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WHO rejects call for Rio Olympic Games to be moved or postponed, despite outbreak of Zika virus in Brazil

The World Health Organization (WHO) has rejected a call for the Rio Olympic Games to be moved or postponed despite the threat posed by the outbreak of Zika virus in Brazil.

WHO public health advice regarding the Olympics and Zika virus: News Release

Based on current assessment, cancelling or changing the location of the 2016 Olympics will not significantly alter the international spread of Zika virus. Brazil is 1 of almost 60 countries and territories which to date report continuing transmission of Zika by mosquitoes. People continue to travel between these countries and territories for a variety of reasons. The best way to reduce risk of disease is to follow public health travel advice.

Based on the current assessment of Zika virus circulating in almost 60 countries globally and 39 in the Americas, there is no public health justification for postponing or cancelling the games,” the WHO said in a statement.

The statement is in response to a letter signed by a group of at least 152 doctors, researchers, and health professionals to the United Nations health agency calling for the Rio Olympics to be postponed or moved because of concerns of the spread of the Zika virus.

“Our greater concern is for global health. The Brazilian strain of Zika virus harms health in ways that science has not observed before,” states the letter, signed by experts in the United States, India, Canada, Britain, Australia, Norway, the Philippines, Russia, South Africa, Switzerland, Taiwan and Brazil, among others.

“An unnecessary risk is posed when 500,000 foreign tourists from all countries attend the Games, potentially acquire that strain, and return home to places where it can become endemic,” it said.

“Should that happen to poor, as-yet unaffected places (e.g., most of South Asia and Africa) the suffering can be great.”

“… the Brazilian viral strain causes microcephaly and probably Guillain-Barré syndrome. Further, because human, animal and in vitro studies demonstrate that the virus is neurotrophic and causes cell death, it is biologically plausible that there are other as yet undiscovered neurological injuries, as exist for similar viruses (e.g. dengue). [… ] That while Zika’s risk to any single individual is low, the risk to a population is undeniably high. Currently, Brazil’s government reports 120,000 probable Zika cases,9 and 1,300 confirmed cases of microcephaly (with another 3,300 under investigation)10, which is above the historical level of microcephaly. […] Rio de Janeiro is highly affected by Zika. Brazil’s government reports Rio de Janeiro state has the second-highest number of probable Zika cases in the country (32,000)… and the fourth-highest incidence rate (195 per 100,000), demonstrating active transmission. […] despite Rio’s new mosquito-killing program, the transmission of mosquito-borne disease has gone up rather than down. While Zika is a new epidemic and lacks historical data, using dengue fever as a proxy, cases in Rio from January thru April 2016 are up 320% and 1150% over the same periods in 2015 and 2014, respectively.”

“It is indisputable that option (a) of holding the Games as scheduled has a greater risk of accelerating the spread of the Brazilian viral strain than the alternatives. Postponing and/or moving the Games also mitigates other risks brought on by historic turbulence in Brazil’s economy, governance, and society at large—which are not isolated problems, but context that makes the Zika problem all but impossible to solve with the Games fast approaching.”

The Letter questions whether the UN health agency can give a non-biased view of the situation because of its “secret” high – level partnership with the International Olympic Committee.

WHO and IOC in Partnership

WHO has a decades – long, high – level partnership with the International Olympic Committee. That partnership was last affirmed in 2010 at an event where the Director General of WHO and President of the IOC signed a Memorandum of Understanding, which is secret because neither has disclosed it.

Inappropriately, WHO sees its role as not just providing public health advice. It established a “Virtual Interdisciplinary Advisory Group”, whose “ important promotional point,” according to WHO is “that the Group can help in bidding for major events (like the Olympic Games)”.  That is a clear conflict of interest, when WHO must also evaluate and make recommendations about Olympic travel during a Public Health Emergency of International Concern (PHEIC).

The overly close relationship between WHO and the IOC is apparent in the comments of WHO’s Executive Director responsible for Zika, just days after it was declared a PHIEC:

“Brazil is going to have a fantastic Olympics and it’s going to be a successful Olympics and the world is going to go there. I just wish I was going there, but there’s not going to be a lot of problems there by then. ”

With respect, this is a troubling statement. WHO cannot credibly assess the public health risks of Zika and the Olympics when it sets neutrality aside. Declaring that “it’s going to be a successful Olympics and the world is going to be there” implies that WHO has given the Olympics an unconditional green light, without regard to rapidly emerging medical, entomological, and epidemiological evidence — all of which must be considered in assessing whether this mass gathering could accelerate the global spread of the Brazilian strain of Zika virus. To prejudge that “there’s not going to be a lot of problems” before reviewing this evidence is extremely inappropriate of WHO, and suggests that a change in leadership may be required to restore WHO’s credibility.

ZIKV Transmission Documented in 55 Countries and Territories

Geographical distribution of Zika virus steadily widening

A total of 55 countries and territories have documented Zika virus transmission between 1 January 2007 and 3 March 2016.

• Colombia reported 42,706 suspected cases of ZIKV btween  1 October 2015 and 20 February 2016, with 1,612 cases confirmed.

• Starting 2007, locally acquired Zika cases have been reported in 15 countries and territories in the Western Pacific Region.
  • Four Pacific Island countries and areas (American Samoa, Marshall Islands, Samoa and Tonga) have reported Zika infections in 2016.
  • Nauru has declared Zika virus as a national emergency of concern for purposes of preparedness, but to date no Zika virus cases have been reported.

• Between 1 October 2015 and 7 February 2016, Cabo Verde (African region), reported 7,325 suspected cases of Zika virus disease (two cases have been confirmed, so far).
  • The outbreak peaked during the week of 22 November 2015 and has been in decline since then; 44 cases were reported in the week up to 21 February 2016. The number of suspected cases of Zika virus disease reported each week in Praia (light blue) and other municipalities (dark blue) of Cabo Verde (Fi g. 4).
  • The outbreak appears to have begun in Praia and then spread to other municipalities. Preliminary information, subject to confirmation, indicates that this outbreak has been caused by an African strain of Zika virus.
  • No neurological abnormalities have been reported.

Incidence of microcephaly

• Between 22 October 2015 and 27 February 2016 a total of 5,909 cases of microcephaly and/or central nervous system (CNS) malformation were reported by Brazil including 139 deaths including miscarriage or stillbirth. [Previously an average of 163 microcephaly cases was recorded nationwide.]
  • 31 of these were confirmed as having microcephaly and/or CNS malformation potentially linked to congenital Zika virus infection, 96 remain under investigation and 12 were discarded.
  • The reported increase in microcephaly incidence in Brazil is concentrated in the Northeast Region.

• An outbreak of Zika virus in French Polynesia was followed by an increase in the number of CNS malformations in children born between March 2014 and May 2015. A total of 19 cases were reported including eight microcephaly cases compared to the national average of 0 – 2 cases per year.

• Zika virus is not yet proven to be a cause of the increased incidence of microcephaly in Brazil. However, (i) given the temporal and geographical associations between Zika virus infections and microcephaly, (ii) the repeated discovery of virus in fetal brain tissue, and (iii) in the absence of a compelling alternative hypothesis, a causal role for Zika virus is a strong possibility that is under active investigation, says WHO.

Incidence of Guillain – Barré syndrome (GBS)

In the context of Zika virus circulation, nine countries or territories have reported increased GBS incidence and/or laboratory confirmation of a Zika virus infection among GBS cases.

• Reported increase in incidence of GBS cases, with no GBS cases biologically documented of Zika virus infection: El Salvador and Colombia.

• Reported increase in incidence of GBS cases, with at least one GBS case confirmed with previous Zika virus infection: Brazil, French Polynesia, Suriname and Venezuela.

• No increase in GBS incidence reported but at least one GBS case confirmed with previous Zika virus infection: Martinique, Panama and Puerto Rico.

Between October 2013 and April 2014, French Polynesia experienced the first Zika virus outbreak ever recorded in the country. During the outbreak, 42 patients were admitted to hospital with GBS. This represents a 20 – fold increase in incidence of GBS in French Polynesia compared with the previous four years.

• Of the 42 patients, 16 (38%) required admission to an intensive care unit and 12 (29%) received mechanical ventilation. No deaths were reported.

• The majority of these cases (88%) reported symptomatic Zika virus infection in the days that preceded the onset of neurological symptoms. A recently published formal analysis of these data (case – control study) showed a strong association between Zika infection and GBS .

