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Zika virus outbreak report

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  1. ZIKA VIRUS (01): AMERICAS, ASIA, AFRICA, RESEARCH
  2. *************************************************
  3. A ProMED-mail post
  4. <http://www.promedmail.org>
  5. ProMED-mail is a program of the
  6. International Society for Infectious Diseases
  7. <http://www.isid.org>
  8.  
  9. In this update:
  10. [1] PAHO/WHO epidemiological update
  11. [2] Cases in various countries:
  12. Americas
  13. Americas cumulative case numbers
  14.  
  15. North America
  16. ---
  17. USA
  18. - National
  19. - Florida (Miami-Dade county)
  20. - Georgia
  21. - Texas (Travis county)
  22. - Rhode Island
  23.  
  24. Mexico and Central America
  25. ---
  26. Mexico (national)
  27. Costa Rica (national)
  28. Honduras (national)
  29.  
  30. Caribbean
  31. ---
  32. St Lucia (national)
  33. Turks and Caicos (national)
  34. Martinique blood donors, 2016
  35.  
  36. South America
  37. ---
  38. Bolivia (national)
  39. Brazil
  40. - Microcephaly, national
  41. - Eye involvement
  42. Colombia (national)
  43.  
  44. Asia
  45. ---
  46. Philippines (national)
  47. Viet Nam (national)
  48. Singapore (national)
  49. Malaysia (Petaling Jaya, Selangor)
  50.  
  51. Africa
  52. ---
  53. Angola (national)
  54.  
  55. Imported cases with no possibility of ongoing mosquito transmission
  56. ---
  57. Canada
  58. Israel
  59. South Korea
  60. USA
  61. - Case numbers mainland
  62. - New York City, New York
  63. - Territories and Commonwealth
  64.  
  65. [3] Brazil: fetal infections, Brazil
  66. [4] USA: birth defects
  67. [5] Prolonged viremia
  68. [6] Virus protein and neurological defects
  69. [7] Virus molecular evolution
  70. [8] Antibody-dependent enhancement
  71. [9] False positive test
  72. [10] Mosquito vectors
  73. [11] Severe thrombocytopenia
  74.  
  75. ******
  76. [1] PAHO/WHO epidemiological update
  77. Date: Thu 12 Jan 2017
  78. Source: PAHO/WHO Zika - epidemiological update [edited]
  79. <http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=37671>
  80.  
  81.  
  82. Zika virus - incidence and trends
  83. ---------------------------------
  84. Since epidemiological week (EW) 44 of 2016 [29 Oct-4 Nov 2016], no
  85. additional countries or territories of the Americas have confirmed
  86. autochthonous, vectorborne transmission of Zika virus disease. To
  87. date, 48 countries and territories in the Americas (1) have confirmed
  88. autochthonous, vectorborne transmission of Zika virus disease since
  89. 2015 (figure 1). In addition, 5 countries in the Americas have
  90. reported sexually transmitted Zika cases (2).
  91.  
  92. Figure 1. [available at the source URL above] Countries and
  93. territories in the Americas with confirmed autochthonous (vectorborne)
  94. Zika virus cases, 2015-2017
  95.  
  96. (1) Anguilla; Antigua and Barbuda; Argentina; Aruba; the Bahamas;
  97. Barbados; Belize; Bolivia (Plurinational State of); Bonaire, Sint
  98. Eustatius, and Saba; Brazil; the British Virgin Islands; Cayman
  99. Islands; Colombia; Costa Rica; Cuba; Curaçao; Dominica; the Dominican
  100. Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe;
  101. Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico;
  102. Montserrat; Nicaragua; Panama; Paraguay; Peru; Puerto Rico; Saint
  103. Barthélemy; Saint Kitts and Nevis; Saint Lucia; Saint Martin; Saint
  104. Vincent and the Grenadines; Sint Maarten; Suriname; Trinidad and
  105. Tobago; Turks and Caicos Islands; the United States of America; the
  106. United States Virgin Islands; and Venezuela (Bolivarian Republic of).
  107.  
  108. (2) Argentina, Canada, Chile, Peru, and the USA.
  109.  
  110. Highlighted below is a summary of the epidemiological situation by
  111. sub-regions of the Americas.
  112.  
  113. North America
  114. In the United States, since 30 Dec 2016, the US Centers for Disease
  115. Control and Prevention (CDC) has not reported new locally-acquired
  116. cases of Zika virus disease.
  117.  
  118. Central America
  119. In Panama, a growing trend of suspected and confirmed cases continued
  120. to be observed between EW 30 to EW 49. In the other countries of the
  121. sub region, the number of cases continues a downward trend.
  122.  
  123. Caribbean
  124. In the countries and territories in the Caribbean, the downward trend
  125. in the number of Zika cases continues.
  126.  
  127. South America
  128. In Peru, between EW 40 and 50 of 2016 [1 Oct-16 Dec 2016], an increase
  129. in the number of suspected and confirmed cases was observed,
  130. particularly in the 4 districts of the city of Iquitos.
  131.  
  132. All the other countries and territories in South America continue to
  133. report decreasing numbers of Zika cases.
  134.  
  135. Congenital syndrome associated with Zika virus infection
  136. --------------------------------------------------------
  137. To date, 22 countries and territories in the Americas have reported
  138. confirmed cases of congenital syndrome associated with Zika virus
  139. infection. Since December of 2016, no additional countries or
  140. territories have reported confirmed cases of congenital syndrome
  141. associated with Zika virus infection for the 1st time. In the last 2
  142. weeks, Brazil, Colombia, and the United States of America updated
  143. their number of cases of congenital syndrome associated with Zika
  144. virus infection.
  145. As of 1 Sep 2016, the table with the number of confirmed cases of
  146. congenital syndrome is published on a weekly basis on the PAHO/WHO
  147. website and is available on the Zika Cumulative Cases website
  148. [<http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090>].
  149.  
  150. Guillain-Barré syndrome (GBS) and other neurological disorders
  151. --------------------------------------------------------------
  152. Since December 2016, no additional countries or territories have
  153. reported cases of Guillain-Barré syndrome (GBS) associated with Zika
  154. virus infection.
  155.  
  156. Following is a list of countries and territories in the Americas
  157. reporting increased cases of Guillain-Barré syndrome (GBS) and/or
  158. laboratory confirmation of Zika virus in at least one GBS case.
