ZIKA VIRUS (13): AMERICAS, RESEARCH, OBSERVATIONS

Posted on 18TH JUN 2017
tagged Zika Virus, Americas

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

Cases in various countries not mentioned above or more recent case numbers.
Central America
---
Honduras

Imported cases with little or no possibility of ongoing mosquito transmission
---
USA:
- Case numbers mainland
- Territories and Commonwealth

[2] Risk for infants
[3] Dysphagia in microcephalic infants
[4] Virus load and pregnancy outcomes
[5] Fetal brain imaging
[6] Ultrasound imaging

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[1] Cases in various countries
Americas
---
Americas cumulative case numbers
As of 15 Jun 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 / 507 / 0 / 1
USA / 0 / 225 / 5026 / 0 / 72

Latin America:
Mexico / 0 / 8821 / 15 / 0 / 5

Central American Isthmus:
Belize / 1294 / 206 / 0 / 0 / 0
Costa Rica / 6422 / 1830 / 32 / 0 / 5
El Salvador / 11 531 / 51 / 0 / 0 / 4
Guatemala / 3678 / 921 / 0 / 0 / 140
Honduras / 32 130 / 302 / 0 / 0 / 4
Nicaragua / 0 / 2060 / 3 / 0 / 2
Panama / 4178 / 969 / 42 / 0 / 8

Latin Caribbean:
Cuba / 0 / 187/ 58 / 0 / 0
Dominican Republic / 4906 / 345 / 0 / 0 / 93
French Guiana / 10 500 / 483 / 10 / 0 / 1
Guadeloupe / 30 845 / 382 / 0 / 0 / 5
Haiti / 2955 / 5 / 0 / 0 / 1
Martinique / 36 680 / 21 / 0 / 0 / 7
Puerto Rico / 0 / 40 398 / 137 / 5 / 38
Saint Barthelemy / 990 / 61 / 0 / 0 / 0
Saint Martin / 3280 / 200 / 0 / 0 / 0

Non-Latin Caribbean:
Anguilla / 31 / 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 / 235 / 381 / 0 / 0 / 0
Caymans / 232 / 31 / 10 / 0 / 0
Curacao / 2589 / 1259 / 0 / 0 / 0
Dominica / 1154 / 79 / 0 / 0 / 0
Grenada / 335 / 118 / 0 / 0 / 2
Guyana / 0 / 37 / 0 / 0 / 0
Jamaica / 7650 / 203 / 0 / 0 / 0
Montserrat / 18 / 5 / 0 / 0 / 0
Saint Kits and Nevis / 554/ 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 / 2768 / 724 / 0 / 4 / 4
Trinidad and Tobago / 0 / 718 / 1 / 0 / 3
Turks and Caicos / 200 / 25 / 3 / 0 / 0
Virgin Islands (UK) / 74 / 53 / 0 / 0 / 0
Virgin Islands (USA) / 1131 / 1017/ 2 / 0 / 0

Andean Area:
Bolivia / 1767 / 585 / 4 / 0 / 14
Colombia / 98 161 / 9802 / 0 / 0 / 163
Ecuador / 3842 / 1759 / 15 / 0 / 4
Peru / 5874 / 1218 / 22 / 0 / 0
Venezuela / 59 965 / 2413 / 0 / 0 / 0

[Brazil and] Southern Cone:
Brazil / 224 670 / 134 057 / 0 / 11 / 2722
Argentina / 869 / 121 / 40 / 0 / 2
Chile / 0 / 0 / 34 / 0 / 0
Paraguay / 672 / 16 / 0 / 0 / 2
Uruguay / 0 / 0 / 1 / 0 / 0

Totals, Americas / 566 135 / 213 081 / 5981 / 20 / 3303

[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]

Cases in various countries not mentioned above or more recent case numbers.

Central America
---
Honduras. 15 Jun 2017. (reported) 209 cases this year [2017] or whom 8 pregnant.
http://www.news.va/en/news/americahonduras-zika-virus-prevention-campaig...