• This study is the first large observational study to compare exposure to Zika virus among people with and without GBS and provides important information about the causal role of Zika infection.

• In 2015 in the state of Bahia in Brazil, 42 GBS cases were reported, among which 26 (62%) had a history of symptoms consistent with Zika virus infection. A total of 1,708 cases of GBS were registered nationwide, representing a 19% increase from the previous year (1,439 cases of GBS in 2014), though not all states reported an increase in incidence.

• In Colombia, 201 GBS cases with a history of suspected Zika virus infection were reported in the nine weeks to 14 February 2016. Most of the cases are from Norte de Santander and Barranquilla – areas where many of the Zika virus cases have been registered.

• To date, none of the cases of GBS have been laboratory confirmed for Zika virus infection, or other possible causes, and the patterns of infection and disease by age and sex need confirmation.

Additional information [sourced from who]

Zika Virus

Zika virus disease is caused by a virus transmitted by Aedes mosquitoes. Other transmission modes are still under investigation. People with Zika virus disease usually have a mild fever, skin rash (exanthema), and conjunctivitis. These symptoms normally last f or 2 – 7 days. At present there is no specific treatment or vaccine currently available. The best form of prevention is protection against mosquito bites. Zika virus is known to circulate in Africa, the Americas, Asia, and the Pacific region. Zika virus had only been known to cause sporadic infections in humans until 2007, when an outbreak in Micronesia infected 31 people.

Microcephaly

Microcephaly is an uncommon condition where a baby’s head circumference is less than expected based on the average for their age and sex. The condition is usually a result of the failure of the brain to develop properly, and can be caused by genetic or environmental factors such as exposure to toxicins, radiation, or infection during development in the womb. Microcephaly can be present as an isolated condition or may be associated with other symptoms such as convulsions, developmental delays, or feeding difficulties.

Guillain – Barré syndrome

Guillain – Barré syndrome in its typical form is an acute illness of the nerves that produces a lower, bilateral, and symmetrical sensorimotor development deficit. In many cases there is a history of infection prior to the development of the Guillain – Barré syndrome. The a nnual incidence of GBS is estimated to be between 0.4 and 4.0 cases per 100,000 inhabitants per year. In North America and Europe GBS is more common in adults and increases steadily with age. Several studies indicate that men tend to be more affected than women.

Resources from WHO

Zika virus http://www.who.int/mediacentre/factsheets/zika

Microcephaly http://www.who.int/emergencies/zi ka – virus/microcephaly/en/

Guillain – Barré syndrome http://www.who.int/mediacentre/factsheets/guillain – barre – syndrome/en/

Infants with microcephaly http://www.who.int/csr/resources/publications/zika/assessment – infants/en/

Guillain – Barré syndrome http://www.who.int/csr/resources/publications/zika/guillain – barre – syndrome/en/

Breastfeeding http://www.who.int/csr/resources/publications/zika/breastfeeding/en/

Sexual transmission http://who.int/csr/resources/publications/zika/sexual – transmission – prevention/en/

Vector control http://www.who.int/emergencies/zika – virus/articles/mosquito – control/en/

Blood safety http://who.int/csr/resources/publica tions/zika/safe – blood/en/index.html

Eighth ZIKV Case Confirmed in Australia

ZIKV infected man staying in area infested with Aedes aegypti mosquitoes

Authorities are on high alert in Queensland, Australia after the eighth person in the country contracted Zika virus.

A Rockhampton man has become the eighth Queenslander to be diagnosed with Zika virus, but is the first to have brought it back to an area inhabited by the type of mosquito that could spread it.

Aedes aegypti mosquitoes, the main Zika vector, have been found around the hotel in Rockhampton where the infected patient is staying, prompting the health alert.

“This is the most concerning case of Zika so far in Queensland because it’s someone who has the virus in an area where there is the mosquito capable of transmitting the virus,” said Queensland Health Minister.

Authorities are now spraying chemicals designed to kill mosquitoes in a 200-meter radius of the hotel, said a report.

*

State of Emergency Declared in Hawaii over Mosquitoes

Mosquitoes Become Enemy No. 1 in Hawaii

Hawaii Gov. Ige has declared a state of emergency to prevent the spread of mosquito-borne diseases, like the dengue outbreak on Hawaii Island.

“There have been no locally acquired Zika cases in the U.S. or Hawai‘i, and we’d like to keep it that way,” said Ige in a statement. “This is about getting in front of the situation across the state. I will be coordinating planning efforts with the Hawai‘i Emergency Management Agency, all county mayors and Civil Defense coordinators.”

The Department of Health has identified a new case of dengue fever, bringing the total to 255 since the outbreak began in September 2015. “On Hawai‘i Island, dengue fever cases continue to be fewer and farther between. However, the battle is not over and state continues to focus resources to break the cycle of dengue fever infection and transmission,” officials said.

Dengue Fever and Zika virus (ZIKV) share the same vector, mosquitoes of Aedes species (A. Aegypti & A. albopictus), and public health officials are concerned ZIKV could make its way to the Aloha State.

The same mosquitoes are also responsible for the spread chikungunya viruses.

Aedes aegypti mosquito

Aedes albopictus mosquito

 

FIRE-EARTH expects the Gulf of Mexico Border States to also declare states of emergency over the mosquitoes in the near future.

Related Links

• ZIKV Infection: Local Transmission in United States February 13, 2016
• State of Emergency Declared in Hawaii over Dengue Fever February 9, 2016

ZIKV Infection: Local Transmission in United States

ZIKV infection: Increased risk of fetal microcephaly, Guillain-Barré syndrome —CDC

Aedes aegypti, the most common mosquito vector of ZIKV globally, is present in Puerto Rico. Therefore, the virus is expected to continue to spread throughout Puerto Rico, posing risk of infection to 3.5 million residents, including about 43,000 pregnant women per year.

The first locally acquired case of Zika virus disease in Puerto Rico was identified in early December 2015, and 29 additional laboratory-confirmed cases have been detected since, including in one pregnant woman and in a man with Guillain-Barré syndrome.

Zika virus, a mosquito-borne flavivirus, spread to the Region of the Americas (Americas) in mid-2015, and appears to be related to congenital microcephaly and Guillain-Barré syndrome (1,2). On February 1, 2016, the World Health Organization (WHO) declared the occurrence of microcephaly cases in association with Zika virus infection to be a Public Health Emergency of International Concern. On December 31, 2015, Puerto Rico Department of Health (PRDH) reported the first locally acquired (index) case of Zika virus disease in a jurisdiction of the United States in a patient from southeastern Puerto Rico. During November 23, 2015–January 28, 2016, passive and enhanced surveillance for Zika virus disease identified 30 laboratory-confirmed cases. Most (93%) patients resided in eastern Puerto Rico or the San Juan metropolitan area. The most frequently reported signs and symptoms were rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three (10%) patients were hospitalized. One case occurred in a patient hospitalized for Guillain-Barré syndrome, and one occurred in a pregnant woman. [CDC]

Clinicians in Puerto Rico are now required to report all cases of microcephaly, Guillain-Barré syndrome, and suspected Zika virus infection to PRDH. “Other adverse reproductive outcomes, including fetal demise associated with Zika virus infection, should be reported to PRDH.”

Index case. The first case of Zika virus disease identified in Puerto Rico occurred in a man aged 80 years with multiple chronic medical conditions, who reported onset of symptoms on November 23, 2015.

Eight days after illness onset, he was evaluated in a hospital emergency department for progressive weakness after several days of watery, nonbloody diarrhea, recent episodes of falling, shoulder pain, chills, malaise, and abdominal pain. He did not report myalgia, headache, or retro-orbital pain. He was febrile, tachycardic, tachypneic, and hypotensive, with bilateral erythematous sclera. Laboratory results revealed leukocytosis with a predominance of neutrophils; hemoconcentration; thrombocytopenia; elevated serum transaminases, blood urea nitrogen, and creatinine; hyponatremia; and hypoglycemia. He received a diagnosis of sepsis, was admitted to the intensive care unit for fluid resuscitation and monitoring, and was treated with broad spectrum antibiotics. Diagnostic considerations included leptospirosis and dengue. He experienced respiratory decompensation requiring intubation and 5 days of mechanical ventilation. He was hospitalized for 2 weeks, during which time he underwent an extensive evaluation. Blood and stool cultures were negative, as were serologic tests for human immunodeficiency virus, Leptospira, and Strongyloides. Schistosoma immunoglobulin G titers were elevated, for which praziquantel was administered. On December 2, serum was collected for dengue and chikungunya diagnostic testing, and was positive for anti-dengue virus IgM, negative for anti-chikungunya virus IgM, and negative for detection of dengue virus and chikungunya virus RNA. Because a hospital-based enhanced surveillance protocol was in place for detection of Zika virus, the same serum specimen was tested for Zika virus infection by RT-PCR with a positive result. Confirmatory molecular diagnostic testing was performed at CDC. Detection of anti-dengue virus IgM antibody likely was a result of cross-reactive anti-Zika virus IgM antibody. Although no pathogen other than Zika virus was identified, the patient’s clinical course suggests that he also had an occult bacterial infection. Read more…

Suggested citation: Thomas DL, Sharp TM, Torres J, et al. Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–6. DOI: http://dx.doi.org/10.15585/mmwr.mm6506e2er

Disease Outbreak News – 12 February 2016  – Mirrored from WHO

Sexually transmitted ZIKV infection in Dallas, Texas

On 5 February 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of a probable case of sexual transmission of Zika virus.