  159.  
  160. Table 1. Countries and territories in the Americas with GBS in the
  161. context of Zika virus circulation.
  162. Increase in GBS with Zika virus lab confirmation in at least one case
  163. of GBS:
  164. Brazil
  165. Colombia
  166. Dominican Republic
  167. El Salvador
  168. French Guiana
  169. Guadeloupe
  170. Guatemala
  171. Honduras
  172. Jamaica
  173. Martinique
  174. Puerto Rico
  175. Suriname
  176. Venezuela
  177.  
  178. Zika virus infection laboratory confirmation in at least one case of
  179. GBS:
  180. Bolivia
  181. Costa Rica
  182. Grenada
  183. Haiti
  184. Mexico
  185. Panama
  186. St. Martin
  187.  
  188. Increase in GBS with no Zika virus lab confirmation in any of the
  189. cases:
  190. Paraguay
  191. Saint Vincent and the Grenadines
  192.  
  193. --
  194. communicated by:
  195. ProMED-mail rapporteur Marianne Hopp
  196.  
  197. [It will be interesting to see if the case numbers begin to increase
  198. in South America with the onset of warmer, summer weather. - Mod.TY]
  199.  
  200. ******
  201. [2] Cases in various countries
  202. Americas
  203. ---
  204. Americas cumulative case numbers
  205. As of 12 Jan 2017
  206. <http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090>
  207. Country / Locally acquired: suspected / confirmed / Imported / Deaths
  208. / Conf. Congenital Syndrome
  209. North America:
  210. Bermuda / 0 / 0 / 5 / 0 / 0
  211. Canada / 0 / 0 / 439 / 0 / 1
  212. USA / 0 / 217 / 46449 / 0 / 41
  213.  
  214. Latin America:
  215. Mexico / 0 / 7575 / 15 / 0 / 0
  216.  
  217. Central American Isthmus:
  218. Belize / 756 / 68 / 0 / 0 / 0
  219. Costa Rica / 5737 / 1649 / 32 / 0 / 2
  220. El Salvador / 11 434 / 51 / 0 / 0 / 4
  221. Guatemala / 3343 / 788 / 0 / 0 / 15
  222. Honduras / 31 936 / 298 / 0 / 0 / 2
  223. Nicaragua / 0 / 2053 / 3 / 0 / 2
  224. Panama / 2663 / 676 / 42 / 0 / 5
  225.  
  226. Latin Caribbean:
  227. Cuba / 0 / 3 / 30 / 0 / 0
  228. Dominican Republic / 4908 / 322 / 0 / 0 / 22
  229. French Guiana / 9700 / 483 / 10 / 0 / 16
  230. Guadeloupe / 30 845 / 379 / 0 / 0 / 6
  231. Haiti / 2955 / 5 / 0 / 0 / 1
  232. Martinique / 36 680 / 12 / 0 / 0 / 18
  233. Puerto Rico / 0 / 36 375 / 1 / 5 / 10
  234. Saint Barthélemy / 975 / 61 / 0 / 0 / 0
  235. Saint Martin / 3115 / 200 / 0 / 0 / 0
  236.  
  237. Non-Latin Caribbean:
  238. Anguilla / 28 / 16 / 1 / 0 / 0
  239. Antigua and Barbuda / 465 / 14 / 2 / 0 / 0
  240. Aruba / 676 / 28 / 7 / 0 / 0
  241. Bahamas / 0 / 22 / 3 / 0 / 0
  242. Barbados / 699 / 46 / 0 / 0 / 0
  243. Bonaire, St Eustatius, and Saba / 0 / 85 / 0 / 0 / 0
  244. Caymans / 211 / 30 / 10 / 0 / 0
  245. Curacao / 0 / 820 / 0 / 0 / 0
  246. Dominica / 1150 / 79 / 0 / 0 / 0
  247. Grenada / 316 / 111 / 0 / 0 / 1
  248. Guyana / 0 / 37 / 0 / 0 / 0
  249. Jamaica / 7052 / 186 / 0 / 0 / 0
  250. Montserrat / 2 / 5 / 0 / 0 / 0
  251. Saint Kits and Nevis / 549 / 33 / 0 / 0 / 0
  252. Saint Lucia / 822 / 50 / 0 / 0 / 0
  253. Saint Vincent and the Grenadines / 508 / 83 / 0 / 0 / 0
  254. Sint Maarten / 367 / 143 / 0 / 0 / 0
  255. Suriname / 2760 / 723 / 0 / 4 / 2
  256. Trinidad and Tobago / 0 / 643 / 1 / 0 / 1
  257. Turks and Caicos / 179 / 17 / 3 / 0 / 0
  258. Virgin Islands (UK) / 74 / 52 / 0 / 0 / 0
  259. Virgin Islands (USA) / 1034 / 917 / 0 / 0 / 0
  260.  
  261. Andean Area:
  262. Bolivia / 741 / 156 / 4 / 0 / 14
  263. Colombia / 96 860 / 9799 / 0 / 0 / 77
  264. Ecuador / 2680 / 875 / 15 / 0 / 0
  265. Peru / 1767 / 389 / 21 / 0 / 0
  266. Venezuela / 59 235 / 2380 / 0 / 0 / 0
  267.  
  268. [Brazil and] Southern Cone:
  269. Brazil / 214 193 / 128 266 / 0 / 9 / 2366
  270. Argentina / 1821 / 26 / 29 / 0 / 1
  271. Chile / 0 / 0 / 33 / 0 / 0
  272. Paraguay / 555 / 14 / 0 / 0 / 2
  273. Uruguay / 0 / 0 / 1 / 0 / 0
  274.  
  275. Totals, Americas / 539 791 / 197 271 / 5356 / 18 / 2609
  276.  
  277. [Maps showing the location of the affected islands and countries in
  278. the Americas mentioned above and below
  279. can be accessed at
  280. <http://healthmap.org/promed/p/35574>;
  281. North America at http://healthmap.org/promed/p/106;
  282. Central America <http://healthmap.org/promed/p/39455>;
  283. Caribbean <http://www.mapsofworld.com/caribbean-islands/>, and
  284. South America at <http://healthmap.org/promed/p/6186>. - Mod.TY]
  285.  
