ZIKA VIRUS (15) - AMERICAS, RESEARCH, OBSERVATIONS

Posted on 06TH JUL 2017
tagged Zika Virus, Americas

A ProMED-mail post
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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.
Mexico and Central America
---
Mexico:
- Jalisco state
- Tamaulipas state

Imported cases with little or no possibility of ongoing mosquito transmission
---
USA:
- Case numbers mainland
- Florida economic loss
- Kansas vector mosquitoes
- Territories and Commonwealth

[2] Situation in the Americas
[3] Sexual transmission, monkeys
[4] No dengue antibody ADE with Zika virus
[5] Zika virus tropism
[6] Case definition

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[1] Cases in various countries
WHO Tool Kit for the care and support of people affected by complications associated with Zika virus is available at http://www.who.int/mental_health/neurology/zika_toolkit/en/

Americas
---
Americas cumulative case numbers
As of 29 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 / 5033 / 0 / 80

Latin America:
Mexico / 0 / 8864 / 15 / 0 / 5

Central American Isthmus:
Belize / 1294 / 206 / 0 / 0 / 0
Costa Rica / 6508 / 1833 / 32 / 0 / 6
El Salvador / 11 594 / 51 / 0 / 0 / 4
Guatemala / 3723 / 966 / 0 / 0 / 140
Honduras / 32 130 / 302 / 0 / 0 / 4
Nicaragua / 0 / 2060 / 3 / 0 / 2
Panama / 4307 / 985 / 42 / 0 / 9

Latin Caribbean:
Cuba / 0 / 187/ 58 / 0 / 0
Dominican Republic / 4909 / 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 / 40 357 / 137 / 5 / 42
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 / 681 / 7 / 0 / 0
Bahamas / 440 / 25 / 3/ 0 / 0
Barbados / 705 / 150 / 0 / 0 / 1
Bonaire, St Eustatius and Saba / 235 / 437 / 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 / 253 / 149 / 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) / 1138 / 1019 / 2 / 0 / 0

Andean Area:
Bolivia / 2288 / 712 / 4 / 0 / 14
Colombia / 98 245 / 9802 / 0 / 0 / 171
Ecuador / 3842 / 1848 / 15 / 0 / 5
Peru / 6128 / 1283 / 22 / 0 / 0
Venezuela / 59 965 / 2413 / 0 / 0 / 0

[Brazil and] Southern Cone:
Brazil / 224 670 / 134 057 / 0 / 11 / 2775
Argentina / 869 / 126 / 40 / 0 / 2
Chile / 0 / 0 / 34 / 0 / 0
Paraguay / 666 / 16 / 0 / 0 / 2
Uruguay / 0 / 0 / 1 / 0 / 0

Totals, Americas / 567 767 / 213 706 / 5988 / 20 / 3379

[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.

Mexico and Central America
---
Mexico:
- Jalisco state. 26 Jun 2017. (registered) 12 cases.
http://wradio.com.mx/emisora/2017/06/26/guadalajara/1498513259_758799.html [in Spanish]

- Tamaulipas state. 23 Jun 2017. (conf.) 17 cases; Sanitary jurisdictions most involved: Matamoros, Valle Hermoso, Tampico, Reynosa, Victoria, Padilla, San Fernando.
https://www.elmanana.com/lideranreynosaytampicoendengue-3828410.html [in Spanish]

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 - 28 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 15 / 1
Colorado 3 / 0
Connecticut 0 / 0
Delaware 0 / 0
District of Columbia 0 / 0
Florida 16 / 3
Georgia 1 / 0
Hawaii 1 / 0
Idaho 0 / 0
Illinois 3/ 0
Indiana 1 / 0
Iowa 1 / 0
Kansas 2 / 0
Kentucky 1 / 0
Louisiana 1 / 0
Maine 1 / 0
Maryland 5/ 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 27 / 1
North Carolina 3 / 0
North Dakota 0 / 0
Ohio 3 / 0
Oklahoma 0 / 0
Oregon 2 / 0
Pennsylvania 4/ 1
Rhode Island 3 / 0
South Carolina 2 / 0
South Dakota 0 / 0
Tennessee 0 / 0
Texas 12 / 1
Utah 0 / 0
Vermont 3 / 0
Virginia 3 / 0
Washington 2 / 0
West Virginia 0 / 1
Wisconsin 2 / 0
Wyoming 2 / 0
Totals 143 / 8

- Florida economic loss. 27 June 2017. (reported) Some Wynwood businesses in the Zika virus transmission zone in 2016 in Miami saw revenue and profit dip by as much as 40 percent, according to a new study by Florida International University's Robert Stempel College of Public Health and Social Work. According to the study, 91 percent of businesses studied experienced loss of revenue and profits compared to the same time in 2015. The majority, 53 percent, saw losses of 21 to 30 percent. About 13 percent of businesses experienced declines as high as 31 to 40 percent.
http://www.miamiherald.com/news/business/article158512584.html

- Kansas vector mosquitoes. 26 Jun 2017. (conf.) _Aedes albopictus_ reported for the 1st time in 38 counties; _Ae. aegypti_ has been found in 4 counties in the upper northeastern part of the state.
http://www.gctelegram.com/news/state/mosquitoes-that-can-carry-zika-spre...

