 months, beginning in July 2016.

Dangerous arrhythmias were detected in 8 of the 9 patients: 3 cases of atrial fibrillation, 2 cases of non-sustained atrial tachycardia and 2 cases of ventricular arrhythmias, which can be deadly. Heart failure was present in 6 cases. Of these, 5 patients had heart failure with low ejection fraction -- when the amount of blood the heart is able to squeeze out is much less than what it normally would be -- and one had heart failure with preserved ejection fraction along with pre-eclampsia and a moderate to severe amount of fluid around the heart (called pericardial effusion). So far, none of the patients' cardiac issues have resolved, though symptoms are much improved due to guideline-directed treatment for heart failure or atrial fibrillation. Of note, cardiovascular symptoms tend to manifest later in the process. Data show an average lag of 10 days from patients' initial complaints of Zika symptoms to reports of symptoms suggestive of heart problems.

"Since the majority of people with Zika virus infections present with mild or non-specific symptoms and symptoms of cardiovascular complications may not occur right away, we need to raise awareness about the possible association," Carta said.

Although cardiovascular manifestations are fairly rare against the total number of patients treated at the clinic, Carta believes many more cases will be diagnosed, not only in patients with clear symptoms, but also among those with less severe or no signs of myocarditis, an inflammation of the myocardium, the middle layer of the heart wall. Myocarditis can affect the heart's muscle and electrical system.

"It's likely that many more people are affected, especially as many clinicians and people may not make the connection between symptoms," Carta said. "We need larger, systematic studies to understand the actual risk of Zika-related cardiac problems and what makes one patient more prone to develop them."

For now, she advises that people who are traveling to areas with known Zika virus consider talking with their doctor so they know what basic measures can be taken to prevent infection. Researchers are continuing to follow these patients and are setting up new strategies to screen more patients for cardiovascular problems.

Symptoms of the Zika virus usually include mild fever, skin rash, conjunctivitis (pink eye), muscle and joint pain, malaise or headache, which typically last for 2 to 7 days, according to the World Health Organization. The best way to prevent the Zika virus is by preventing mosquito bites.

While this study points to another potential risk of Zika virus infection, it is limited due to its small size. What remains unclear is whether and how the Zika virus might affect people with existing heart disease. However, Carta says that based on our knowledge of other arboviral infections, patients who have pre-existing cardiovascular disease tend to have worse outcomes.

Carta will present the study, "Myocarditis, Heart Failure and Arrhythmias in Patients With Zika," on Sat 18 Mar 2017, at the American College of Cardiology's 66th Annual Scientific Session in Washington.

--
Communicated by:
ProMED-mail

[Zika virus infections continue to provide unpleasant surprises. One hopes that the results of this small study will stimulate additional follow up studies of individuals convalescent from Zika virus infections. - Mod.TY]

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[5] Persistence in donated whole blood
Date: May 2017 [ahead of print]
Source: Emerging Infectious Diseases journal [edited]
https://wwwnc.cdc.gov/eid/article/23/5/16-1631_article

Ref: Mansuy JM, Mengelle C, Pasquier C, et al: Zika virus infection and prolonged viremia in whole-blood specimens. Emerg Infect Dis. 2017; 23(5); doi: 10.3201/eid2305.161631
----------------------------------------------------------------------
Abstract
--------
We tested whole-blood and plasma samples from immunocompetent patients who had had benign Zika virus infections and found that Zika virus RNA persisted in whole blood substantially longer than in plasma. This finding may have implications for diagnosis of acute symptomatic and asymptomatic infections and for testing of blood donations.

[Results]
---------
Results from the follow-up (18 whole-blood and 21 plasma samples) showed that the median duration of Zika virus was 22 (range 14-100) days in whole blood and 10 (range 7-37) days in plasma (p=0.058). Mean viral loads of positive samples were 3.39 log copies/mL in whole blood (n=13) and 2.52 log copies/mL in plasma (n=6; p=0.001). Viral loads in the last positive samples varied from 2.7 to 3.9 log copies/mL in whole blood and 2.2 to 2.8 log copies/mL in plasma (p=0.06). Whole-blood samples from 2 patients remained positive at 14 and 63 days after their plasma samples had become negative.

[Conclusion]
------------
Overall, our data show that use of whole-blood specimens is much more sensitive than use of plasma samples to detect Zika virus RNA. These data could be useful in recommending the use of whole blood instead of plasma for the molecular diagnosis of acute symptomatic and asymptomatic Zika virus infections and for the safety of whole blood and blood components from donors, as well as for the safety of organs, tissues, and cells from deceased and living donors.

--
Communicated by:
ProMED-mail

[This information should be useful for blood banks screening for Zika virus presence. - Mod.TY]

******
[6] Virus in banked sperm
Date: Tue 14 Mar 2017 0351 GMT
Source: CNN [edited]
http://edition.cnn.com/2017/03/13/health/zika-florida-sperm-warning/inde...

Sperm donated in 3 Florida counties since [15 Jun 2016] may be infected with the Zika virus, the US Centers for Disease Control and Prevention cautioned [Mon 13 Mar 2017]. "When semen is donated it can be stored frozen for periods of time. It does not necessarily inactivate Zika, so it could be stored in tissue banks, used subsequently, and people should be made aware," said Dr Peter Marks, director of the Center for Biologics Evaluation and Research at the US Food and Drug Administration. He went on to say having this information can help individuals make informed decisions and they "might want to use these donations from other sources." Sources other than the 12 sperm banks in Miami-Dade, Palm Beach, and Broward counties of Florida, that is.