Person A, a resident of Dallas, Texas, travelled to Venezuela for one week between late December and the beginning of January. Several days after returning to the United States, Person A developed symptoms consistent with Zika virus infection, including fever, rash, conjunctivitis, and malaise. One day prior to symptom onset and once during the symptomatic period, Person A had sex with Person B (non-traveller). Approximately one week after the onset of illness in Person A, Person B developed symptoms consistent with Zika virus disease, including fever, pruritic rash, conjunctivitis, small joint arthralgia and malaise.

Laboratory tests confirmed Zika virus infection in both Person A and Person B. Samples collected from Person A at 14 days after symptom onset and from Person B at 4 and 7 days after illness onset had evidence of Zika virus IgM and neutralizing antibodies. Additional tests are being carried out. Local meteorological conditions at the time would not have supported mosquito activity; furthermore, entomological sampling that was conducted in the concerned area yielded no mosquitoes. Read more…

Related Links

• Zika or Not? February 12, 2016

‘Evidence of Zika Virus Infection in Brain and Placental Tissues’

Morbidity and Mortality Weekly Report (MMWR)

Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015

The following are field notes from Brazil on ZIKV infection posted in the latest issue of CDC’s Morbidity and Mortality Weekly Report

Zika virus is a mosquito-borne flavivirus that is related to dengue virus and transmitted primarily by Aedes aegypti mosquitoes, with humans acting as the principal amplifying host during outbreaks. Zika virus was first reported in Brazil in May 2015 (1). By February 9, 2016, local transmission of infection had been reported in 26 countries or territories in the Americas.* Infection is usually asymptomatic, and, when symptoms are present, typically results in mild and self-limited illness with symptoms including fever, rash, arthralgia, and conjunctivitis. However, a surge in the number of children born with microcephaly was noted in regions of Brazil with a high prevalence of suspected Zika virus disease cases. More than 4,700 suspected cases of microcephaly were reported from mid-2015 through January 2016, although additional investigations might eventually result in a revised lower number (2). In response, the Brazil Ministry of Health established a task force to further investigate possible connections between the virus and brain anomalies in infants (3).

Since November 2015, CDC has been developing assays for Zika virus testing in formalin-fixed, paraffin-embedded (FFPE) tissue samples. In December 2015, FFPE tissues samples from two newborns (born at 36 and 38 weeks gestation) with microcephaly who died within 20 hours of birth and two miscarriages (fetal losses at 11 and 13 weeks) were submitted to CDC, from the state of Rio Grande do Norte in Brazil, for histopathologic evaluation and laboratory testing for suspected Zika virus infection. All four mothers had clinical signs of Zika virus infection, including fever and rash, during the first trimester of pregnancy, but did not have clinical signs of active infection at the time of delivery or miscarriage. The mothers were not tested for antibodies to Zika virus. Samples included brain and other autopsy tissues from the two newborns, a placenta from one of the newborns, and products of conception from the two miscarriages.

FFPE tissues were tested by Zika virus reverse transcription-polymerase chain reaction (RT-PCR) targeting the nonstructural protein 5 and envelope genes using general methods for RT-PCR (4), and by immunohistochemistry using a mouse polyclonal anti-Zika virus antibody, using methods previously described (5). Specific specimens from all four cases were positive by RT-PCR, and sequence analysis provided further evidence of Zika virus infection, revealing highest identities with Zika virus strains isolated from Brazil during 2015. In the newborns, only brain tissue was positive by RT-PCR assays. Specimens from two of the four cases were positive by immunohistochemistry: viral antigen was noted in mononuclear cells (presumed to be glial cells and neurons within the brain) of one newborn, and within the chorionic villi from one of the miscarriages. Testing for dengue virus was negative by RT-PCR in specimens from all cases.

For both newborns, significant histopathologic changes were limited to the brain, and included parenchymal calcification, microglial nodules, gliosis, and cell degeneration and necrosis. Other autopsy tissues and placenta had no significant findings. Tests for toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV were negative in the two mothers who experienced miscarriages. Placental tissue from one miscarriage showed heterogeneous chorionic villi with calcification, fibrosis, perivillous fibrin deposition, and patchy intervillositis and focal villitis, while tissue from the other miscarriage had sparsely sampled normal-appearing chorionic villi.

This report describes evidence of a link between Zika virus infection and microcephaly and fetal demise through detection of viral RNA and antigens in brain tissues from infants with microcephaly and placental tissues from early miscarriages. Histopathologic findings indicate the presence of Zika virus in fetal tissues. These findings also suggest brain and early gestational placental tissue might be the preferred tissues for postmortem viral diagnosis. Nonfrozen, formalin-fixed specimens or FFPE blocks are the preferred sample type for histopathologic evaluation and immunohistochemistry, and RT-PCR can be performed on either fresh frozen or formalin-fixed specimens. To better understand the pathogenesis of Zika virus infection and associated congenital anomalies and fetal death, it is necessary to evaluate autopsy and placental tissues from additional cases, and to determine the effect of gestational age during maternal illness on fetal outcomes.

Suggested citation for this article: Martines RB, Bhatnagar J, Keating MK, et al. Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2. DOI: http://dx.doi.org/10.15585/mmwr.mm6506e1er

Related Links

• Pharma Phleecing: It’s Déjà vu All Over Again! February 9, 2016
• Tonga Declares Zika Outbreak February 5, 2016
• Zika Virus Sold Online February 4, 2016
• ZIKV: Health Emergency Declared in 4 Florida Counties February 4, 2016

• ZIKV Update – Feb. 3, 2016 February 3, 2016
• Zika Virus Outbreak Result of Bioweapon? February 2, 2016

• WHO Declares Microcephaly Cluster a ‘Public Health Emergency of International Concern’  February 2, 2016
• ZIKV: Additional Information on Transmission January 29, 2016
• ZIKV: Media Sensationalism Forcing WHO to Overreact? January 28, 2016
• ZIKV: CDC Adds Two More Countries to Travel Warning List  January 27, 2016
• ZIKV Found in Australian Travelers Returning from S. America January 26, 2016

• ZIKV Emergency: New Warnings Issued by Colombia, Ecuador, El Salvador & Jamaica January 23, 2016

Additional Links

ZIKV

• CDC Issues Travel Warning as Zika Virus Epidemic Continues to Spread January 16, 2016
• Zika Virus: Coming to a Place Near You…  January 5, 2016
• Disasters/ Significant Events – Dec 25, 2015 Posted on December 25, 2015
• Most Dangerous Pathogens  December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects  December 4, 2015

DENGUE

• Latest Dengue Fever Outbreaks January 20, 2016
• Top Emerging Diseases Likely to Cause Major Epidemics December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects December 4, 2015
• Dengue Fever Kills 204 in Taiwan  December 16, 2015
• State of Emergency Declared in East Java  January 26, 2015
• Dengue Fever Outbreak Prompts State of Emergency in Brazil City  January 21, 2013
• State of emergency in Marshall Islands as dengue outbreak spirals  October 29, 2011
• Chikungunya Makes West Nile Look Like Nappy Rash  September 19, 2009

State of Emergency Declared in Hawaii over Dengue Fever

Dengue Fever and ZIKV share the same vector: mosquitoes of Aedes species

Hawaii County has declared a state of emergency amid the growing dengue fever outbreak in the state.

“A state of emergency for Hawaii County is authorized in order to prevent the continued spread of this outbreak and to eliminate the dengue fever virus from Hawaii Island,” said the mayor.

