ZIKA VIRUS (08): AMERICAS, ASIA, RESEARCH, OBSERVATIONS

Posted on 01ST MAY 2017
tagged Zika Virus, Americas; Asia

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] Cases in various countries:
Americas
Americas cumulative case numbers
Central America
---
Guatemala
Honduras

Caribbean
---
Jamaica
Barbados

Asia
---
Singapore

Imported cases with no possibility of ongoing mosquito transmission
---
Canada (Quebec province)
China (Hong Kong)
Japan
South Korea
USA:
- case numbers mainland
- Territories and Commonwealth
- Puerto Rico: microcephaly
- birth defects

[2] Epilepsy
[3] Spinal chord injury
[4] RADAR Diagnostic test
[5] Virus persistence
[6] Persistence in blood
[7] Intercontinental virus spread

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[1] Cases in various countries
Americas
---
Americas cumulative case numbers
As of 27 Apr 2017
http://www.paho.org/hq/index.php?option=com_content&view=article&id=1239...
Country / Locally acquired: suspected / Confirmed / Imported / Deaths / Confirmed congenital syndrome
North America:
Bermuda / 0 / 0 / 6 / 0 / 0
Canada / 0 / 0 / 486 / 0 / 1
USA / 0 / 225 / 4963 / 0 / 65

Latin America:
Mexico / 0 / 8707 / 15 / 0 / 5

Central American Isthmus:
Belize / 816 / 73 / 0 / 0 / 0
Costa Rica / 6249 / 1790 / 32 / 0 / 5
El Salvador / 11 482 / 51 / 0 / 0 / 4
Guatemala / 3634 / 921 / 0 / 0 / 59
Honduras / 32 130 / 302 / 0 / 0 / 2
Nicaragua / 0 / 2060 / 3 / 0 / 2
Panama / 4122 / 910 / 42 / 0 / 5

Latin Caribbean:
Cuba / 0 / 187 / 58 / 0 / 0
Dominican Republic / 4906 / 345 / 0 / 0 / 54
French Guiana / 10 385 / 483 / 10 / 0 / 17
Guadeloupe / 30 845 / 382 / 0 / 0 / 18
Haiti / 2955 / 5 / 0 / 0 / 1
Martinique / 36 680 / 21 / 0 / 0 / 23
Puerto Rico / 0 / 40 067 / 137 / 5 / 29
St Barthélemy / 990 / 61 / 0 / 0 / 0
St Martin / 3280 / 200 / 0 / 0 / 1

Non-Latin Caribbean:
Anguilla / 29 / 23 / 1 / 0 / 0
Antigua and Barbuda / 465 / 14 / 2 / 0 / 0
Aruba / 1208 / 468 / 7 / 0 / 0
Bahamas / 0 / 25 / 3 / 0 / 0
Barbados / 705 / 150 / 0 / 0 / 1
Bonaire, St Eustatius, and Saba / 325 / 381 / 0 / 0 / 0
Caymans / 217 / 31 / 10 / 0 / 0
Curacao / 2589 / 1259 / 0 / 0 / 0
Dominica / 1150 / 79 / 0 / 0 / 0
Grenada / 336 / 117 / 0 / 0 / 2
Guyana / 0 / 37 / 0 / 0 / 0
Jamaica / 7655 / 203 / 0 / 0 / 0
Montserrat / 18 / 5 / 0 / 0 / 0
St Kitts and Nevis / 554 / 33 / 0 / 0 / 0
St Lucia / 822 / 50 / 0 / 0 / 0
St Vincent and the Grenadines / 508 / 83 / 0 / 0 / 0
Sint Maarten / 247 / 147 / 0 / 0 / 0
Suriname / 2768 / 723 / 0 / 4 / 4
Trinidad and Tobago / 0 / 718 / 1 / 0 / 3
Turks and Caicos / 201 / 25 / 3 / 0 / 0
Virgin Islands (UK) / 74 / 52 / 0 / 0 / 0
Virgin Islands (USA) / 1084 / 1020 / 2 / 0 / 0

Andean Area:
Bolivia / 1767 / 585 / 4 / 0 / 14
Colombia / 97 899 / 9802 / 0 / 0 / 148
Ecuador / 3285 / 1300 / 15 / 0 / 2
Peru / 4411 / 997 / 22 / 0 / 0
Venezuela / 59 903 / 2413 / 0 / 0 / 0