  286. North America
  287. ---
  288. USA
  289. - National. 6 Jan 2017. 2 more babies have been born in the United
  290. States with Zika-related birth defects, raising the total to 36, the
  291. Centers for Disease Control and Prevention (CDC) said yesterday [5 Jan
  292. 2016] in an update. The number of Zika-related pregnancy losses
  293. remained at 5; of 1292 women who were included in the US Zika
  294. Pregnancy Registry as of 27 Dec 2016, 875 pregnancies have been
  295. completed with or without birth defects.
  296. <http://www.cidrap.umn.edu/news-perspective/2017/01/news-scan-jan-06-2017>
  297.  
  298. [A 13 Jan 2017 study in the USA reported a study reporting that out of
  299. 442 cases, 271 pregnant were asymptomatic, 167 had symptoms related to
  300. Zika, and symptoms were missing in 4 cases. 26 fetuses or infants (6
  301. percent) had birth defects, 22 had a brain anomaly, while 4 had other
  302. malformations. Among the 22 cases, where the brain was affected, 14
  303. had microcephaly and other brain abnormalities together, 4 had only
  304. microcephaly, while 4 had only other brain malformations. Among the 4
  305. cases, where brain abnormalities were not detected, 2 had
  306. encephalocele (a protrusion of the brain), 1 had eye and 1 had hearing
  307. anomalies. The risk of abnormalities was the same in both symptomatic
  308. and asymptomatic cases (6 per cent). In cases where pregnant women
  309. were only exposed in the first trimester, 11 per cent had birth
  310. defects, while in cases where exposure took place in multiple
  311. trimesters including the 1st trimester, 7 per cent of the fetuses or
  312. infants presented with birth defects. However, exposure in only the
  313. 2nd trimester did not result in birth defects
  314. (<https://www.medicalnewsbulletin.com/birth-defects-zika-related-pregnancies-us/>)]
  315.  
  316. - Florida (Miami-Dade county). 12 Jan 2017. (confirmed [conf]) 1 new
  317. locally acquired case in Miami-Dade County, bringing the total of
  318. locally acquired cases to 257.
  319. <http://www.floridahealth.gov/newsroom/2017/01/011217-zika-update.html>
  320.  
  321. - Georgia. 11 Jan 2017. (conf) A Zika-related birth defect has been
  322. documented in Georgia, public health officials reported.
  323. <http://savannahnow.com/news/2017-01-11/zika-related-birth-defect-reported-georgia-health-officials-say>
  324.  
  325. - Texas (Travis county). 7 Jan 2017. (conf) Health officials say a
  326. child born in Travis County with microcephaly has a Zika virus
  327. infection.
  328. <http://www.kbtx.com/content/news/Child-born-in-Austin-has-Zika-virus-409982215.html>
  329.  
  330. [A 22 Dec 2016 reports the occurrence of the 6th locally acquired case
  331. in Texas, in Cameron county
  332. (<http://www.krgv.com/story/34117108/cameron-co-health-officials-confirm-sixth-locally-transmitted-zika-case>)
  333.  
  334. On 14 Dec 2016, CDC issued guidance related to Zika for people living
  335. in or traveling to Brownsville, Cameron County, Texas
  336. (<https://www.cdc.gov/zika/intheus/texas-update.html>). - Mod.TY]
  337.  
  338. - Rhode Island. 21 Dec 2016. (conf) 1st infant born with the virus in
  339. state, had no defects, mother traveled to a Zika prevalent area while
  340. pregnant.
  341. <http://www.abc6.com/story/34107190/first-rhode-island-baby-born-with-zika-virus>
  342.  
  343. Mexico and Central America
  344. ---
  345. Mexico (national). 17 Dec 2016. (reported) 347 cases.
  346. <http://sipse.com/novedades/cancun-zika-microcefalia-chikungunya-gestacion-embarazo-serviciosm-agua-hombres-busquedas-234987.html>
  347. [in Spanish]
  348.  
  349. Costa Rica (national). 2 Jan 2017. (conf) in 2016, 1581 cases. Cantons
  350. most affected: Orotina 159 cases for each 10 000 residents, Nandayure,
  351. Liberia, Santa Cruz, Nicoya and Abangares each ranked within the top
  352. 20 cantons.
  353. <http://www.vozdeguanacaste.com/en/articles/2017/01/02/canas-reports-2nd-highest-number-zika-cases-2016>
  354.  
  355. Honduras (national). 30 Dec 2016. (reported) 623 pregnant women under
  356. surveillance, 127 cases of microencephaly of which 13 recently;
  357. Guillain-Barré syndrome 164 cases.
  358. <http://www.radiohrn.hn/l/noticias/salud-reporta-13-casos-de-microcefalia-en-las-%C3%BAltimas-semanas>
  359.  
  360. Caribbean
  361. ---
  362. St Lucia (national). 16 Dec 2016. (reported) 50 pregnant women have
  363. tested positive for Zika virus infections and are bing monitored due
  364. to concerns about microcephaly.
  365. <http://www.jamaicaobserver.com/latestnews/St-Lucia-Gov-t-moves-to-decrease-impact-of-ZikV-on-pregnant-women>
  366.  
  367. Turks and Caicos (national). 6 Jan 2017. (conf) 24 cases, of which 8
  368. are new cases, 7 on Grand Turk.
  369. <http://tcweeklynews.com/eight-new-zika-cases-brings-total-to-p7599-127.htm>
  370.  
  371. Martinique blood donors, 2016. 12 Jan 2017. (conf.) between 19 Jan-10
  372. Jun 2016, 4129 consecutive blood donations were tested (mean age, 41.9
  373. years; sex ratio [M/F], 0.88). Positive individual nucleic acid
  374. testing detection occurred in 76 blood donations (1.8 per cent), with
  375. the most intense detection rate (3 per cent) during weeks 17-20 (mean
  376. age, 41.8 years; sex ratio, 1.2). Inquiry consisted of a telephone
  377. call at day 7 post-donation to identify symptoms compatible with ZIKV
  378. infection. When the donor declared no sign, a new call was 14 days
  379. after donation. This information was obtained from 75 viremic donors:
  380. 34 (45.3 per cent) remained asymptomatic, and 41 (54.7 per cent)
  381. reported symptoms (1-6 days post-donation).
  382. <http://www.bloodjournal.org/content/129/2/263>
  383.  