The state Health Department had confirmed 251 cases of dengue fever on Hawaii Island, including two potentially infectious individuals.

“The decision to issue an emergency proclamation is one made by professionals,” said Hawaii Gov. Ige. “There is a continuous conversation about it, as we proceed through an event and identify a course of action.”

Dengue Fever and Zika virus (ZIKV) share the same vector, mosquitoes of Aedes species (A. Aegypti & A. albopictus), and public health officials are concerned ZIKV could make its way to the Aloha State.

The same mosquitoes are also responsible for the spread chikungunya viruses.

Aedes aegypti mosquito

 

Aedes albopictus mosquito

Dengue Outbreak 2015 – 2016

Dengue Fever – Hawaii Island Outbreak

The Hawaii Department of Health (HDOH) is investigating a cluster of locally-acquired cases of dengue fever on Hawaii Island (the Big Island). Dengue is not endemic to Hawaii. However, it is intermittently imported from endemic areas by infected travelers. This is the first cluster of locally-acquired dengue fever since the 2011 outbreak on Oahu.  The Big Island and the rest of Hawaii remain safe destinations for visitors and residents.

• As of February 8, some 227 of the confirmed cases are Hawaii Island residents and 24 are visitors.
• 206 cases have been adults; 45 have been children (<18 years of age). Onset of illness has ranged between 9/11/15 – 2/1/16.
• A total of 1,124 reported potential cases have been excluded based on test results and/or not meeting case criteria (!)

 

Zika Virus Sold Online!

Zika virus (ATCC® VR-84™) patented in 1947 by the Rockefeller Foundation

History & Description

Agent: Zika virus
Strain: MR 766 (Original)
Effect on Host: Paralysis and death
Name of Depositor: J. Casals, Rockefeller Foundation
Source: Blood from experimental forest sentinel rhesus monkey, Uganda, 1947
Year of Origin: 1947
Classification: Flaviviridae, Flavivirus
Product Format: freeze-dried
Storage Conditions: -70°C or colder
References: Dick GW. Trans. R. Soc. Trop. Med. Hyg. 46: 509, 1952.

Biosafety Level: 2

Biosafety classification is based on U.S. Public Health Service Guidelines, it is the responsibility of the customer to ensure that their facilities comply with biosafety regulations for their own country.

Permits and Restrictions: View Permits

ATCC

ATCC is the premier global biological materials resource and standards organization whose mission focuses on the acquisition, authentication, production, preservation, development, and distribution of standard reference microorganisms, cell lines, and other materials. While maintaining traditional collection materials…

LGC Standards

LGC Standards is a division of the LGC Group, the UK’s designated National Measurement Institute for chemical and bioanalytical measurements and an international leader in the laboratory services, measurement standards, reference materials, genomics …

Headquartered in Teddington, Middlesex, UK, LGC Standards has a network of dedicated sales offices extending across 20 countries in 5 continents … We have an unparalleled breadth of ISO Guide 34 accredited reference material production in facilities at 4 sites across the UK, the US and Germany.

Links

• http://www.lgcstandards-atcc.org/products/all/VR-84.aspx
• http://www.lgcstandards-atcc.org/

ZIKV: Health Emergency Declared in 4 Florida Counties

Florida Governor Declares Health Emergency in Four Counties

Gov. Scott has signed Executive Order 16-29 directing Florida State Surgeon General Dr. John Armstrong to declare a public health emergency in the four counties which have the Zika virus, according to the governor’s website.

The Executive Order follows the discovery of a total of nine travel-associated cases (defined as disease believed to be contracted outside of the state) of the Zika virus across Miami-Dade, Hillsborough, Lee and Santa Rosa Counties.

“Today I am directing Surgeon General Dr. John Armstrong to declare a public health emergency in the four counties that have individuals with the Zika virus.  Although Florida’s current nine Zika cases were travel-related, we have to ensure Florida is prepared and stays ahead of the spread of the Zika virus in our state.  Our Department of Health will continue to be in constant communication with all county health offices, hospitals and the Federal Centers for Disease Control and Prevention (CDC).  We know that we must be prepared for the worst even as we hope for the best,” said Scott on Wednesday.

To view the Executive Order, click HERE.

Link to Microcephaly

Researchers suspect a possible link between Zika virus infection and microcephaly, a severe birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly.

Microcephaly can occur as a result of changes in babies genes, as well as other causes that can include the following exposures during pregnancy:

• Infections, such as rubella, toxoplasmosis, or cytomegalovirus
• Severe malnutrition
• Exposure to harmful substances, such as alcohol, certain drugs, or toxic chemicals

Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly. Microcephaly is not a common condition. State birth defects tracking systems have estimated that microcephaly ranges from 2 babies per 10,000 live births to about 12 babies per 10,000 live births in the Unites States.

Ae. aegypti Mosquitoes: The Principal Vectors of ZIKV

Ae. aegypti and Ae. albopictus are the principal vectors of dengue (DENV-1, DENV-2, DENV-3, DENV-4), chikungunya (CHIKV), yellow fever (YFV), and Zika (ZIKV) viruses. Of these seven arboviruses, DENV, YFV and CHIKV have caused outbreaks within the United States and its territories in the past 110 years.

With a newly-obtained fiery red blood meal visible through her transparent abdomen, the now heavy female Aedes aegypti mosquito took flight as she left her host’s skin surface. Photo Credit: James Gathany/ CDC

Approximate distribution of Ae. aegypti and Ae. albopictus mosquitoes in the United States. -CDC-

ZIKV in Brief [CDC]

Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.

Outbreaks of Zika have occurred in areas of Africa, Southeast Asia, the Pacific Islands, and the Americas. Because the Aedes species mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will spread to new countries. In December 2015, Puerto Rico reported its first confirmed Zika virus case. Locally transmitted Zika has not been reported elsewhere in the United States, but cases of Zika have been reported in returning travelers.

There is no vaccine to prevent or medicine to treat Zika. Travelers can protect themselves from this disease by taking steps to prevent mosquito bites. When traveling to countries where Zika virus (see map) or other viruses spread by mosquitoes have been reported, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

Zika and pregnancy

Zika Travel Notices

• Zika Virus in Cape Verde
• Zika Virus in the Caribbean
  Currently includes: Barbados; Curaçao; Dominican Republic; Guadeloupe; Haiti; Jamaica; Martinique; the Commonwealth of Puerto Rico, a U.S. territory; Saint Martin; U.S. Virgin Islands
• Zika Virus in Central America
  Currently includes: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama
• Zika Virus in Mexico
• Zika Virus in the Pacific Islands
  Currently includes: American Samoa, Samoa, Tonga
• Zika Virus in South America
  Currently includes: Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Suriname, Venezuela

Latest Health Warnings

Authorities in four countries—Colombia, Ecuador, El Salvador and Jamaica—have warned women to avoid pregnancy as cases of microcephaly, believed to be caused by Zika virus (ZIKV), continue to multiply.

Brazil. Authorities say the number of babies born with suspected microcephaly has now reached about 4,000 since October, 2015.

Colombia. Health Minister has urged women to delay pregnancies for about eight months.

Ecuador, El Salvador and Jamaica. Authorities have told women to delay pregnancies by up to two years.

U.S. In January, explosive outbreaks of ZIKV, a dangerous tropical disease linked to birth defects, prompted the  U.S. health officials to issue a travel alert for people traveling to regions and countries where the virus transmission is spreading: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

Countries that have past or current evidence of Zika virus transmission

AFRICA: Angola*, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Cote d’Ivoire, Egypt*, Ethiopia*, Gabon, Gambia*, Kenya*, Nigeria, Senegal, Sierra Leone*, Somalia*, Tanzania*, Uganda and Zambia*.

AMERICAS: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela.

OCEANIA/PACIFIC ISLANDS: Cook Islands, Easter Island, Federated States of Micronesia, French Polynesia, New Caledonia, Samoa, Solomon Islands and Vanuatu.

ASIA: Cambodia, India*, Indonesia, Malaysia, Pakistan*, Philippines, Thailand and Vietnam*.

[*For these countries, the only evidence of Zika virus transmission is from studies that detected Zika virus antibodies in healthy people.  These studies cannot determine where the people were infected or if they were infected with Zika virus because the antibodies may have resulted from infections with other closely related viruses, such a; s dengue virus.]