Imported cases with little or no possibility of ongoing mosquito transmission
---
USA:
- Case numbers mainland. Zika virus disease in the United States, 1 Jan 2017 - 14 Jun 2017
http://www.cdc.gov/zika/geo/united-states.html
State/ Symptomatic cases / Viremic blood donors
Alabama 3 / 0
Alaska 1 / 0
Arizona 1 / 0
Arkansas 0 / 0
California 14 / 1
Colorado 3 / 0
Connecticut 0 / 0
Delaware 0 / 0
District of Columbia 0 / 0
Florida 15 / 3
Georgia 1 / 0
Hawaii 1 / 0
Idaho 0 / 0
Illinois 4/ 0
Indiana 1 / 0
Iowa 1 / 0
Kansas 2 / 0
Kentucky 1 / 0
Louisiana 1 / 1
Maine 1 / 0
Maryland 3 / 0
Massachusetts 6 / 0
Michigan 6 / 0
Minnesota 0 / 0
Mississippi 2 / 0
Missouri 1 / 0
Montana 0 / 0
Nebraska 1 / 0
Nevada 1 / 0
New Hampshire 0/ 0
New Jersey 2 / 0
New Mexico 0 / 0
New York 26 / 1
North Carolina 3 / 0
North Dakota 0 / 0
Ohio 3 / 0
Oklahoma 0 / 0
Oregon 1 / 0
Pennsylvania 3 / 1
Rhode Island 3 / 0
South Carolina 2 / 0
South Dakota 0 / 0
Tennessee 0 / 0
Texas 11 / 1
Utah 0 / 0
Vermont 3 / 0
Virginia 3 / 0
Washington 2 / 0
West Virginia 0 / 1
Wisconsin 2 / 0
Wyoming 0 / 0
Totals 136 / 9

- Territories and Commonwealth with local transmission:
Symptomatic / Blood donors
American Samoa 3 / 0
Puerto Rico 465 / 3
US Virgin Islands 37/ 0
Total 505 / 3
[A map of the USA showing the states and territories mentioned above can be accessed at
http://www.mapsofworld.com/usa/]

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[2] Risk for infants
Date: Mon 12 Jun 2017 4:41 AM ET
Source: NPR [edited]
http://www.npr.org/sections/goatsandsoda/2017/06/12/532083664/is-zika-da...

Zika may have fallen from headlines but the threat remains.

And recommendations for pregnant women haven't changed: Pregnant women -- and those trying to get pregnant -- should not travel to places where the Zika virus is circulating. It's just too risky because Zika can cause birth defects.

But what about babies? Or kids? Is it safe to travel with them?
"So we don't have tons of data on that particular question," says Dr Neil Silverman, at the Center for Fetal Medicine in Los Angeles. But, he says, doctors can offer some recommendations based on what's known about how Zika damages developing brains The biggest concern is with infants. "I would not take a small newborn -- under 6 months -- to a country at risk for Zika," Silverman says.

Several studies have shown that Zika can damage a fetus's brain in the 3rd trimester. "Even when a mother is infected late in pregnancy, adverse outcomes can occur," Silverman says.

A newborn's brain, at least in terms of development, is similar to that of fetuses late in the 3rd trimester.

The problem is that Zika attacks developing brain cells. They're called neural progenitor cells. And newborns' brains are filled with them, just like the brains of fetuses late in pregnancy. "So I don't think any of us know quite yet what the break point is from being a newborn or a late pregnancy fetus in terms of Zika's risk," Silverman adds. By about age 2, many of these developing brain cells are gone. "And the majority of brain development has already occurred," Silverman says.

So Zika's danger is likely reduced. "Kids older than 2 probably don't have any significantly higher risk than an adult who's not pregnant," Silverman says.

Several studies have supported this hypothesis. In particular, a study published in September followed 158 children, under age 18, with Zika. In all instances, kids had similar symptoms as seen in adults -- a rash, fever and joint pain. None of the children developed Guillain-Barre syndrome, which occurs rarely in Zika patients. [In that study,] 2 of the children were hospitalized. One was 4-years-old, and the other was only one-year-old. All the children recovered with no apparent long-term damage.

So when traveling with kids above age 2, Zika doesn't really add more risks, especially if you take a few precautions, says Dr Desiree LaBeaud, an infectious disease pediatrician at Stanford University, who studies mosquito-borne viruses.