The agency had previously designated only Miami-Dade County as an area to take precautions after the 1st local transmission of the virus in the continental United States was confirmed in the Wynwood neighborhood of Miami in July [2016]. The area was declared Zika free in December [2016].

The 1st known sexual transmission of Zika virus in US was 8 years ago. However, the CDC is now warning anyone in Palm Beach and Broward counties to also consider themselves at an increased risk for the virus. This applies to anyone who has traveled to or between these 3 counties since 15 Jun 2016, a change from previous guidance that designated 29 Jun [2016] as the start of the increased risk period.

It is possible that someone could have Zika without knowing, because an estimated 80 percent of those infected have no symptoms. When symptoms occur, they can include fever, rash, joint pain, and red eyes, and they can last from a few days to about a week.

Pregnant women are at greatest risk because they can unknowingly pass the virus to their fetus, causing devastating consequences including miscarriage and neurological deficits that last a lifetime.

Because the virus can also be sexually transmitted, pregnant women or those trying to become pregnant have been advised to avoid unprotected sex with a partner who has been infected or who has lived in or traveled to an area where the virus is circulating.

The ongoing investigation into reported cases of the virus in Florida has found that residents of Miami-Dade, Palm Beach, and Broward counties travel frequently between the counties and either forget, or fail to, consider that they've visited an area of increased risk, thus not realizing they could be infected.

Women who live in these 3 counties who have become pregnant since 15 Jun [2016] are advised to speak with their physicians about the potential increased risk as are women who want to use a sperm donation from a donor in these counties, advised Dr. Denise Jamieson, incident commander for the CDC Zika emergency response and chief of the women's health and fertility branch at the CDC's division of reproductive health.

CDC officials said they are acting only out of an abundance of caution and there have not been any reports of the virus being transmitted through donated sperm.

"Now we understand more than we did months ago is that evidence of the Zika virus is present in semen for up to 3 months after a man is infected and people may not have accurately recalled potential exposure [to the virus] especially if in a local area," said Dr Matthew Kuehnert, who is part of the CDC Zika emergency response team and director of the CDC office of blood, organ and other tissue safety.

Unlike blood donations, which are routinely screened for the virus in the United States, there is no available test to screen semen for Zika. The existing test is still in the research phase and accuracy is being assessed, which is why men in these counties should not donate sperm. Their donated sperm may be infected.

The Florida Department of Health last reported a case of local transmission of the virus on [2 Mar 2017]. However, that report included confirmation of 2 cases from October of last year [2016]. A 3rd case was also reported then but this was an individual who donated blood in January [2017] and through routine blood screening was found to have previously been infected but no longer had an active case of the virus.

--
Communicated by:
ProMED-mail from HealthMap Alerts

[Although this may seem like an over precautious stance, the risk of Zika virus transmission from donated sperm is small but real. The consequence of fetal infections is serious for families that have to deal with the consequences of a child with microcephaly or other birth defects. - Mod.TY]

******
[7] _Culex quinquefasciatus_ and _Aedes taeniorhynchus_ refractory
Date: March 2017 [ahead of print]
Source: Emerging Infectious Diseases journal [edited]
https://wwwnc.cdc.gov/eid/article/23/3/16-1636_article

Ref: Hart CE, Roundy CM, Azar SR, et al: Zika virus vector competency of mosquitoes, Gulf Coast, United States. Emerg Infect Dis. 2017; 23(3): 559-60. doi: 10.3201/eid2303.161636.
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Abstract
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Zika virus has recently spread throughout the Americas. Although _Aedes aegypti_ mosquitoes are considered the primary vector, _Culex quinquefasciatus_ and mosquitoes of other species may also be vectors. We tested _Cx quinquefasciatus _ and _Ae taeniorhynchus_ mosquitoes from the US Gulf Coast; both were refractory to [Zika virus] infection and incapable of transmission.

--
Communicated by:
ProMED-mail

[This is yet another report indicating that _Culex quinquefasciatus_ mosquitoes are refractory to Zika virus infection. There is one previous report from China indicating that this species of mosquito is a competent vector. Several studies done in North America do not support that observation. - Mod.TY]

******
[8] Virus diversity, Americas
Date: Sat 18 Feb 2017
Source: BioRxIV [edited]
http://biorxiv.org/content/early/2017/02/18/109348

Ref: Metsky HC, Matranga CB, Wohl S, et al: Genome sequencing reveals Zika virus diversity and spread in the Americas. bioRxiv 109348; doi: 10.1101/109348
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Abstract
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Despite great attention given to the recent Zika virus (ZIKV) epidemic in the Americas, much remains unknown about its epidemiology and evolution, in part due to a lack of genomic data. We applied multiple sequencing approaches to generate 100 ZIKV genomes from clinical and mosquito samples from 10 countries and territories, greatly expanding the observed viral genetic diversity from this outbreak. We analyzed the timing and patterns of introductions into distinct geographic regions, confirming phylogenetic evidence for the origin and rapid expansion of the outbreak in Brazil, and for multiple introductions from Brazil into Honduras, Colombia, Puerto Rico, other Caribbean islands, and the continental US. We find that ZIKV circulated undetected in many regions of the Americas for up to a year before the 1st locally transmitted cases were confirmed, highlighting the challenge of effective surveillance for this virus. We further characterize genetic variation across the outbreak to identify mutations with possible functional implications for ZIKV biology and pathogenesis.

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This report provides a recent historical overview of Zika virus in the Americas. One hopes that there is a repository of Zika virus isolates to provide the materials necessary for continued study of Zika virus evolution in the Americas over the long-term. - Mod.TY]

See Also
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2016
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