[Brazil and] Southern Cone:
Brazil / 220 213 / 132 021 / 0 / 11 / 2653
Argentina / 2251 / 63 / 40 / 0 / 2
Chile / 0 / 0 / 34 / 0 / 0
Paraguay / 653 / 14 / 0 / 0 / 2
Uruguay / 0 / 0 / 1 / 0 / 0

Totals, Americas / 559 721 / 209 628 / 5897 / 20 / 3122

[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]

Central America
---
Guatemala. 21 Apr 2017. (reported) 170 cases; Zika virus associated microcephaly (suspected [susp]) 14 cases, (confirmed [conf]) 22 cases.
http://emisorasunidas.com/noticias/nacionales/confirman-22-casos-microce... [in Spanish]

Honduras. 18 Apr 2017. (reported) 19 cases of microcephaly; 12 cases of Guillain-Barré syndrome [not all of which may be due to Zika virus infection. - Mod.TY]
http://www.latribuna.hn/2017/04/18/secretaria-salud-advierte-rebrote-den... [in Spanish]

Caribbean
---
Jamaica. 16 Apr 2017. For the period of January 2016-March 2017, (susp) 7767 cases, (conf) 203 cases; 827 pregnant women may have been exposed to Zika virus, of which 698 are suspected Zika virus infection cases and 78 are confirmed infections.
http://jamaica-gleaner.com/article/lead-stories/20170416/zika-attack-alm...

Barbados. 22 Apr 2017. (susp) since outbreak began in 2016 until 1 Apr 2017, (reported) 705 cases (conf) 150, 3 in 2017.
http://www.nationnews.com/nationnews/news/96000/zika-barbados

Asia
---
Singapore. 20 Apr 2017. (conf) 2 cases, locally transmitted at the Glasgow Road area near Kovan.
http://www.channelnewsasia.com/news/singapore/2-cases-of-zika-confirmed-...

[The report above was provided by ProMED-mail rapporteur Mary Marshall. A 26 Apr 2017 report indicated that there are 2 cases in the new cluster near Upper Serangoon Road and one other new case in the Glasgow Road cluster on Mon 24 Apr 2017.

Maps of Singapore can be accessed at http://www.lib.utexas.edu/maps/middle_east_and_asia/singapore_pol_05.jpg and http://healthmap.org/promed/p/150. - Mod.TY]

Imported cases with no possibility of ongoing mosquito transmission (except USA Florida and Texas)
---
Canada (Quebec province). 23 Apr 2017. (conf) since January 2016, 102 cases, all imported except for one baby infected in utero; 20 pregnant women underwent preventive abortions.
http://www.lifeinquebec.com/over-100-zika-cases-in-quebec-20991/

[A HealthMap/ProMED-mail map of Canada can be accessed at http://healthmap.org/promed/p/268. - Mod.TY]

China (Hong Kong). 26 Apr 2017. (conf) 1 imported case ex South America.
http://news.xinhuanet.com/english/2017-04/26/c_136238416.htm

[A HealthMap/ProMED-mail map of China can be accessed at http://healthmap.org/promed/p/198. - Mod.TY]

Japan. July 2017 [ahead of print]. (conf) 1 case ex Viet Nam in November 2016.
https://wwwnc.cdc.gov/eid/article/23/7/17-0519_article

[A HealthMap/ProMED-mail map of Japan can be accessed at http://healthmap.org/promed/p/156. - Mod.TY]

South Korea. 23 Mar 2017. (conf.) 19 cases, 1 recent case imported from Bolivia.
http://www.koreaherald.com/view.php?ud=20170323000809

[A HealthMap/ProMED-mail map of South Korea can be accessed at http://healthmap.org/promed/p/195. - Mod.TY]