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[The risk of adverse neurological effects of Zika virus infection of neonates has not been well documented, but the advice to avoid that risk offered above should be heeded. - Mod.TY]

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[3] Dysphagia in microcephalic infants
Date: August 2017 [ahead of print]
Source: Emerg Infect Dis. https://doi.org/10.3201/eid2308.170354 [edited]
https://wwwnc.cdc.gov/eid/article/23/8/17-0354_article#suggestedcitation

Ref. Leal MC, van der Linden V, Bezerra TP, de Valois L, Borges ACG, Antunes MMC, et al. Characteristics of dysphagia in infants with microcephaly caused by congenital Zika virus infection, Brazil, 2015.

Abstract

We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe.

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[A range of physical consequences of teratogenic effects on infants that survive Zika virus infection is beginning to emerge. The social and economic impacts on affected families must be considerable. - Mod.TY]

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[4] Virus load and pregnancy outcomes
Date: Tue 23 May 2017
Source: Clin Infect Dis 2017 cix472. doi: 10.1093/cid/cix472 [edited]
https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/cix472/384...

UA Halai, M.D., K Nielsen-Saines, M.D., ME Moreira, M.D., Ph.D., et al. Maternal Zika Virus Disease Severity, Virus Load, Prior Dengue Antibodies and their Relationship to Birth Outcomes.

Abstract

Background:
Congenital Zika virus (ZIKV) syndrome is a newly identified condition resulting from infection during pregnancy. We analyzed outcome data from a mother-infant cohort in Rio de Janeiro in order to assess whether clinical severity of maternal ZIKV infection was associated with maternal virus load, prior dengue antibodies or abnormal pregnancy/infant outcomes.

Methods:
A clinical severity assessment tool was developed based on duration of fever, severity of rash, multisystem involvement and duration of symptoms during ZIKV infection. ZIKV-RNA load was quantified by PCR cycles in blood/ urine. Dengue IgG antibodies were measured at baseline. Adverse outcomes were defined as fetal loss or a live infant with grossly abnormal clinical or brain imaging findings. Regression models were used to study potential associations.

Results:
131 ZIKV-PCR positive pregnant women were scored for clinical disease severity, 6 (4.6 percent) had mild disease, 98 (74.8 percent) had moderate disease and 27 (20.6 percent) severe manifestations of ZIKV infection. There were 58 (46.4 percent) abnormal outcomes with 9 fetal losses (7.2 percent) in 125 pregnancies. No associations were found between: disease severity and abnormal outcomes (p=0.961; OR:1.00; 95 percent CI: 0.796- 1.270); disease severity and viral load (p = 0.994); viral load and adverse outcomes (p=0.667; OR:1.02; 95 percent CI: 0.922- 1.135); or existence of prior dengue antibodies (88 percent subjects) with severity score, ZIKV-RNA load or adverse outcomes (p = 0.667; OR 0.78; 95 percent CI : 0.255 - 2.397).

Conclusions:
Congenital ZIKV syndrome does not appear to be associated with maternal disease severity, ZIKV-RNA load at time of infection or existence of prior dengue antibodies.

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and
Roland Hübner
Superior Health Council
Brussels
Belgium

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[5] Fetal brain imaging
Date: Tue 6 Jun 2017
Source: Obstetrics & Gynecology doi: 10.1097/AOG.0000000000002105 [edited]
http://journals.lww.com/greenjournal/Abstract/publishahead/Serial_Head_a...

Parra-Saavedra, Miguel MD, PhD; Reefhuis, Jennita PhD; Piraquive, Juan Pablo MD, et al. Serial Head and Brain Imaging of 17 Fetuses With Confirmed Zika Virus Infection in Colombia, South America.