  384. South America
  385. ---
  386. Bolivia (national). 20 Dec 2016. (conf) 2 new cases of microcephaly,
  387. bringing the total to 13, of these, 12 in Santa Cruz and 1 in
  388. Chuquisaca.
  389. <http://www.eldeber.com.bo/santacruz/Confirman-otros-dos-casos-de-microcefalia-20161220-0047.html>
  390. [in Spanish]
  391.  
  392. Brazil
  393. - Microcephaly, national. 12 Jan 2017. Microcephaly (conf) 2289 cases,
  394. with 3144 other suspected cases pending confirmation.
  395. <https://www.yahoo.com/news/mothers-brazils-zika-babies-struggle-071456132.html>
  396.  
  397. - Eye involvement. 11 Jan 2017. (reported) 2 cases of blindness in
  398. babies born Greater São Paulo -- one in Guarulhos and another in the
  399. capital -- because of the Zika virus infections in utero.
  400. <http://www1.folha.uol.com.br/internacional/en/scienceandhealth/2017/01/1848868-two-babies-are-born-blind-because-of-zika-in-greater-sao-paulo.shtml>
  401.  
  402. Colombia (national). 31 Dec 2016. (reported) week 32 of 2015-week 52
  403. of 2016 [9 Aug 2015-31 Dec 2016], (suspected [susp]) 3578 cases, (susp
  404. clinically) 93 262 cases, (conf laboratory) 9799 cases.
  405. <http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2016%20Bolet%C3%ADn%20epidemiológico%20semana%2052%20-.pdf>
  406.  
  407. [AC Jaramillo MD is thanked for sending in this bulletin. - Mod.TY]
  408.  
  409. Asia
  410. ---
  411. [A good summary of Zika virus infections in Asia 1952-2016 is
  412. available at
  413. <http://www.ijidonline.com/article/S1201-9712(16)31640-X/fulltext>. -
  414. Mod.TY]
  415.  
  416. Philippines (national). 28 Dec 2016. (conf) 52 cases, 4 of whom are
  417. pregnant (1 of them already gave birth to a normal baby).
  418. <http://www.rappler.com/nation/156836-december-update-zika-cases-philippines>
  419.  
  420. [Maps of the Philippines can be accessed at
  421. <http://www.charleskeng.com/images-map/philmap.jpg> and
  422. <http://healthmap.org/promed/p/158>. - Mod.TY]
  423.  
  424. Viet Nam (national). 15 Jan 2017. (conf) since the 1st cases were
  425. detected, 212 cases. Most affected locality: Ho Chi Minh city 186
  426. cases with 12 pregnant. From December 2016 to early January 2017, 4
  427. cases of Zika infections in Vinh Thanh commune, Nhon Trach district, 1
  428. case in Ben Tri province.
  429. <http://outbreaknewstoday.com/vietnam-zika-news-epidemic-dong-nai-1st-case-ben-tre-26233/>
  430.  
  431. [Maps of Viet Nam can be accessed at
  432. <http://www.onlineasiatravel.com/images/vn/vietnam-map.png> and
  433. <http://healthmap.org/promed/p/152>. - Mod.TY]
  434.  
  435. Singapore (national). 27 Dec 2016. (conf) no new cases since 11 Dec
  436. 2016. Zika virus infected pregnant women 17 as of 21 Dec 2016, 3 have
  437. given birth to babies without microcephaly, all babies to be monitored
  438. until age 3 for development progress.
  439. <http://www.channelnewsasia.com/news/singapore/babies-born-to-zika-patients-to-be-monitored-until-age-3-moh/3396876.html>
  440.  
  441. [Maps of Singapore can be accessed at
  442. <http://sunsite.nus.edu.sg/SEAlinks/maps/singapore.gif> and
  443. <http://healthmap.org/promed/p/150>. - Mod.TY]
  444.  
  445. Malaysia (Petaling Jaya, Selangor). 18 Dec 2016. (conf) 8th case in a
  446. 67 year old man from Petaling Jaya, Selangor.
  447. <http://www.nst.com.my/news/2016/12/197763/eighth-confirmed-zika-case-malaysia-67-year-old-man-petaling-jaya-infected>
  448.  
  449. [Maps of Malaysia can be accessed at
  450. <http://www.ezilon.com/maps/images/asia/political-map-of-Malaysian.gif>
  451. and <http://healthmap.org/promed/p/2293>. - Mod.TY]
  452.  
  453. Africa
  454. ---
  455. Angola (national). 9 Jan 2017. (conf). 2 cases, one a French tourist,
  456. another local Luanda resident.
  457. <https://www.yahoo.com/news/angola-records-first-zika-cases-155335367.html>
  458.  
  459. [Maps of Angola can be accessed at
  460. <http://www.un.org/Depts/Cartographic/map/profile/angola.pdf> and
  461. <http://healthmap.org/promed/p/165>. - Mod.TY]
  462.  
  463. Imported cases with no possibility of ongoing mosquito transmission
  464. (except USA Florida and Texas)
  465. ---
  466. Canada. 5 Jan 2017. (conf.) As of 13 Dec 2016, 421 cases of whom 20
  467. pregnant with 2 Zika-related abnormalities in fetuses and newborns; 3
  468. cases sexually transmitted.
  469. <http://globalnews.ca/news/3163257/zika-virus-update-canadian-cases-what-to-do-to-prevent-it/>
  470.  
  471. [A HealthMap/ProMED-mail map of Canada can be accessed at
  472. <http://healthmap.org/promed/p/12>. - Mod.TY]
  473.  
  474. Israel. 22 Dec 2016. (conf) 20 cases in recent months, all imported.
  475. <http://www.jpost.com/Israel-News/New-Zika-case-identified-in-central-Israel-resident-476194>
  476.  
  477. [A HealthMap/ProMED-mail map of Israel can be accessed at
  478. <http://healthmap.org/promed/p/90>. - Mod.TY]
  479.  
  480. South Korea. 6 Jan 2017. (conf) 17 cases of which 13 ex South East
  481. Asia, 4 ex Latin America.
  482. <http://world.kbs.co.kr/english/news/news_Dm_detail.htm?No=124448&id=Dm>
  483.  
  484. [A HealthMap/ProMED-mail map of South Korea can be accessed at
  485. <http://healthmap.org/promed/p/195>. - Mod.TY]
  486.  