USA
- Case numbers mainland. Zika virus disease in the United States, 2015-2017, as of 26 Apr 2017
http://www.cdc.gov/zika/geo/united-states.html
State Symptomatic cases / Viremic blood donors
Alabama 40 / 1
Arizona 55 / 1
Arkansas 15 / 0
California 444 / 5
Colorado 59 / 0
Connecticut 58 / 0
Delaware 17 / 0
District of Columbia 43 / 0
Florida 1134 / 26
Georgia 110 / 0
Hawaii 16 / 0
Idaho 4 / 0
Illinois 103 / 0
Indiana 51 / 0
Iowa 27 / 1
Kansas 22 / 0
Kentucky 33 / 0
Louisiana 39 / 0
Maine 14 / 0
Maryland 134 / 0
Massachusetts 127 / 1
Michigan 73 / 0
Minnesota 64 / 0
Mississippi 25 / 0
Missouri 38 / 0
Montana 9 / 0
Nebraska 13 / 0
Nevada 22 / 1
New Hampshire 13 / 0
New Jersey 189 / 0
New Mexico 10 / 0
New York 1021 / 3
North Carolina 100 / 0
North Dakota 3 / 0
Ohio 85 / 0
Oklahoma 29 / 0
Oregon 49 / 0
Pennsylvania 179 / 0
Rhode Island 57 / 0
South Carolina 59 / 0
South Dakota 3 / 0
Tennessee 61 / 0
Texas 326 / 5
Utah 22 / 0
Vermont 13 / 0
Virginia 115 / 0
Washington 72 / 0
West Virginia 11 / 1
Wisconsin 56 / 0
Wyoming 2 / 0
Total 5264 / 45

- Territories and Commonwealth
Symptomatic / Blood donors
American Samoa 132 / 0
Puerto Rico 35 423 / 325
US Virgin Islands 1020 / 0
Total 36 575 / 325

[Maps of the USA showing the states and territories mentioned above can be accessed at http://www.mapsofworld.com/usa/ and http://healthmap.org/promed/p/106. - Mod.TY]

- Puerto Rico: microcephaly. An 18 Apr 2017 report indicated that the number of microcephalic babies in Puerto Rico was less than predicted. Some experts are beginning to question whether the actual count is being significantly underreported. The criteria for microcephaly used in Puerto Rico are different from those used by the USA CDC, and might account for the small number of reported cases in Puerto Rico.
https://www.statnews.com/2017/04/18/zika-virus-puerto-rico-pregnancies/

- Birth defects. 24 Apr 2017. Among pregnant women in the US with confirmed Zika virus, about one in 10 had a fetus or baby with birth defects.
http://www.gosanangelo.com/story/life/wellness/2017/04/24/infectious-dis...

--
communicated by:
ProMED-mail

and
Roland Hübner
Superior Health Council
Brussels
Belgium

******
[2] Epilepsy
Date: Tue 18 Apr 2018
Source: American Hospital Association (AHA) News [edited]
http://news.aha.org/article/170418-cdc-zika-cases-in-brazil-highlight-ne...

Seizures and epilepsy were reported last year [2016] in some infants in Brazil with probable or laboratory evidence of congenital Zika virus infection, according to a commentary co-authored by the Centers for Disease Control and Prevention in JAMA Neurology [http://goo.gl/ev1jU5]. In a study of 48 infants with probable congenital Zika virus syndrome, 50 per cent reportedly had clinical seizure, the authors said. In another study of 13 infants with laboratory evidence of congenital Zika virus, 54 per cent were diagnosed as having epilepsy. CDC said cases of Zika virus-associated epilepsy may be misdiagnosed or underreported because seizure symptoms in infants and children are difficult to recognize. "Better recognition, diagnosis, and reporting of seizures and epilepsy in infants and young children will help guide interventions to make sure families receive the right support and treatment," the agency said.

--
communicated by:
ProMED-mail

[One hopes that pediatricians will be aware of this report and watch for Zika virus-related epilepsy. - Mod.TY]

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[3] Spinal chord injury
Date: Fri 21 Apr 2017
Source: Clinical Infectious Diseases journal [edited]
https://doi.org/10.1093/cid/cix374

ref: Ramalho FS, Yamamoto AY, da Silva LL, et al. Congenital Zika virus infection induces severe spinal cord injury. Clin Infect Dis. 2017. doi: 10.1093/cid/cix374. [Epub ahead of print]
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Abstract
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We reported 2 fatal cases of congenital Zika virus (ZIKV) infection. Brain anomalies including atrophy of the cerebral cortex and brainstem, and cerebellar aplasia were observed. The spinal cord showed architectural distortion, severe neuronal loss and microcalcifications. The ZIKV proteins and flavivirus-like particles were detected in cytoplasm of spinal neurons, and spinal cord samples were positive for the ZIKV RNA.