Abstract

Objective: To evaluate fetal ultrasound and magnetic resonance imaging findings among a series of pregnant women with confirmed Zika virus infection to evaluate the signs of congenital Zika syndrome with respect to timing of infection.
Methods: We conducted a retrospective case series of pregnant women referred to 2 perinatal clinics in Barranquilla and Ibague, Colombia, who had findings consistent with congenital Zika syndrome and Zika virus infection confirmed in maternal, fetal, or neonatal samples. Serial ultrasound measurements, fetal magnetic resonance imaging results, laboratory results, and perinatal outcomes were evaluated.
Results: We describe 17 cases of confirmed prenatal maternal Zika virus infection with adverse fetal outcomes. Among the 14 symptomatic women, the median gestational age for maternal Zika virus symptoms was 10 weeks (range 7-14 weeks of gestation). The median time between Zika virus symptom onset and microcephaly (head circumference less than 3 standard deviations below the mean) was 18 weeks (range 15-24 weeks). The earliest fetal head circumference measurement consistent with microcephaly diagnosis was at 24 weeks of gestation. The earliest sign of congenital Zika syndrome was talipes equinovarus [club foot], which in 2 patients was noted 1st at 19 weeks of gestation. Common findings on fetal magnetic resonance imaging were microcephaly, ventriculomegaly [hydrocephalus], polymicrogyria [too many brain folds, and the folds are unusually small], and calcifications.

Conclusion: Our analysis suggests a period of at least 15 weeks between maternal Zika virus infection in pregnancy and development of microcephaly and highlights the importance of serial and detailed neuroimaging.

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[6] Ultrasound imaging
Date: Tue 13 Jun 2017
Source: The Lancet: Child and Adolescent Health DOI: http://dx.doi.org/10.1016/S2352-4642(17)30001-9 [edited]
http://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(17)30001-9/fulltext

Bruno Schaub, MD, Michèle Gueneret, MD, Eugénie Jolivet, MD, Valérie Decatrelle, MW, et al. Ultrasound imaging for identification of cerebral damage in congenital Zika virus syndrome: a case series.

Summary

Background
Zika virus is a novel teratogenic agent associated with cerebral anomalies. Because of the challenges associated with assessment of antenatal diagnosis and prognosis in fetuses, screening for other congenital infections mostly relies on ultrasound. We aimed to assess whether a similar approach might be adequate for Zika virus congenital syndrome provided that early markers of infection and adequate timing for screening are established.

Methods
For this case series we reviewed all pregnant women who had a laboratory-confirmed Zika virus infection in their 1st trimester or early 2nd trimester and abnormal fetal ultrasound findings who were managed at the Pluridisciplinary Center for Prenatal Diagnosis of Martinique during the Zika virus epidemic (1 Jan - 10 Nov 2016) in Martinique, a French Caribbean island. Ultrasound imaging was done with GE Healthcare Voluson E10 and E8 machines with abdominal and vaginal probes.

Findings
We analyzed 14 cases of pregnant women with confirmed Zika virus infection and fetal abnormalities of the brain, and 31 ultrasound imaging results. Between 16 - 20 weeks of gestation, 4 (33 percent) of 12 fetuses had an abnormal ultrasound examination. Anomalies were detected in 9 (90 percent) of the 10 fetuses from whom ultrasound images were obtained between 20 - 24 weeks of gestation. All 5 remaining fetuses at 24-28 weeks of gestation, and all 4 after 28 weeks, had severe anomalies. Major anomalies identified were ventriculomegaly (12 fetuses, 86 percent), cortical atrophy (11, 79 percent), calcifications (10, 71 percent); particularly located at the corticosubcortical junction), and anomalies of the corpus callosum (ten, 71 percent). Prenatal assessment of head circumference measurement by imaging was not an effective screening tool for congenital Zika virus infection, with microcephaly only identified in 9 (64 percent) fetuses.

Interpretation
Ultrasound monitoring appears to be a good screening strategy to monitor Zika virus-exposed pregnancies. Public health efforts should focus on scanning at 22-26 weeks of gestation. Identification of ventriculomegaly, cortical atrophy, calcifications, and anomalies of the corpus callosum should prompt laboratory screening for Zika virus.

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[

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/52913.]

See Also

Zika virus (12): Americas, Asia, research, observations 5099103
Zika virus (11): Americas, research, observations 20170604.5083731
Zika virus (10): Americas, Asia, Middle East, research 20170529.5069572
Zika virus (09): Americas, Asia, Europe, research, observations 20170517.5043638
Zika virus (08): Americas, Asia, research, observations 20170501.5005629
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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