  487. USA
  488. - Case numbers mainland. Zika virus disease in the United States,
  489. 2015-2016 as of 11 Jan 2017
  490. <http://www.cdc.gov/zika/geo/united-states.html>
  491. State / no. imported cases / no. locally acquired cases
  492. Alabama / 30 / 0
  493. Arizona / 52 / 0
  494. Arkansas / 15 / 0
  495. California / 393 / 0
  496. Colorado / 49 / 0
  497. Connecticut / 58 / 0
  498. Delaware / 17 / 0
  499. District of Columbia / 31
  500. Florida / 833 / 210
  501. Georgia / 106 / 0
  502. Hawaii / 16 / 0
  503. Idaho / 4 / 0
  504. Illinois / 90 / 0
  505. Indiana / 50 / 0
  506. Iowa / 21 / 0
  507. Kansas / 19 / 0
  508. Kentucky / 31 / 0
  509. Louisiana / 35 / 0
  510. Maine / 13 / 0
  511. Maryland / 129 / 0
  512. Massachusetts / 117 / 0
  513. Michigan / 65 / 0
  514. Minnesota / 64 / 0
  515. Mississippi / 23 / 0
  516. Missouri / 35 / 0
  517. Montana / 7 / 0
  518. Nebraska / 13 / 0
  519. Nevada / 19 / 0
  520. New Hampshire / 12 / 0
  521. New Jersey / 173 / 0
  522. New Mexico / 9 / 0
  523. New York / 997 / 0
  524. North Carolina / 86 / 0
  525. North Dakota / 2 / 0
  526. Ohio / 82 / 0
  527. Oklahoma / 29 / 0
  528. Oregon / 42 / 0
  529. Pennsylvania / 167 / 0
  530. Rhode Island / 50 / 0
  531. South Carolina / 54 / 0
  532. South Dakota / 2 / 0
  533. Tennessee / 59 / 0
  534. Texas / 290 / 6
  535. Utah / 20 / 0
  536. Vermont / 11 / 0
  537. Virginia / 107 / 0
  538. Washington / 62 / 0
  539. West Virginia / 11 / 0
  540. Wisconsin / 48 / 0
  541. Wyoming / 2
  542. Total / 4650 / 216
  543.  
  544. - New York City, New York. 7 Dec 2016. (conf) The city has 4 new cases
  545. of congenital Zika virus syndrome.
  546. <https://abc7.com/news/4-more-infants-in-nyc-reported-to-have-zika-related-birth-defects/1644318/>
  547.  
  548. - Territories and Commonwealth:
  549. American Samoa: 1 imported, 114 locally acquired
  550. Puerto Rico: 132 imported, 34 249 locally acquired
  551. US Virgin Islands: 2 imported, 917 locally acquired
  552.  
  553. Total locally acquired 35 280
  554.  
  555. [A map of the USA showing the states and territories mentioned above
  556. can be accessed at <http://www.mapsofworld.com/usa/>]
  557.  
  558. --
  559. communicated by:
  560. ProMED-mail
  561. <promed@promedmail.org>
  562. and
  563. Roland Hübner
  564. Superior Health Council
  565. Brussels
  566. Belgium
  567. <roland.hubner@sante.belgique.be>
  568.  
  569. ******
  570. [3] Brazil: fetal infections
  571. Date: Tue 13 Dec 2016
  572. Source: Stat [edited]
  573. <https://www.statnews.com/2016/12/13/zika-abnormal-pregnancy-rates/>
  574.  
  575.  
  576. The toll that Zika virus takes on pregnancies appears to be even
  577. higher than was previously estimated, with a newly updated study from
  578. Brazil suggesting that 42 per cent of infants infected in the womb may
  579. have significant birth defects. When the authors factored in
  580. stillbirths and miscarriages suffered by women who had been infected
  581. with Zika, 46 per cent of pregnancies were affected. Microcephaly (a
  582. condition in which babies are born with smaller than normal heads) was
  583. seen in only about 3 per cent of babies in the study.
  584.  
  585. "Microcephaly is just the tip of the iceberg. It's definitely not
  586. where the focus should be," said Dr Karin Nielsen-Saines, the paper's
  587. senior author. "For every case of microcephaly you're probably going
  588. to have 10 cases of other problems that haven't been recognized."
  589. Nielsen-Saines is a professor in the division of pediatric infectious
  590. diseases at the University of California, Los Angeles. Her co-authors
  591. are from Brazil and the US.
  592.  
  593. The group reported adverse outcomes (pregnancy losses or birth
  594. defects) in 55 per cent of pregnancies in which infection occurred in
  595. the 1st trimester, 52 per cent of pregnancies in which infection
  596. occurred in the 2nd trimester, and 29 per cent in which infection
  597. occurred in the 3rd trimester.
  598.  
  599. Nielsen-Saines told STAT on [Tue 13 Dec 2016] that she'd been
  600. surprised by the 29 per cent figure and is more surprised still by the
  601. updated estimates. But on the issue of the danger the virus poses to
  602. developing fetuses, she is now clear. "I actually don't think there's
  603. anything more harmful to a fetus than Zika [virus]," she said. "It's
  604. probably the most teratogenic virus that exists." The March study and
  605. the update are published in the New England Journal of Medicine.
  606.  
  607. An unrelated study, from scientists at the Centers for Disease Control
  608. and Prevention, may shed some light on why Zika is so harmful to
  609. developing brains. That study, published in the journal Emerging
  610. Infectious Diseases, found levels of virus in the brains of infected
  611. infants (who died after birth) were 1000 times higher than in viral
  612. levels in women's placentas.
  613.  
  614. "Our findings show that Zika virus can continue to replicate in
  615. infants' brains even after birth, and that the virus can persist in
  616. placentas for months; much longer than we expected," said Julu
  617. Bhatnagar, head of the molecular pathology team at CDC's Infectious
  618. Diseases Pathology Branch and the study's lead author. "We don't know
  619. how long the virus can persist, but its persistence could have
  620. implications for babies born with microcephaly and for apparently
  621. healthy infants whose mothers had Zika [virus infections] during their
  622. pregnancies."
  623.  
  624. Women who developed a fever and a rash were enrolled in the study and
  625. tested to see if they had Zika [virus]. The study, which is ongoing,
  626. follows both women who tested positive for the virus and women who
  627. didn't. The latter group is used as a comparator.