Related Links

• ZIKV Update – Feb. 3, 2016 February 3, 2016
• Zika Virus Outbreak Result of Bioweapon? February 2, 2016

• WHO Declares Microcephaly Cluster a ‘Public Health Emergency of International Concern’  February 2, 2016
• ZIKV: Additional Information on Transmission January 29, 2016
• ZIKV: Media Sensationalism Forcing WHO to Overreact? January 28, 2016
• ZIKV: CDC Adds Two More Countries to Travel Warning List  January 27, 2016
• ZIKV Found in Australian Travelers Returning from S. America January 26, 2016

• ZIKV Emergency: New Warnings Issued by Colombia, Ecuador, El Salvador & Jamaica January 23, 2016

Additional Links

ZIKV

• CDC Issues Travel Warning as Zika Virus Epidemic Continues to Spread January 16, 2016
• Zika Virus: Coming to a Place Near You…  January 5, 2016
• Disasters/ Significant Events – Dec 25, 2015 Posted on December 25, 2015
• Most Dangerous Pathogens  December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects  December 4, 2015

DENGUE

• Latest Dengue Fever Outbreaks January 20, 2016
• Top Emerging Diseases Likely to Cause Major Epidemics December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects December 4, 2015
• Dengue Fever Kills 204 in Taiwan  December 16, 2015
• State of Emergency Declared in East Java  January 26, 2015
• Dengue Fever Outbreak Prompts State of Emergency in Brazil City  January 21, 2013
• State of emergency in Marshall Islands as dengue outbreak spirals  October 29, 2011
• Chikungunya Makes West Nile Look Like Nappy Rash  September 19, 2009

Zika Virus Outbreak Result of Bioweapon?

ZIKV outbreak possibly resulted from  biological warfare: Russian expert

Russia’s former Surgeon General has said that the Zika virus (ZIKV) outbreak could be due to the use of biological warfare, said a report.

One of the possible causes for the spread of the deadly Zika virus outbreak could be the use of biological warfare, Russia’s former Chief State Sanitary Physician Gennady Onishchenko said Tuesday.

“This is being looked into… If we don’t do anything at all, this will become a man-made spread [of the disease]. This infection has been known since 1948 and it lived very quietly, but over the last few years, it began to grow,” Onishchenko told RIA Novosti.

The World Health Organization (WHO) declared the Zika virus outbreak a Public Health Emergency of International Concern on February 1.

WHY WHO Imposed No Travel Ban?

WHO failed to explain, however, as to why its Emergency Committee had “found no public health justification for restrictions on travel or trade to prevent the spread of Zika virus,” despite the “explosive” outbreak.

State of Emergency Declared in Honduras

Meanwhile, Honduras declared a state of emergency, after recording nearly 3,700 suspected cases of Zika infections since late November, reports said.

ZIKV: Additional Information on Transmission

 Microcephaly:  Zika virus or Guillain-Barré syndrome?

ZIKV is transmitted primarily by Aedes aegypti mosquitoes (1,7). Aedes albopictus mosquitoes also might transmit the virus. Aedes aegypti and Ae. albopictus mosquitoes are found throughout much of the Americas, including parts of the United States, and also transmit dengue and chikungunya viruses.

In addition to mosquito-to-human transmission, Zika virus infections have been documented through:

• Intrauterine [in mother’s womb, or uterus] transmission resulting in congenital infection
• Intrapartum [during the act of birth] transmission from a viremic mother to her newborn
• Sexual transmission
• Blood transfusion
• Laboratory exposure

There is a theoretical concern that transmission could occur through organ or tissue transplantation, and although Zika virus RNA has been detected in breast milk, transmission through breastfeeding has not been documented.

The Brazil Ministry of Health has reported a marked increase in the number of infants born with microcephaly in 2015, although it is not known how many of these cases are associated with Zika virus infection. Guillain-Barré syndrome also has been reported in patients following suspected Zika virus infection. Studies are under way to evaluate the risks for Zika virus transmission during pregnancy, the spectrum of outcomes associated with congenital infection, and the possible association between Zika virus infection and Guillain-Barré syndrome.

There is no commercially available test for ZIKV. The virus testing is performed in the United States at CDC and four state health department laboratories.

Source: Hennessey M, Fischer M, Staples JE. Zika Virus Spreads to New Areas — Region of the Americas, May 2015–January 2016. MMWR Morb Mortal Wkly Rep 2016;65:55–58. DOI: http://dx.doi.org/10.15585/mmwr.mm6503e1

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that usually last for a few weeks. Most people recover fully from GBS, but some people have long-term nerve damage. In very rare cases, people have died of GBS, usually from difficulty breathing.

• The background rate for GBS in the U.S. is about 80 to 160 cases of GBS each week, regardless of vaccination.

What causes GBS?

Many things can cause GBS; about two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with diarrhea or a respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS. People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.

 

ZIKV: Media Sensationalism Forcing WHO to Overreact?

If WHO believes ZIKV outbreak is that serious, WHY wait until WHEN?

The WHO announced today it will convene Emergency Committee on Zika virus (ZIKV) and observed increase in neurological disorders and neonatal malformations on February 1, 2016.

Statement by WHO:

WHO Director-General, Margaret Chan, will convene an International Health Regulations Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations.

The Committee will meet on Monday 1 February in Geneva to ascertain whether the outbreak constitutes a Public Health Emergency of International Concern.

Decisions concerning the Committee’s membership and advice will be made public on WHO’s website.

Outbreak in the Americas

In May 2015, Brazil reported its first case of Zika virus disease. Since then, the disease has spread within Brazil and to 22 other countries and territories in the region.

Arrival of the virus in some countries of the Americas, notably Brazil, has been associated with a steep increase in the birth of babies with abnormally small heads and in cases of Guillain-Barré syndrome, a poorly understood condition in which the immune system attacks the nervous system, sometimes resulting in paralysis.

A causal relationship between Zika virus infection and birth defects and neurological syndromes has not been established, but is strongly suspected.

WHO action

WHO’s Regional Office for the Americas (PAHO) has been working closely with affected countries since May 2015. PAHO has mobilized staff and members of the Global Outbreak and Response Network (GOARN) to assist ministries of health in strengthening their abilities to detect the arrival and circulation of Zika virus through laboratory testing and rapid reporting. The aim has been to ensure accurate clinical diagnosis and treatment for patients, to track the spread of the virus and the mosquito that carries it, and to promote prevention, especially through mosquito control.

The Organization is supporting the scaling up and strengthening of surveillance systems in countries that have reported cases of Zika and of microcephaly and other neurological conditions that may be associated with the virus. Surveillance is also being heightened in countries to which the virus may spread. In the coming weeks, the Organization will convene experts to address critical gaps in scientific knowledge about the virus and its potential effects on fetuses, children and adults.

WHO will also prioritize the development of vaccines and new tools to control mosquito populations, as well as improving diagnostic tests.

A “news” outlet said:

“Three to four million people will be infected with Zika in the Americas this year, the World Health Organization says.” [They have provided NO link to the person saying this.]

“Most cases result in no symptoms and it is hard to test for, but WHO officials said an estimated 1.5 million people had been infected in the country.” [Again, no one in WHO is aware of any source for this statement.]

The only statement made in this regard is the following:

FIRE-EARTH Models show more than one million incidences of ZIKV infections may have occurred worldwide since October 2015.

Neither WHO (PAHO), nor CDC currently has a working model for predicting the “explosive” growth of ZIKV.

“Zika virus spreading in Europe”

Earlier this week, another “news” outlet predicted that the virus would be spreading in Europe rapidly because a Danish traveler had been found infected with the disease.

The idiots who make up such silly stories about the virus outbreaks have ZERO to NO idea how the disease is transmitted, or how fast it could spread.

Related Links

• ZIKV: CDC Adds Two More Countries to Travel Warning List  January 27, 2016

ZIKV Found in Australian Travelers Returning from S. America

Submitted by a reader – Edited by FEWW

Australians authorities echo warning to travelers planing to visit 22 countries affected by ZIKV

Australian health experts report mosquito-borne Zika virus (ZIKV), linked to brain damage in thousands of babies in Brazil, has already been discovered in Australia in travelers returning from South America, said a report.

For the virus to spread, however, it would require specific species of mosquitoes to act as a vector. The Aedes aegypti mosquito, one such vector, is currently found only in far north Queensland.

The Department of Foreign Affairs and Trade has issued new advice warning Australians, particularly pregnant women, to reconsider plans to travel to 22 countries affected by the virus, including many in South and Central America, and the Pacific island nation Samoa.