--
communicated by:
ProMED-mail

[More Zika virus-related pathological changes to watch out for. - Mod.TY]

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[4] RADAR diagnostic test
Date: Mon 17 Apr 2017 8:51 AM
Source: MedCity News [edited]
http://medcitynews.com/2017/04/xprize-winner-nanobiosym-gets-fda-emergen...

Nanobiosym, a former Nokia XPRIZE winner, has been granted emergency use authorization for its point of care diagnostic test to detect the Zika virus from the US Food and Drug Administration. The authorization for the Gene-RADAR Zika Virus Test is Nanobiosym's 1st FDA-cleared test, although this is one of several that have been authorized to screen for the Zika virus, which is carried by mosquitoes.

The Gene-RADAR Zika Virus Test is designed to cut the amount of time it takes for a diagnosis by analyzing blood samples with a nanochip.

The authorization is not the same as a clearance and only lasts as long as the declaration that circumstances exist justifying the authorization of the emergency use of in vitro diagnostic tests for detection of Zika virus as well as the Zika virus infection, a company press release said.

Nanobiosym's Zika Virus test will only be used to detect the presence of the virus in human serum, not for any other body fluids or any other viruses or pathogens, the release said.

What makes the Zika virus particularly worrisome is that when infection occurs during pregnancy, it can produce devastating neurological problems in developing infants, such as severe microcephaly, decreased brain tissue, and brain damage. More than 43 000 people in the US and its territories have been infected by the Zika virus, including at least 4750 pregnant women, according to data from the Centers for Disease Control and Prevention.

[byline: Stephanie Baum]

--
communicated by:
ProMED-mail

[An increasing number of diagnostic tests are being developed that are reported to be fast and sensitive enough to differentiate between infection with Zika, dengue, and chikungunya viruses. A recent entry in the field is the DiaSorin launches the new LIAISON® XL Zika Capture IgM, reported to be the 1st and the only fully automated test for specific and accurate diagnosis of Zika virus infection (http://www.diasorin.com/en/news/diasorin-launches-new-liaisonr-xl-zika-c...). It is particularly important to be able to identify Zika virus infections in pregnant women, so that the development of their fetuses can be monitored. It will be interesting to see which of these recently developed diagnostic tests performs best in the field. - Mod.TY

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[5] Virus persistence
Date: Thu 27 Apr 2017
Source: Science News [edited]
https://www.sciencenews.org/article/zika-hides-out-bodys-hard-reach-spots

Zika virus plays hard to get. Weeks after the virus disappears from the bloodstream, it still lingers in the lymph nodes and the central nervous system of rhesus monkeys, researchers report online [27 Apr 2017] in Cell. That could help explain why Zika infection can cause neurological problems in both infants and adults.

"Zika does stick around for a lot longer than we originally thought," says Dan Streblow, a virologist at Oregon Health & Science University in Portland, who wasn't involved in the study. Streblow's lab recently reported in PLoS Pathogens that Zika can also linger in rhesus monkeys' reproductive tracts and peripheral nervous systems. And recent studies in humans have shown evidence of the virus hanging around in semen (SN Online: 14 Feb 2017; https://www.sciencenews.org/blog/science-ticker/see-how-long-zika-lasts-...). Now, it appears the central nervous system and lymph nodes are also long-term hiding places.

That persistence could help explain why Zika "does substantial damage in the central nervous system," says Dan Barouch, a study coauthor and virologist at Harvard Medical School. Infection in utero can cause microcephaly in infants, for instance, and the virus has been linked to an increased risk for a neurological autoimmune disease called Guillain-Barré syndrome in adults (SN: 2 Apr 2016, p. 29; https://www.sciencenews.org/article/scientists-probe-zika's-link-neurological-disorder).

Barouch and colleagues infected rhesus monkeys with Zika [virus] and monitored the early stages of infection. The virus disappeared from the monkeys' bloodstreams after 10 days. But it lingered for as long as 42 days in cerebrospinal fluid, which circulates throughout the brain, and up to 72 days in the lymph nodes. Even though antibodies that recognize and disable the Zika virus appeared within days in the bloodstream, they weren't detected in the cerebrospinal fluid during the study.

A look at how the monkeys were making certain proteins revealed a few potential reasons for the virus's persistence. Monkeys with ongoing Zika [virus] infection in their cerebrospinal fluid made more of a protein called mTOR and a set of other proteins that interact with mTOR, the researchers found. That makes sense because mTOR, also called mechanistic target of rapamycin, has previously been shown to influence both immune response and neural development, Barouch says. Increased levels of the protein might be contributing to Zika's effects on the brain, though more research is needed to show exactly how.