  628.  
  629. Several scientists not involved in the study noted that the effect it
  630. recorded might be artificially high, because all women who had Zika
  631. [virus] had a symptomatic infection. It's known that most people who
  632. contract Zika [virus] don't have symptoms, and women with those milder
  633. infections may not give birth to babies with birth defects at the same
  634. rate, suggested Dave O'Connor, a professor of pathology and laboratory
  635. medicine at the University of Wisconsin-Madison who has been studying
  636. Zika in non-human primates. "Asymptomatic infections certainly carry
  637. risk too, but symptomatic infections may have disproportionately high
  638. risk. This is still speculative, but an important caveat on their
  639. results," O'Connor said in an email.
  640.  
  641. It is known that women who have asymptomatic Zika infections do
  642. sometimes give birth to babies with microcephaly. Scientists from
  643. Colombia and the Centers for Disease Control and Prevention reported
  644. on 4 such cases in June [2016].
  645.  
  646. In the Brazilian study, researchers reported on 125 pregnant women who
  647. were infected with Zika [virus] and had given birth or lost their
  648. pregnancy between 1 Jan and 31 Jul [2016]. They compared them to 61
  649. women who were not infected with Zika [virus] during their
  650. pregnancies. Cases of microcephaly were actually rare in the study; 4
  651. babies born to Zika-infected mothers had microcephaly, but 2 of those
  652. babies were small and their heads were proportionate to their bodies.
  653. There would have been at least 1 more case. But a woman whose
  654. ultrasound showed a profoundly affected fetus dropped out of the
  655. study; Nielsen-Saines said multiple attempts to find her failed.
  656.  
  657. The range of other birth defects was substantial, including seizure
  658. activity, visual and hearing impairment, spasticity, contracted limbs,
  659. and difficulty swallowing and feeding. All these are signs of brain
  660. damage, Nielson-Saines said, adding she expects with time that more
  661. developmental problems will become apparent. "The newborns may appear
  662. to be normal, but they may not be normal at 6 months, and there's a
  663. whole gradient of problems," she said. The researchers plan to track
  664. these babies for 2 years, if their mothers will allow it.
  665. Nielsen-Saines admitted some mothers are reluctant to bring the babies
  666. back for medical assessment. "They don't want to know."
  667.  
  668. While infection early in pregnancy appeared to carry the highest risk,
  669. infection as late as 39 weeks was associated with problems in some
  670. cases. This is unlike rubella (another virus infamous for causing
  671. birth defects) where the danger period for infection is in the first
  672. 20 weeks of pregnancy, the authors noted. Note: paper said 16 [weeks]
  673. but she said 20 and multiple websites say 20.
  674.  
  675. The women who were not infected with Zika also had an unusually high
  676. percentage of problems; 11.5 per cent. But 42 per cent of them were
  677. infected during their pregnancy with chikungunya, another virus that
  678. has also been associated with pregnancy losses (stillbirths and
  679. miscarriages).
  680.  
  681. Two of the leaders of the Zika response team at the Centers for
  682. Disease Control and Prevention said the findings suggest the Zika
  683. virus will have a large effect where it spreads. "The scope of the
  684. ZIKV outbreak in the Americas suggests that ZIKV infections will have
  685. a profound impact on the cohort of infants delivered in the 9 months
  686. after the outbreak peak in each country," Margaret Honein and Dr
  687. Denise Jamieson wrote in an editorial published by the journal.
  688.  
  689. --
  690. communicated by:
  691. ProMED-mail
  692. <promed@promedmail.org>
  693.  
  694. [Zika virus infections of mothers and their fetuses continue to
  695. provide unpleasant surprises. Those surprises may continue as the
  696. status of apparently normal but infected neonates is studied
  697. prospectively over 2 or more years. The adverse social and economic
  698. consequences of Zika virus infected newborns and their families are
  699. certain to be significant.
  700.  
  701. Readers interested in seeing the original 13 Dec 2016 New England
  702. Journal of Medicine can find it at
  703. <http://www.nejm.org/doi/full/10.1056/NEJMoa1602412> and the 13 Dec
  704. 2016 Emerging Infectious Diseases at
  705. <https://wwwnc.cdc.gov/eid/article/23/3/16-1499_article#suggestedcitation>.
  706.  
  707. A 3 Jan 2017 review of more than 100 studies in various reporting
  708. sources found sufficient evidence to conclude that Zika virus is a
  709. cause of congenital abnormalities and is a trigger of GBS
  710. (Guillain-Barré Syndrome)
  711. <http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002203>.
  712. - Mod.TY]
  713.  
  714. ******
  715. [4] USA: birth defects
  716. Date: Tue 13 Dec 2016
  717. Source: JAMA [edited]
  718. <http://jamanetwork.com/journals/jama/fullarticle/2593702>
  719.  
  720.  
  721. Honein MA, Dawson AL, Petersen EE, et al. Birth defects among fetuses
  722. and infants of US women with evidence of possible Zika virus infection
  723. during pregnancy. JAMA. 2017;317(1):59-68. doi:
  724. 10.1001/jama.2016.19006, PMID: 27960197.
  725.  
  726. Key Points
  727. Question: What proportion of fetuses and infants of women in the
  728. United States with laboratory evidence of possible Zika virus
  729. infection during pregnancy have birth defects?
  730. Findings: Based on preliminary data from the US Zika Pregnancy
  731. Registry, among 442 completed pregnancies, 6 per cent overall had a
  732. fetus or infant with evidence of a Zika virus-related birth defect,
  733. primarily microcephaly with brain abnormalities, whereas among women
  734. with possible Zika virus infection during the first trimester, 11 per
  735. cent had a fetus or infant with a birth defect.
  736.  
  737. Meaning: These findings support the importance of screening pregnant
  738. women for Zika virus exposure.
  739.  
  740. Abstract
  741. --------
  742. Importance: Understanding the risk of birth defects associated with
  743. Zika virus infection during pregnancy may help guide communication,
  744. prevention, and planning efforts. In the absence of Zika virus,
  745. microcephaly occurs in approximately 7 per 10 000 live births.
  746.  
  747. Objective: To estimate the preliminary proportion of fetuses or
  748. infants with birth defects after maternal Zika virus infection by
  749. trimester of infection and maternal symptoms.