[FIRE-EARTH Models show more than one million incidences of ZIKV infections may have occurred worldwide since October 2015. —Editor]

The new travel advice comes in response to a warning by the World Health Organisation that Zika virus is now likely to spread to all countries in South, Central and North America except Canada and Chile. [Blog Moderators have not found any evidence to confirm either PAHO or WHO has issued a warning to this effect. This appears to be media sensationalism at best, or a desperate ruse designed for phishing more information from independent sources. —Editor]

At least 3,893 suspected cases of microcephaly had occurred in Brazil as of January 22, 2016, or over 30 times more than in any year since 2010 and equivalent to 1 to 2 per cent of all newborns in the state of Pernambuco, one of the worst-hit areas, said WHO.

ZIKV was first detected in a monkey in Zika forest near Lake Victoria, Uganda, in 1947.

Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly. Microcephaly is not a common condition. State birth defects tracking systems have estimated that microcephaly ranges from 2 babies per 10,000 live births to about 12 babies per 10,000 live births in the Unites States.

• Zika and pregnancy [CDC]

Countries that have past or current evidence of Zika virus transmission

AFRICA: Angola*, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Cote d’Ivoire, Egypt*, Ethiopia*, Gabon, Gambia*, Kenya*, Nigeria, Senegal, Sierra Leone*, Somalia*, Tanzania*, Uganda and Zambia*.

AMERICAS: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela.

OCEANIA/PACIFIC ISLANDS: Cook Islands, Easter Island, Federated States of Micronesia, French Polynesia, New Caledonia, Samoa, Solomon Islands and Vanuatu.

ASIA: Cambodia, India*, Indonesia, Malaysia, Pakistan*, Philippines, Thailand and Vietnam*.

[*For these countries, the only evidence of Zika virus transmission is from studies that detected Zika virus antibodies in healthy people.  These studies cannot determine where the people were infected or if they were infected with Zika virus because the antibodies may have resulted from infections with other closely related viruses, such as dengue virus.]

Related Links

• ZIKV Emergency: New Warnings Issued by Colombia, Ecuador, El Salvador & Jamaica January 23, 2016

Additional Links

ZIKV

• CDC Issues Travel Warning as Zika Virus Epidemic Continues to Spread January 16, 2016
• Zika Virus: Coming to a Place Near You…  January 5, 2016
• Disasters/ Significant Events – Dec 25, 2015 Posted on December 25, 2015
• Most Dangerous Pathogens  December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects  December 4, 2015

DENGUE

• Latest Dengue Fever Outbreaks January 20, 2016
• Top Emerging Diseases Likely to Cause Major Epidemics December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects December 4, 2015
• Dengue Fever Kills 204 in Taiwan  December 16, 2015
• State of Emergency Declared in East Java  January 26, 2015
• Dengue Fever Outbreak Prompts State of Emergency in Brazil City  January 21, 2013
• State of emergency in Marshall Islands as dengue outbreak spirals  October 29, 2011
• Chikungunya Makes West Nile Look Like Nappy Rash  September 19, 2009

Latest Dengue Fever Outbreaks

Brazil reported record number of dengue cases in 2015

Brazil registered 1.6 million cases of dengue fever in 2015, up from the previous record of 1.4 million cases in 2013, the Health Ministry reported.

• Peak incidence of dengue infection rates occurred in April, with 229.1 cases for every 100,000 people.

• Dengue-related fatalities reached 863 in 2015, also a record high.

• Two other diseases transmitted by the Aedes mosquito, the Zika virus and chikungunya fever, are also spreading rapidly across the country.Transmission of the Dengue Virus [CDC]

Cambodia

Cambodia reported 15,412 cases of dengue fever in 2015, a rise 314 percent from the previous year.

• “The incident rate was 93.5 cases out of 100,000 people,” said a senior health official. “Some 71 percent of the patients were children aged between 5 and 14 years old.”

• At least 38 children were killed by the infection in 2015, a rise of 81 percent.

Taiwan

Tiwan reported 43,259 cases of dengue infection in 2015, which killed at least 212 people across the island, the worst outbreak on record.

• In 2014, the country reported 15,732 cases, compared with the previous annual average of 2,000 cases.

Paraguay

Authorities and citizens alike in the Latin American country are concerned that another epidemic of dengue fever could “easily start up following December’s rains, which in Asuncion flooded entire neighborhoods and forced some 100,000 residents to evacuate their homes,” the Paraguayan Health Ministry said.

More than 150,000 people were infected in a 2013 dengue epidemic, which killed 252 people,  Agencia EFE reported.

Stats from WHO

• Cases across the Americas, South-East Asia and Western Pacific exceeded 1.2 million in 2008 and over 3 million in 2013 (based on official data submitted by Member States). Recently the number of reported cases has continued to increase. In 2013, 2.35 million cases of dengue were reported in the Americas alone, of which 37 687 cases were of severe dengue.

• Not only is the number of cases increasing as the disease spreads to new areas, but explosive outbreaks are occurring. The threat of a possible outbreak of dengue fever now exists in Europe and local transmission of dengue was reported for the first time in France and Croatia in 2010 and imported cases were detected in 3 other European countries. In 2012, an outbreak of dengue on the Madeira islands of Portugal resulted in over 2000 cases and imported cases were detected in mainland Portugal and 10 other countries in Europe.

• In 2013, cases have occurred in Florida (United States of America) and Yunnan province of China. Dengue also continues to affect several South American countries, notably Costa Rica, Honduras and Mexico. In Asia, Singapore has reported an increase in cases after a lapse of several years and outbreaks have also been reported in Laos. In 2014, trends indicate increases in the number of cases in the People’s Republic of China, the Cook Islands, Fiji, Malaysia and Vanuatu, with Dengue Type 3 (DEN 3) affecting the Pacific Island countries after a lapse of over 10 years. Dengue was also reported in Japan after a lapse of over 70 years. In 2015 an increase in the number of cases was reported in Brazil and several neighbouring countries. The Pacific island countries of Fiji, Tonga and French Polynesia have continued to record cases.

• [At least] 500 000 people with severe dengue require hospitalization each year, a large proportion of whom are children. About 2.5% of those affected die.

Epidemiology of dengue [ncbi.nlm.nih.gov]

Dengue is currently regarded globally as the most important mosquito-borne viral disease. A history of symptoms compatible with dengue can be traced back to the Chin Dynasty of 265–420 AD. The virus and its vectors have now become widely distributed throughout tropical and subtropical regions of the world, particularly over the last half-century. Significant geographic expansion has been coupled with rapid increases in incident cases, epidemics, and hyperendemicity, leading to the more severe forms of dengue. Transmission of dengue is now present in every World Health Organization (WHO) region of the world and more than 125 countries are known to be dengue endemic. The true impact of dengue globally is difficult to ascertain due to factors such as inadequate disease surveillance, misdiagnosis, and low levels of reporting. Currently available data likely grossly underestimates the social, economic, and disease burden. Estimates of the global incidence of dengue infections per year have ranged between 50 million and 200 million; however, recent estimates using cartographic approaches suggest this number is closer to almost 400 million.

Introduction

Dengue is an acute mosquito-borne viral infection that places a significant socioeconomic and disease burden on many tropical and subtropical regions of the world. It is currently regarded as the most important arboviral disease internationally as over 50% of the world’s population live in areas where they are at risk of the disease, and approximately 50% live in dengue endemic countries.

Dengue virus

There are four distinct dengue virus serotypes, all of which originate from the family Flaviviridae and genus Flavivirus. The serotypes are termed DENV-1, DENV-2, DENV-3, and DENV-4, and infection with any of the four viruses results in lifelong immunity to that specific serotype. Each of the four serotypes has been individually found to be responsible for dengue epidemics and associated with more severe dengue. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753061/

Female Aedes aegypti mosquito

With a newly-obtained fiery red blood meal visible through her transparent abdomen, the now heavy female Aedes aegypti mosquito took flight as she left her host’s skin surface. Photo Credit: James Gathany/ CDC

 

Transmission of the Dengue Virus [CDC]

Dengue is transmitted between people by the mosquitoes Aedes aegypti and Aedes albopictus, which are found throughout the world.  Insects that transmit disease are vectors.  Symptoms of infection usually begin 4 – 7 days after the mosquito bite and typically last 3 – 10 days.  In order for transmission to occur the mosquito must feed on a person during a 5- day period when large amounts of virus are in the blood; this period usually begins a little before the person become symptomatic.  Some people never have significant symptoms but can still infect mosquitoes.  After entering the mosquito in the blood meal, the virus will require an additional 8-12 days incubation before it can then be transmitted to another human. The mosquito remains infected for the remainder of its life, which might be days or a few weeks.