Sick monkeys also made less of certain proteins that coordinate communication between cells. Blocking those cell-to-cell messages might prevent immune cells from making their way to the virus's hiding places. That group of proteins is similarly affected by dengue virus, suggesting that the 2 illnesses might share some of the same infection tricks.

The findings suggest that the virus might have neurological effects beyond what's been seen so far, Barouch says. And it adds another layer of complexity for scientists searching for a treatment: A successful treatment will need to remove the virus from the bloodstream as well as the nooks and crannies in the body where it seems to hide.

It also makes finding a preventative strategy more important than ever. Barouch's lab is one of many working on a Zika vaccine to stop infection from ever setting in (SN: 18 Mar 2017, p. 12; https://www.sciencenews.org/article/dna-may-offer-rapid-road-zika-vaccine). Their vaccine is currently in early stage clinical trials.

--
communicated by:
Roland Hübner
Superior Health Council
Brussels
Belgium

[The original report published in Cell on April 2017 ahead of print (http://www.cell.com/cell/fulltext/S0092-8674(17)30421-X) contains the details of this study. ProMED-mail thanks Sukie Crandall who also sent this report. It will be interesting to see if Zika virus persistence in these tissues can be demonstrated in human infections. - Mod.TY]

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[6] Persistence in blood
Date: May 2017 [ahead of print]
Source: Emerging Infectious Diseases journal [edited]
https://dx.doi.org/10.3201/eid2305.161631

ref: Mansuy J, Mengelle C, Pasquier C, et al: Zika virus infection and prolonged viremia in whole-blood specimens. Emerg Infect Dis. 2017; 23(5): 863-5. doi: 10.3201/eid2305.161631
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Abstract
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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.

--
communicated by:
ProMED-mail

[This report will be of interest to individuals and organizations responsible for safety of blood and blood products for transfusion. - Mod.TY]

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[7] Intercontinental virus spread
Date: Thu 27 Apr 2017
Source: PLoS (Public Library of Science) ONE [edited]
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176710

ref: Liang D, Leung RKK, Lee SS, Kam KM: Insights into intercontinental spread of Zika virus. PLoS One. 2017; 12(4): e0176710. doi: 10.1371/journal.pone.0176710. eCollection 2017.

Abstract
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The epidemic of Zika virus (ZIKV) infection in South America has led to World Health Organization's declaration of a Public Health Emergency of International Concern. To further inform effective public health policy, an understanding of ZIKV's transmission mechanisms is crucial. To characterize the intercontinental transmission of ZIKV, we compiled and analyzed more than 250 gene sequences together with their sequence-related geographic and temporal information, sampled across 27 countries spanning from 1947 to 2016. After filtering and selecting appropriate sequences, extensive phylogenetic analyses were performed. Although phylogeographic reconstruction supported the transmission route of the virus in Africa, South-eastern Asia, Oceania, and Latin America, we discovered that the Eastern Africa origin of ZIKV was disputable. On a molecular level, purifying selection was found to be largely responsible for the evolution of non-structural protein 5 and envelope protein E. Our dataset and ancestral sequences reconstruction analysis captured previously unidentified amino acid changes during evolution. Finally, based on the estimation of the time to the most recent common ancestors for the non-structural protein 5 gene, we hypothesized potential specific historic events that occurred in the 1940s and might have facilitated the spread of Zika virus from Africa to South-eastern Asia. Our findings provide new insights into the transmission characteristics of ZIKV, while further genetic and serologic studies are warranted to support the design of tailored prevention strategies.

--
communicated by:
ProMED-mail

See Also
Zika virus (07): Americas, PAHO/WHO 20170429.5003908
Zika virus (06): Americas, Pacific, Asia, Africa, research 20170416.4974439
Zika virus (05): Americas, Pacific, Asia, research, observations 20170326.4927523
Zika virus (04): Americas, Asia Europe, research, observations 20170320.4912123
Zika virus (03): Americas, research 20170309.4888510
Zika virus (02): Americas, Asia, Africa, Pacific, research, observations 20170217.4846633
Zika virus (01): Americas, Asia, Africa, research 20170117.4772206
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