  750.  
  751. Design, setting, and participants: Completed pregnancies with
  752. maternal, fetal, or infant laboratory evidence of possible recent Zika
  753. virus infection and outcomes reported in the continental United States
  754. and Hawaii from 15 Jan to 22 Sep 2016, in the US Zika Pregnancy
  755. Registry, a collaboration between the CDC and state and local health
  756. departments.
  757.  
  758. Exposures: Laboratory evidence of possible recent Zika virus infection
  759. in a maternal, placental, fetal, or infant sample.
  760.  
  761. Main outcomes and measures: Birth defects potentially Zika associated:
  762. brain abnormalities with or without microcephaly, neural tube defects
  763. and other early brain malformations, eye abnormalities, and other
  764. central nervous system consequences.
  765.  
  766. Results: Among 442 completed pregnancies in women (median age, 28
  767. years; range, 15-50 years) with laboratory evidence of possible recent
  768. Zika virus infection, birth defects potentially related to Zika virus
  769. were identified in 26 (6 per cent; 95 per cent confidence interval
  770. [CI] 4-8 per cent) fetuses or infants. There were 21 infants with
  771. birth defects among 395 live births and 5 fetuses with birth defects
  772. among 47 pregnancy losses. Birth defects were reported for 16 of 271
  773. (6 per cent; CI 4-9 per cent) pregnant asymptomatic women and 10 of
  774. 167 (6 per cent; CI 3-11 per cent) symptomatic pregnant women. Of the
  775. 26 affected fetuses or infants, 4 had microcephaly and no reported
  776. neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had
  777. brain abnormalities without microcephaly; reported brain abnormalities
  778. included intracranial calcifications, corpus callosum abnormalities,
  779. abnormal cortical formation, cerebral atrophy, ventriculomegaly,
  780. hydrocephaly, and cerebellar abnormalities. Infants with microcephaly
  781. (18/442) represent 4 per cent of completed pregnancies. Birth defects
  782. were reported in 9 of 85 (11 per cent; CI 6-19 per cent) completed
  783. pregnancies with maternal symptoms or exposure exclusively in the 1st
  784. trimester (or 1st trimester and periconceptional period), with no
  785. reports of birth defects among fetuses or infants with prenatal
  786. exposure to Zika virus infection only in the 2nd or 3rd trimesters.
  787.  
  788. Conclusions and relevance: Among pregnant women in the United States
  789. with completed pregnancies and laboratory evidence of possible recent
  790. Zika infection, 6 per cent of fetuses or infants had evidence of
  791. Zika-associated birth defects, primarily brain abnormalities and
  792. microcephaly, whereas among women with 1st-trimester Zika infection,
  793. 11 per cent of fetuses or infants had evidence of Zika-associated
  794. birth defects. These findings support the importance of screening
  795. pregnant women for Zika virus exposure.
  796.  
  797. --
  798. communicated by:
  799. ProMED-mail
  800. <promed@promedmail.org>
  801.  
  802. ******
  803. [5] Prolonged viremia
  804. Date: Thu 29 Dec 2016
  805. Source: N Engl J Med [edited]
  806. <http://www.nejm.org/doi/full/10.1056/NEJMc1607580#t=article>
  807.  
  808.  
  809. Suy A, Sulleiro E, Rodó C, et al. Prolonged Zika virus viremia during
  810. pregnancy. N Engl J Med. 2016;375(26):2611-2613. doi:
  811. 10.1056/NEJMc1607580, PMID: 27959695.
  812.  
  813. We describe a case of Zika virus (ZIKV) infection during pregnancy in
  814. a Colombian woman. She was infected in December 2015 while she was
  815. visiting her home country. At 9 weeks' gestation, she had a
  816. self-limited maculopapular, nonconfluent rash for 3 days that affected
  817. her trunk, arms, and legs; she had no fever or other concurrent
  818. symptoms. She was screened for ZIKV and other flaviviruses.
  819.  
  820. A reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay
  821. (RealStar Zika Virus RT-PCR Kit 1.0, Altona Diagnostics) of a serum
  822. sample was positive for ZIKV, and testing remained positive for 89
  823. days (or 107 days after the onset of symptoms, until 29 weeks'
  824. gestation), in 6 consecutive blood samples. Testing for ZIKV in the
  825. urine, vagina, and endocervix was negative. No fetal brain
  826. abnormalities were observed on scans obtained at 12 and 15 weeks'
  827. gestation. Neurosonography performed at 20, 24, and 29 weeks'
  828. gestation revealed bilateral mild ventriculomegaly and a shortened
  829. corpus callosum. The posterior fossa was normal. The brain parenchyma
  830. had calcifications and severe atrophy. Similar findings were seen on
  831. magnetic resonance imaging (MRI). No other anomalies were found in the
  832. fetus or the placenta. An RT-PCR assay of the amniotic fluid was
  833. positive for ZIKV, and screening was negative for dengue virus,
  834. chikungunya virus, cytomegalovirus, varicella-zoster virus, parvovirus
  835. B19, _Toxoplasma gondii_, and sexually transmitted infectious agents
  836. (_Chlamydia trachomatis_, _Neisseria gonorrhoeae_, _Mycoplasma
  837. hominis_, _Ureaplasma parvum_, _M. genitalium_, _U. urealiticum_, and
  838. _Trichomonas vaginalis_). The ZIKV viral load in the amniotic fluid
  839. was higher than that in the maternal serum (cycle threshold values, 28
  840. vs. 35; RT-PCR cycle threshold values were used as an indirect marker
  841. of viral load). Results of targeted genetic testing of the amniotic
  842. fluid by means of microarray-based comparative genomic hybridization
  843. (SurePrint G3 Unrestricted CGH ISCA v2 Microarray Kit, 8x60K, Agilent
  844. Technologies) were normal.
  845.  
  846. The baby was delivered at 37 weeks' gestation because of suspected
  847. growth restriction. At this time, RT-PCR assays of the maternal serum,
  848. urine, amniotic fluid, placenta, membranes, and umbilical cord were
  849. negative for ZIKV. RT-PCR assays of the neonatal serum, urine, and
  850. cerebrospinal fluid were also negative. Postnatal ultrasonography and
  851. MRI studies confirmed the presence of microcephaly with a thinned
  852. corpus callosum and brain atrophy with parenchymal calcifications.