In rare cases dengue can be transmitted in organ transplants or blood transfusions from infected donors, and there is evidence of transmission from an infected pregnant mother to her fetus.  But in the vast majority of infections, a mosquito bite is responsible.

In many parts of the tropics and subtropics, dengue is endemic, that is, it occurs every year, usually during a season when Aedes mosquito populations are high, often when rainfall is optimal for breeding.  These areas are, however, additionally at periodic risk for epidemic dengue, when large numbers of people become infected during a short period.  Dengue epidemics require a coincidence of large numbers of vector mosquitoes, large numbers of people with no immunity to one of the four virus types (DENV 1, DENV 2, DENV 3, DENV 4), and the opportunity for contact between the two.  Although Aedes are common in the southern U. S., dengue is endemic in northern Mexico, and the U.S. population has no immunity, the lack of dengue transmission in the continental U.S. is primarily because contact between people and the vectors is too infrequent to sustain transmission.

Dengue is an Emerging Disease

The four dengue viruses originated in monkeys and independently jumped to humans in Africa or Southeast Asia between 100 and 800 years ago.  Dengue remained a relatively minor, geographically restricted disease until the middle of the 20th century.  The disruption of the second world war – in particular the coincidental transport of Aedes mosquitoes around the world in cargo –  are thought to have played a crucial role in the dissemination of the viruses.  DHF was first documented only in the 1950s during epidemics in the Philippines and Thailand.  It was not until 1981 that large numbers of DHF cases began to appear in the Carribean and Latin America, where highly effective Aedes control programs had been in place until the early 1970s.

Dengue is endemic in at least 125 countries

Dengue is endemic in more than 125 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean.

Related Links

• Top Emerging Diseases Likely to Cause Major Epidemics December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects December 4, 2015
• Dengue Fever Kills 204 in Taiwan  December 16, 2015
• State of Emergency Declared in East Java  January 26, 2015
• Dengue Fever Outbreak Prompts State of Emergency in Brazil City  January 21, 2013
• State of emergency in Marshall Islands as dengue outbreak spirals  October 29, 2011
• Chikungunya Makes West Nile Look Like Nappy Rash  September 19, 2009

ZIKV Infection Cases Reported in Illinois

Two pregnant Illinois women test positive for the Zika virus

Two pregnant Illinois residents, who recently traveled to countries where Zika virus is spreading, have tested positive for the virus, said the Illinois Department of Public Health. 

The latest development follows the case of a ZIKV infected infant in Hawaii who was born with microcephaly, on January 17, 2016.

The following statement was issued by the Illinois Health Department:

Two Illinois Residents Test Positive For Zika Virus

SPRINGFIELD (January 19, 2016). The Illinois Department of Public Health (IDPH) is alerting the public of the potential of contracting Zika virus while traveling abroad.  Zika virus is spread to people through mosquito bites, similar to West Nile virus or dengue fever.  While illness is usually mild and severe disease requiring hospitalization is uncommon, there is a possible link between Zika virus infection in pregnant women and subsequent birth defects.

Two pregnant Illinois residents who recently traveled to countries where Zika virus is found have tested positive for the virus.  Physicians are monitoring their health and pregnancies.

“There is virtually no risk to Illinois residents since you cannot contract Zika virus from another person, but only through the bite of an infected mosquito,” said IDPH Director Nirav D. Shah, M.D., J.D.  “But since this is a time of year when people travel to warmer climates and countries where Zika virus is found, we are urging residents, especially pregnant women, to take preventive measures when traveling in affected countries and check health travel advisories.”

The Centers for Disease Control and Prevention (CDC) issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing, including:

Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico. [See below for the full list.]

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant.  However, additional studies are needed to further characterize this relationship.

Until more is known, CDC recommends that pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing.  Pregnant women, women trying to become pregnant, or women who are thinking about becoming pregnant and must travel to one of these areas should talk with their doctor or other health care provider first and strictly follow steps to avoid mosquito bites during the trip.

The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes).  Symptoms can last from several days to weeks.  There is no vaccine to prevent or medicine to treat Zika virus infection.

When traveling to countries where Zika virus has been reported, all travelers should take steps to prevent mosquito bites, such as using use insect repellent, wearing long sleeves and pants, and staying in places with air conditioning or that use window and door screens.  More information about Zika virus can be found on the CDC website.  CDC has also developed interim Zika virus guidelines for health care providers in the United State caring for pregnant women.

Countries with past or current evidence of Zika virus transmission

Countries that have past or current evidence of Zika virus transmission —CDC

Countries that have past or current evidence of Zika virus transmission

AFRICA: Angola*, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Cote d’Ivoire, Egypt*, Ethiopia*, Gabon, Gambia*, Kenya*, Nigeria, Senegal, Sierra Leone*, Somalia*, Tanzania*, Uganda and Zambia*.
AMERICAS: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela.

OCEANIA/PACIFIC ISLANDS: Cook Islands, Easter Island, Federated States of Micronesia, French Polynesia, New Caledonia, Samoa, Solomon Islands and Vanuatu.

ASIA: Cambodia, India*, Indonesia, Malaysia, Pakistan*, Philippines, Thailand and Vietnam*.

[*For these countries, the only evidence of Zika virus transmission is from studies that detected Zika virus antibodies in healthy people.  These studies cannot determine where the people were infected or if they were infected with Zika virus because the antibodies may have resulted from infections with other closely related viruses, such as dengue virus.]

Related Links

• Baby Born with Brain Damage in Hawaii Infected by Zika Virus January 17, 2016
• CDC Issues Travel Warning as Zika Virus Epidemic Continues to Spread  January 16, 2016
• Zika Virus: Coming to a Place Near You…  January 5, 2016
• Disasters/ Significant Events – Dec 25, 2015 Posted on December 25, 2015
• Most Dangerous Pathogens  December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects  December 4, 2015

 

Baby Born with Brain Damage in Hawaii Infected by Zika Virus

CDC confirms baby born in Hawaii with microcephaly

A baby born with birth defect in an Oahu hospital has tested positive for the Zika virus (ZKIV), the U.S. Centers for Disease Control and Prevention (CDC) has confirmed.

The infant suffers from microcephaly, a rare condition that affects the brain, retarding its growth and leaving the skull size abnormally small.

The baby’s mother acquired the virus while living in Brazil in May 2015 and the baby was likely infected in the womb, said Hawaiian state health officials and the CDC.

The news comes as the Hawaii struggles to contain its largest ever dengue fever outbreak. Most of the infection cases, also transmitted through mosquito bites, have been reported in the Big Island of Hawaii.

CDC has already Issued Travel Warnings as Zika Virus Epidemic Continues to Spread in  Latin America and Caribbean countries.

Zika, a dangerous tropical disease linked to birth defects, is spreading in Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

Countries with past or current evidence of Zika virus transmission

Countries that have past or current evidence of Zika virus transmission (See below for list)

Countries that have past or current evidence of Zika virus transmission

AFRICA: Angola*, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Cote d’Ivoire, Egypt*, Ethiopia*, Gabon, Gambia*, Kenya*, Nigeria, Senegal, Sierra Leone*, Somalia*, Tanzania*, Uganda and Zambia*.
AMERICAS: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela.

OCEANIA/PACIFIC ISLANDS: Cook Islands, Easter Island, Federated States of Micronesia, French Polynesia, New Caledonia, Samoa, Solomon Islands and Vanuatu.

ASIA: Cambodia, India*, Indonesia, Malaysia, Pakistan*, Philippines, Thailand and Vietnam*.

[*For these countries, the only evidence of Zika virus transmission is from studies that detected Zika virus antibodies in healthy people.  These studies cannot determine where the people were infected or if they were infected with Zika virus because the antibodies may have resulted from infections with other closely related viruses, such as dengue virus.]

Related Links

• CDC Issues Travel Warning as Zika Virus Epidemic Continues to Spread  January 16, 2016
• Zika Virus: Coming to a Place Near You…  January 5, 2016
• Disasters/ Significant Events – Dec 25, 2015 Posted on December 25, 2015
• Most Dangerous Pathogens  December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects  December 4, 2015

CDC Issues Travel Warning as Zika Virus Epidemic Continues to Spread

U.S. health officials warn pregnant women against traveling to Latin America, Caribbean countries

Explosive outbreaks of Zika, a dangerous tropical disease linked to birth defects, have prompted the  U.S. health officials to issue a travel alert for people traveling to regions and countries where Zika virus (ZIKV) transmission is ongoing: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for the above-listed areas.

