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ZIKA IN JAMAICA!?
Correspondence to Christopher Dye email: Bulletin of the World Health Organization This document is a historical rendering of the Zika virus disease up until 7 February WHO continuously adds to Zika virus: News and updates with the latest information available on this public health emergency. News and updates Introduction Zika, a flavivirus transmitted mainly by mosquitos in the genus Aedes, was discovered in in Uganda. From the s to s, human infections were found across Africa and Asia, typically accompanied by mild illness. The first large outbreak of disease caused by Zika infection was reported from the Island of Yap Federated States of Micronesia in , as the virus moved from south-east Asia across the Pacific. In South America, the first reports of locally transmitted infection came from Brazil in May In October Brazil reported an association between Zika virus infection and microcephaly. For neither event was a causal link proven. By the start of February , local transmission of Zika infection had been reported from more than 20 countries and territories in the Americas, and an outbreak numbering thousands of cases was under way in Cabo Verde, western Africa. Beyond the range of mosquito vectors, Zika virus infections are expected to be carried worldwide by international travel. Objective To describe the temporal and geographical distribution of Zika virus infection, and associated neurological disorders, from to February EIS contains information about public health events of potential international concern notified to WHO as required by the International Health Regulations. Reports in the timeline below come from EIS unless another reference is given. Notifications of specific events are available from the authors on request. Findings The following timeline summarizes the spread of Zika infection, country by country, from the earliest discovery in to the latest information as of 7 February Figure 1 provides a chronological map of the presence of Zika only in those countries for which there is evidence of autochthonous or indigenous transmission by mosquitos, excluding the many countries that have notified imported Zika infections. Scientists conducting routine surveillance for yellow fever in the Zika forest of Uganda isolate the Zika virus in samples taken from a captive, sentinel rhesus monkey. The virus is recovered from the mosquito Aedes Stegomyia africanus, caught on a tree platform in the Zika forest. The first human cases are detected in Uganda and the United Republic of Tanzania in a study demonstrating the presence of neutralizing antibodies to Zika virus in sera. The virus is isolated from a young girl in Eastern Nigeria. Two further Zika virus strains are isolated from Aedes africanus mosquitos caught in the Zika forest area. A researcher in Uganda who fell ill while working with Zika strains isolated from mosquitoes provides the first proof, by virus isolation and re-isolation, that Zika virus causes human disease. Zika is now being detected in mosquitos and sentinel rhesus monkeys used for field research studies in a narrow band of countries that stretch across equatorial Africa. Altogether, virus is isolated from more than 20 mosquito species, mainly in the genus Aedes. Sporadic human cases are identified, mostly by serological methods, but such cases are rare, and the disease is regarded as benign. No deaths or hospitalizations are reported, and seroprevalence studies consistently indicate widespread human exposure to the virus. The known geographical distribution of Zika expands to equatorial Asia, including India, Indonesia, Malaysia and Pakistan, where the virus is detected in mosquitos. As in Africa, sporadic human cases occur but no outbreaks are detected and the disease in humans continues to be regarded as rare, with mild symptoms. Seroprevalence studies in Indonesia, Malaysia and Pakistan indicate widespread population exposure. Zika spreads from Africa and Asia to cause the first large outbreak in humans on the Pacific island of Yap, in the Federated States of Micronesia. Prior to this event, no outbreaks and only 14 cases of human Zika virus disease had been documented worldwide. Of these, 49 are confirmed RNA identified by PCR or a specific neutralizing antibody response to Zika virus in the serum and 59 are classified as probable patients with IgM antibody against Zika virus who had a potentially cross-reactive neutralizing-antibody response. No deaths, hospitalizations, or neurological complications are reported. In the absence of any evidence that viral mutation can explain changes in epidemic behaviour, several other explanations are suggested including a lack of population immunity; that is, regular exposure to infection in Africa and Asia may have prevented the large outbreaks eventually seen on Pacific Islands and in the Americas. Under-reporting may also be a reason for missing previous outbreaks of infection, due to the clinical similarities of mild illness associated with Zika, dengue, and chikungunya infections, and the frequent co-circulation of all three viruses. A US scientist conducting field work in Senegal falls ill with Zika infection upon his return home to Colorado and infects his wife in what is probably the first documented case of sexual transmission of an infection usually transmitted by insects. Researchers publish findings on the characterization of Zika virus strains collected in Cambodia, Malaysia, Nigeria, Senegal, Thailand and Uganda, and construct phylogenetic trees to assess the relationships. Two geographically distinct lineages of the virus, African and Asian, are identified. Analysis of virus from Yap Island strengthens previous epidemiological evidence that the outbreak on Yap Island originated in south-east Asia. The virus causes