- Territories and Commonwealth with local transmission:
Symptomatic / Blood donors
American Samoa 3 / 0
Puerto Rico 473 / 3
US Virgin Islands 37/ 0
Total 513 / 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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ProMED-mail

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[2] Situation in the Americas
Date: Mon 1 May 2017
Source: Amer J Trop Med Hyg DOI: https://doi.org/10.4269/ajtmh.17-0207 [edited]
http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0207

Carissa Etienne, Thais dos Santos and Marcos A. Espinal. Zika Virus Disease in the Americas: A Storm in the Making.

Abstract
More than 700 000 cases of Zika virus (ZIKAV) disease have been officially reported to the Pan American Health Organization (PAHO) from 48 countries and territories of the Americas. The response led by the PAHO and partners suggests major lessons of this outbreak. A seemingly innocuous pathogen became the new villain, causing fear, economic losses and, most importantly, debilitating birth defects and neurological problems, reaffirming the well-known war principle of never to underestimate one's opponent. The ZIKAV tested public health capacities under the International Health Regulations, highlighting the need for continued investment in health security. Last but not least, the lack of appropriate tools was another reminder of the pressing need for innovative solutions to persistent problems. Latin America and the Caribbean have approximately 500 million persons living in areas at risk for transmission of ZIKAV. The fight against ZIKAV is not a 100-m race, but rather a marathon in which science and public health need to work hand in hand for the benefit of our peoples.

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Communicated by:
ProMED-mail

[In the Americas, the expansion of dengue fever over the past 4 decades, then the recent documented appearance of chikungunya virus and now Zika virus have rung the alarm bells for several decades up to the present time. For whom and for what will the alarm bells ring next time? One hopes that in the aftermath of the Zika virus outbreak, an effective system of surveillance, timely epidemiological field work, all supported by laboratories, will remain in place. Institution memory and political commitment tends to fade in the absence of a crisis. Perhaps this time things will be different and sustainable. - Mod.TY]

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[3] Sexual transmission, monkeys
Date: August 2017 [ahead of print]
Source: Emerg Infect Dis. 23 (8) https://doi.org/10.3201/eid2308170036 DOI: 10.3201/eid2308.170036 [edited]
https://wwwnc.cdc.gov/eid/article/23/8/17-0036_article#suggestedcitation

Haddow AD, Nalca A, Rossi FD, Miller LJ, Wiley MR, Perez-Sautu U, et al. High infection rates for adult macaques after intravaginal or intrarectal inoculation with Zika virus.

Abstract
Unprotected sexual intercourse between persons residing in or traveling from regions with Zika virus transmission is a risk factor for infection. To model risk for infection after sexual intercourse, we inoculated rhesus and cynomolgus macaques with Zika virus by intravaginal or intrarectal routes. In macaques inoculated intravaginally, we detected viremia and virus RNA in 50 percent of macaques, followed by seroconversion. In macaques inoculated intrarectally, we detected viremia, virus RNA, or both, in 100 percent of both species, followed by seroconversion. The magnitude and duration of infectious virus in blood of macaques suggest humans infected with Zika virus through sexual transmission will likely generate viremias sufficient to infect competent mosquito vectors. Our results indicate that transmission of Zika virus by sexual intercourse might serve as a virus maintenance mechanism in the absence of mosquito-to-human transmission and could increase the probability of establishment and spread of Zika virus in regions where this virus is not present.

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ProMED-mail

[As the authors point out, in an environment where active mosquito transmission of Zika virus is occurring, it is difficult to determine what proportion of cases is due to sexual transmission and what proportion to mosquito transmission. It seems certain that the incidence of sexual Zika virus transmission is underestimated. - Mod.TY]

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[4] No dengue antibody ADE with Zika virus
Date: Fri 23 Jun 2017 [ahead of print]
Source: Nature Communications doi:10.1038/ncomms15674 [edited]
https://www.nature.com/articles/ncomms15674#auth-1

Petraleigh Pantoja, Erick X. Pérez-Guzmán, Idia V. Rodríguez, Laura J. White et al. Zika virus pathogenesis in rhesus macaques is unaffected by pre-existing immunity to dengue virus.