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

CDC recommends special precautions, out of an abundance of caution, for pregnant women and women trying to become pregnant:

• Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
• Women trying to become pregnant who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.

Because specific areas where Zika virus transmission is ongoing are difficult to determine and likely to change over time, CDC will update this travel notice as information becomes available. Check the CDC travel website frequently for the most up-to-date recommendations.

Currently, there is no vaccine to prevent or medicine to treat Zika. Four in five people who acquire Zika infection may have no symptoms. Illness from Zika is usually mild and does not require hospitalization. Travelers are strongly urged to protect themselves by preventing mosquito bites:

• Wear long-sleeved shirts and long pants
• Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed.
  • Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant and nursing women and children older than 2 months when used according to the product label. Oil of lemon eucalyptus products should not be used on children under 3 years of age.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents).
• Stay and sleep in screened-in or air-conditioned rooms.

In addition to the steps announced today, CDC is working with public health experts across the U.S. Department of Health and Human Services (HHS) to take additional steps related to Zika. CDC is developing interim guidance for pregnant women as well as sharing additional information about Zika with public health officials, clinicians and the public.  In addition, efforts are underway across HHS to develop vaccines, improved diagnostics and other countermeasures for Zika.

Countries with past or current evidence of Zika virus transmission

Countries that have past or current evidence of Zika virus transmission (See below for list)

Background:

CDC scientists tested samples provided by Brazilian health authorities from two pregnancies that ended in miscarriage and from two infants with diagnosed microcephaly who died shortly after birth. For the two full-term infants, tests showed that Zika virus was present in the brain. Genetic sequence analysis showed that the virus in the four cases was the same as the Zika virus strain currently circulating in Brazil.  All four mothers reported having experienced a fever and rash illness consistent with Zika virus disease (Zika) during their pregnancies.

Locally acquired Zika was reported for the first time in Brazil in May 2015, and the virus has since been reported in 14 countries and territories in Latin America and the Caribbean:  Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Commonwealth of Puerto Rico.

According to Brazilian health authorities, more than 3,500 microcephaly cases were reported in Brazil between October 2015 and January 2016.  Some of the affected infants have had a severe type of microcephaly and some have died.  The full spectrum of outcomes that might be associated with infection during pregnancy and the factors that might increase risk to the fetus are not yet fully understood. Health authorities in Brazil, with assistance from the Pan American Health Organization, CDC, and other agencies, have been investigating the possible association between Zika virus infection and microcephaly in infants. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

In the past, outbreaks of Zika virus infection have occurred in Africa, Southeast Asia, and the Pacific Islands.  Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito.  About one in five people infected with Zika virus will develop symptoms, which include fever, rash, joint pain, and conjunctivitis (pink eye). Other commonly reported symptoms include myalgia, headache, and pain behind the eyes. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. Guillain-Barré syndrome has been reported in patients with probable Zika virus infection in French Polynesia and Brazil . Research efforts will also examine the link between Zika and GBS.

Countries that have past or current evidence of Zika virus transmission

AFRICA: Angola*, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Cote d’Ivoire, Egypt*, Ethiopia*, Gabon, Gambia*, Kenya*, Nigeria, Senegal, Sierra Leone*, Somalia*, Tanzania*, Uganda and Zambia*.

AMERICAS: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname and Venezuela.

OCEANIA/PACIFIC ISLANDS: Cook Islands, Easter Island, Federated States of Micronesia, French Polynesia, New Caledonia, Samoa, Solomon Islands and Vanuatu.

ASIA: Cambodia, India*, Indonesia, Malaysia, Pakistan*, Philippines, Thailand and Vietnam*.

[*For these countries, the only evidence of Zika virus transmission is from studies that detected Zika virus antibodies in healthy people.  These studies cannot determine where the people were infected or if they were infected with Zika virus because the antibodies may have resulted from infections with other closely related viruses, such as dengue virus.]

Related Links

• Zika Virus: Coming to a Place Near You…  January 5, 2016
• Disasters/ Significant Events – Dec 25, 2015 Posted on December 25, 2015
• Most Dangerous Pathogens  December 12, 2015
• ZIKV – Emerging Virus May Cause Severe Birth Defects  December 4, 2015

ZIKV – Emerging Virus May Cause Severe Birth Defects

Brazil records six fold increase in microcephaly: Report

Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease (Zika) are fever, rash, joint pain, and red eye. The illness is usually mild with symptoms lasting from several days to a week, according to CDC.

Zika virus (ZIKV) is a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis viruses. In 2007 ZIKV caused an outbreak of relatively mild disease characterized by rash, arthralgia, and conjunctivitis on Yap Island in the southwestern Pacific Ocean. This was the first time that ZIKV was detected outside of Africa and Asia. The history, transmission dynamics, virology, and clinical manifestations of ZIKV disease are discussed, along with the possibility for diagnostic confusion between ZIKV illness and dengue. The emergence of ZIKV outside of its previously known geographic range should prompt awareness of the potential for ZIKV to spread to other Pacific islands and the Americas. [Edward B. Hayes/CDC]

Zika may be responsible for an “unprecedented epidemic in Brazil and is quickly spreading through Latin America may be responsible for a spike in severe birth defects,” said a report.

Brazilian government has warned that the virus could be responsible for a dramatic rise “in cases of microcephaly, a severe birth defect in which the brain fails to develop properly and the head is much smaller than normal. Children with microcephaly frequently have developmental delays, learning disabilities, impaired motor function, and seizures.”  However, the connection remains to be proven.

“Microcephaly can be caused by genetic factors, infections, or injuries. In recent years, there have been between 150 and 200 cases in Brazil per year. As of 30 November, more than 1200 cases had been reported in 10 states, all of which have also reported Zika virus infections, says Ana Maria Bispo de Filippis, head of the flavivirus laboratory at the Oswaldo Cruz Institute in Rio de Janeiro, Brazil.”

Brazil’s northeastern state of  Pernambuco has recorded at least 487 microcephaly cases so far this year, compared with an average of 10 cases per year between 2010 and 2014, said the report.

“The virus has been found in the amniotic fluid of two fetuses diagnosed with microcephaly via ultrasound. It has also been found in tissues of a baby with microcephaly that died shortly after birth. It seems that in some cases the virus can cross the placenta and infect the fetus directly, says Patricia Garcez, a neurodevelopment expert at the Federal University of Rio de Janeiro in Brazil. It’s possible that the virus then attacks brain cells, she says. If that happens during the key phases of brain development in the first 3 to 4 months of pregnancy, the overall size of the brain would be dramatically reduced, leading to microcephaly.”

Additionally, health authorities in French Polynesia reported “17 cases of unusual central nervous system birth defects following a Zika outbreak there in 2013 and 2014.”

Unpreventable and Untreatable!

There is no vaccine to prevent or medicine to treat Zika. When traveling to countries where Zika virus or other viruses spread by mosquitoes have been reported, travelers should protect themselves from this disease by taking steps to prevent mosquito bites.

Geographic Distribution

Outbreaks of Zika virus disease (or Zika) previously have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika virus likely will continue to spread to new areas. In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil. [CDC]

Countries that have past or current evidence of Zika virus transmission (as of December 2015)

Source: CDC

Countries that have past or current evidence of Zika virus transmission

AFRICA:  Angola*, Burkina Faso, Cameroon, Central African Republic, Cote d’Ivoire, Egypt*, Ethiopia*, Gabon, Gambia*, Kenya*, Nigeria, Senegal, Sierra Leone*, Somalia*, Tanzania*, Uganda and Zambia*

ASIA: Cambodia, India*, Indonesia, Malaysia, Pakistan*, Philippines, Thailand and Vietnam*

AMERICAS: Brazil, Colombia, El Salvador, Guatemala, Mexico, Paraguay and Suriname

OCEANIA/PACIFIC ISLANDS: Cook Islands, Easter Island, Federated States of Micronesia, French Polynesia, New Caledonia, Solomon Islands and Vanuatu

*For these countries, the only evidence of Zika virus transmission is from studies that detected Zika virus antibodies in healthy people.  These studies cannot determine where the people were infected or if they were infected with Zika virus because the antibodies may have resulted from infections with other closely related viruses, such as dengue virus.