outbreaks in four other groups of Pacific islands: The results of retrospective investigations are reported to WHO on 24 November and 27 January These reports indicate a possible association between Zika virus infection and congenital malformations and severe neurological and autoimmune complications. The finding does, however, challenge the notion that Zika infection causes only mild illness. A patient recovering from Zika infection on Tahiti Island in French Polynesia seeks treatment for bloody sperm. Zika virus is isolated from his semen, adding to the evidence that Zika can be sexually transmitted. During the —14 outbreak of Zika virus in French Polynesia, two mothers and their newborns are found to have Zika virus infection, confirmed by PCR performed on serum collected within four days of birth. During the same outbreak of Zika virus in French Polynesia, asymptomatic blood donors are reported to be positive for Zika by PCR. These findings alert authorities to the risk of post-transfusion Zika fever. Brazil notifies WHO of reports of an illness characterized by skin rash in northeastern states. From February to 29 April , nearly cases of illness with skin rash are reported in these states. All cases are mild, with no reported deaths. Tests for chikungunya, measles, rubella, parvovirus B19, and enterovirus are negative. Zika was not suspected at this stage, and no tests for Zika were carried out. Brazil provides further details on reports of an illness, in four northeastern states, characterized by skin rash, with and without fever. Bahia State Laboratory in Brazil informs WHO that samples have tested positive for Zika virus, but full laboratory confirmation is pending. This is the first report of locally acquired Zika disease in the Americas. Brazil reports laboratory-confirmed Zika cases in twelve states. Brazil reports detection of neurological disorders associated with a history of infection, primarily from the north-eastern state of Bahia. Of these cases, all but 2 had a prior history of infection with Zika, chikungunya or dengue. Health centres in the Republic of Cabo Verde begin reporting cases of illness with skin rash, with and without fever, in the capital city of Praia, on the island of Santiago. By 14 October, suspected cases are reported. Brazil reports the results of a review of clinical records of patients with a neurological syndrome, detected between March and August. Colombia reports the results of a retrospective review of clinical records which reveals the occurrence, since July, of sporadic clinical cases with symptoms consistent with Zika infection. A sudden spike is reported between 11 and 26 September. Altogether, 90 cases are identified with clinical symptoms consistent with, but not proven to be, Zika infection. Colombia reports PCR confirmed cases of locally acquired Zika infection. Colombia confirms, by PCR, cases of Zika in thirteen municipalities, with most confirmed cases concentrated in the densely populated Bolivar department. Brazil reports an unusual increase in the number of cases of microcephaly among newborns since August, numbering 54 by 30 October. Suriname reports two PCR confirmed cases of locally acquired Zika infection. Colombia confirms, by PCR, cases of locally acquired Zika infection. Brazil reports suspected cases of microcephaly in Pernambuco state. Further suspected cases are being investigated in two additional states, Paraiba and Rio Grande do Norte. Brazil declares a national public health emergency as cases of suspected microcephaly continue to increase. Suriname reports 5 PCR confirmed cases of locally acquired Zika infection. Panama reports cases with symptoms compatible with Zika. Brazil reports the detection of Zika virus in amniotic fluid samples from two pregnant women from Paraiba whose fetuses were confirmed by ultrasound examinations to have microcephaly. Altogether, cases of suspected microcephaly are being investigated in seven northeastern states. Brazil reports that cases of microcephaly are being investigated in nine states. French Polynesia reports the results of a retrospective investigation documenting an unusual increase in the number of central nervous system malformations in fetuses and infants from March to May At the date of reporting, at least 17 cases are identified with different severe cerebral malformations, including microcephaly, and neonatal brainstem dysfunction. Mexico reports three PCR confirmed cases of Zika infection, of which two were locally acquired. The third case had a travel history to Colombia. Guatemala reports its first PCR confirmed case of locally acquired Zika infection. Paraguay reports six PCR confirmed cases of locally acquired Zika infection. The Bolivarian Republic of Venezuela reports seven suspected cases of locally acquired Zika infection. Four samples test positive by PCR. Brazil detects Zika virus genome in the blood and tissue samples of a baby with microcephaly and other congenital anomalies who died within 5 minutes of birth. Brazil reports three deaths among two adults and a newborn associated with Zika infection. As deaths from Zika infection are extremely rare, these cases are reported in detail. The Pan American Health Organization and WHO issue an alert to the association of Zika virus infection with neurological syndrome and congenital malformations in the Americas. The alert includes guidelines for laboratory detection of the virus. Panama reports its first 3 PCR confirmed cases of locally acquired Zika infection. Cabo Verde reports suspected cases of Zika. No neurological complications are reported. Panama reports four PCR confirmed cases of locally acquired Zika infection, and 95 cases with compatible symptoms. Honduras reports two PCR confirmed cases of locally acquired Zika infection.
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