Zika virus (ZIKV) is a re-emerging virus that has recently spread into dengue virus (DENV) endemic regions and cross-reactive antibodies (Abs) could potentially affect ZIKV pathogenesis. Using DENV-immune serum, it has been shown in vitro that antibody-dependent enhancement (ADE) of ZIKV infection can occur. Here we study the effects of pre-existing DENV immunity on ZIKV infection in vivo. We infect 2 cohorts of rhesus macaques with ZIKV; one cohort has been exposed to DENV 2.8 years earlier and a 2nd control cohort is naïve to flaviviral infection. Our results, while confirming ADE in vitro, suggest that pre-existing DENV immunity does not result in more severe ZIKV disease. Rather our results show a reduction in the number of days of ZIKV viremia compared to naïve macaques and that the previous exposure to DENV may result in modulation of the immune response without resulting in enhancement of ZIKV pathogenesis.

Discussion
It would be interesting to know whether ADE predisposes utero infection and congenital malformations. Although that is not the focus of this study, our results provide valuable clues that the pre-existence of a long-term immune response to DENV neither enhances the peak of ZIKV viremia nor impairs the course of its infection. In addition, we show that the pre-existing immunity to DENV tends to modulate the innate, humoral and T-cell immune responses. Because fetal abnormalities have been associated with prolonged ZIKV viremia, and more recently, higher viremia has been linked to invasion of the central nervous system (CNS) in macaques, results from our work may suggest that pregnant women with previous exposure to DENV may have limited ZIKV viremia and less tendency to have invasion of CNS. These inferences invigorate the need for further direct and in-depth investigations. Our results reinforce the value of NHP model to understand the complex serological interaction among flaviviruses and to support the design of effective flavivirus vaccines.

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ProMED-mail

[It would be interesting to have follow up studies with pregnant monkeys to confirm the author's suggestions that viremia would be suppressed and risk of infection of the placenta and fetus reduced. - Mod.TY]

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[5] Zika virus tropism
Date: Fri 23 Jun 2017
Source: Acta Neuropathologica CommunicationsNeuroscience of Disease20175:50 DOI: 10.1186/s40478-017-0450-8 [edited]
https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-017-0450-8

Stephanie L. Cumberworth, Jennifer A. Barrie,, Madeleine E. Cunningham, Daniely Paulino Gomes de Figueiredo, et al. Zika virus tropism and interactions in myelinating neural cell cultures: CNS cells and myelin are preferentially affected.
Abstract

The recent global outbreak of Zika virus (ZIKV) infection has been linked to severe neurological disorders affecting the peripheral and central nervous systems (PNS and CNS, respectively). The pathobiology underlying these diverse clinical phenotypes are the subject of intense research; however, even the principal neural cell types vulnerable to productive Zika infection remain poorly characterized. Here we used CNS and PNS myelinating cultures from wild type and Ifnar1 knockout mice to examine neuronal and glial tropism and short-term consequences of direct infection with a Brazilian variant of ZIKV. Cell cultures were infected pre-or post-myelination for various intervals, then stained with cell-type and ZIKV-specific antibodies. In bypassing systemic immunity using ex vivo culture, and the type I interferon response in Ifnar1 deficient cells, we were able to evaluate the intrinsic infectivity of neural cells. Through systematic quantification of ZIKV infected cells in myelinating cultures, we found that ZIKV infection is enhanced in the absence of the type I interferon responses and that CNS cells are considerably more susceptible to infection than PNS cells. In particular, we demonstrate that CNS axons and myelinating oligodendrocytes are especially vulnerable to injury. These results have implications for understanding the pathobiology of neurological symptoms associated with ZIKV infection. Furthermore, we provide a quantifiable ex vivo infection model that can be used for fundamental and therapeutic studies on viral neuroinvasion and its consequences.

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[Advances in the pathophysiology of Zika virus infection at the celular level are providing model systems that can lead to effective therapeutics. The road to success is likely to be a long one, but the journey has begun. - Mod.TY]

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[6] Case definition
Date: Mon 26 Jun 2017
Source: PloS 1 https://doi.org/10.1371/journal.pone.0179725 [edited]
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179725

José Ueleres Braga, Clarisse Bressan, Ana Paula Razal Dalvi Guilherme Amaral Calvet, Regina Paiva Daumas, et al. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics.

Abstract
Background
Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic.

Methodology
We evaluated the accuracy of various Zika case definitions in a scenario where dengue and chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features.

Results and discussion
Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86.6 percent and 78.3 percent, respectively. This Zika case definition also had the highest values for auROC (0•903) and R ^2 (0•417), and the lowest Brier score 0•096.

Conclusions
In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.

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Communicated by:
ProMED-mail

[This study was based on 659 participating subjects, of whom 138 were PCR positive for Zika virus, 113 for dengue viruses and 45 for chikungunya virus. The remaining cases were classified as other febrile illnesses. It will be interesting to see if the Zika virus infection case definition holds up over time with a larger series of cases due to infection by the 3 viruses. - Mod.TY]

[

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

See Also

Zika virus (14): Americas, Asia, research, observations 20170623.5127418
Zika virus (13): Americas, research, observations 20170617.5112404
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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