  853. (Table 1.shows the evolution of laboratory and ultrasonographic
  854. findings in the mother and the baby.) [see in the URL].
  855.  
  856. ZIKV has been documented to be detectable in maternal blood by means
  857. of molecular techniques during the acute phase of the infection (the
  858. first 5 days after the onset of clinical symptoms). Driggers et al. (2
  859. Jun 2016 issue) detected ZIKV RNA in maternal serum 8 weeks after the
  860. onset of clinical symptoms. They suggested that persistent viremia may
  861. occur as a consequence of viral replication in the fetus or placenta.
  862. In our case, certain findings would support this hypothesis. 1st, the
  863. viral load in the amniotic fluid was higher than that in the maternal
  864. serum. 2nd, the viral load in the maternal serum remained stable
  865. (cycle threshold value, approximately 35) for 14 weeks and then became
  866. negative, instead of decreasing progressively, as would be expected.
  867. 3rd, neutralizing antibodies and ZIKV RNA were present in the maternal
  868. serum. In addition, RT-PCR assays of the maternal urine were negative,
  869. while testing of the maternal serum was positive. According to
  870. previous studies, ZIKV RNA would be detectable in urine longer than in
  871. serum, so an RT-PCR assay of the maternal urine would be expected to
  872. be positive in the presence of maternal viremia. For all these
  873. reasons, we would hypothesize that the persistent viremia that was
  874. detected in the mother could be the result of viral replication in the
  875. fetus or placenta, which thus acts as a reservoir.
  876.  
  877. We presume that the RT-PCR testing of neonatal samples was negative
  878. because the clinical infection occurred during prenatal life; hence,
  879. it is possible that ZIKV antibodies developed in the baby's immune
  880. system before birth. In summary, persistent ZIKV RNA in maternal serum
  881. could be a sign of fetal infection, and thus the fetus may play a role
  882. in persistent maternal viremia.
  883.  
  884. --
  885. communicated by:
  886. ProMED-mail
  887. <promed@promedmail.org>
  888.  
  889. [This report provides some further insight into the
  890. maternal-fetal-placenta dynamics of Zika virus infection. A maternal
  891. viremia of 89 days is remarkable. - Mod.TY]
  892.  
  893. ******
  894. [6] Virus protein and neurological defects
  895. Date: Thu 1 Dec 2016
  896. Source: PNAS [edited]
  897. <http://www.pnas.org/content/early/2017/01/01/1619735114.abstract>
  898.  
  899.  
  900. Li G, Poulsen M, Fenyvuesvolgyi C, et al. Characterization of
  901. cytopathic factors through genome-wide analysis of the Zika viral
  902. proteins in fission yeast. Proc Natl Acad Sci U S A. 2017. pii:
  903. 201619735. doi: 10.1073/pnas.1619735114, PMID: 28049830.
  904.  
  905. Significance
  906. The Zika virus (ZIKV) causes various neurologic defects including
  907. microcephaly and the Guillain-Barré syndrome. However, little is
  908. known about how ZIKV causes those diseases or which viral protein(s)
  909. is responsible for the observed cytopathic effects involved in
  910. restricted neuronal cellular growth, dysregulation of the cell cycle,
  911. and induction of cell hypertrophy or cell death. A genome-wide
  912. analysis of ZIKV proteins and peptides was conducted using fission
  913. yeast as a surrogate host. Seven ZIKV proteins conferred various
  914. cytopathic effects in which NS4A-induced cellular hypertrophy and
  915. growth restriction were mediated through the target of rapamycin (TOR)
  916. cellular stress-response pathway. These findings provide a foundation
  917. for identifying viral pathogenicity factors associated with the ZIKV
  918. diseases.
  919.  
  920. Abstract
  921. --------
  922. The Zika virus (ZIKV) causes microcephaly and the Guillain-Barré
  923. syndrome. Little is known about how ZIKV causes these conditions or
  924. which ZIKV viral protein(s) is responsible for the associated
  925. ZIKV-induced cytopathic effects, including cell hypertrophy, growth
  926. restriction, cell-cycle dysregulation, and cell death. We used fission
  927. yeast for the rapid, global functional analysis of the ZIKV genome.
  928. All 14 proteins or small peptides were produced under an inducible
  929. promoter, and we measured the intracellular localization and the
  930. specific effects on ZIKV-associated cytopathic activities of each
  931. protein. The subcellular localization of each ZIKV protein was in
  932. overall agreement with its predicted protein structure. Five
  933. structural and 2 nonstructural ZIKV proteins showed various levels of
  934. cytopathic effects. The expression of these ZIKV proteins restricted
  935. cell proliferation, induced hypertrophy, or triggered cellular
  936. oxidative stress leading to cell death. The expression of premembrane
  937. protein (prM) resulted in cell-cycle G1 accumulation, whereas
  938. membrane-anchored capsid (anaC), membrane protein (M), envelope
  939. protein (E), and nonstructural protein 4A (NS4A) caused cell-cycle
  940. G2/M accumulation. A mechanistic study revealed that NS4A-induced
  941. cellular hypertrophy and growth restriction were mediated specifically
  942. through the target of rapamycin (TOR) cellular stress pathway
  943. involving Tor1 and type 2A phosphatase activator Tip41. These findings
  944. should provide a reference for future research on the prevention and
  945. treatment of ZIKV diseases.
  946.  
  947. --
  948. communicated by:
  949. ProMED-mail
  950. <promed@promedmail.org>
  951.  
  952. [A 10 Jan 2017 report in MBio
  953. (<http://mbio.asm.org/content/8/1/e02150-16>) identified that the
  954. p38-Mnk1 cascade regulating phosphorylation of eIF4E is a target of
  955. DENV infection and plays an important role in virus production. "Our
  956. results define several molecular interfaces by which flaviviruses,
  957. which include Zika virus, hijack host cell translation and interfere
  958. with stress responses to optimize the production of new virus
  959. particles. Unlike other RNA viruses, these flaviviruses concomitantly
  960. suppress host cell stress responses, thereby uncoupling translation
  961. suppression from stress granule formation." This suppression likely
  962. contributes to pathogenesis. Roland Hübner is thanked for sending in
  963. this report. - Mod.TY]
  964.  
  965. ******
  966. [7] Virus molecular evolution
  967. Date: Mon 12 Dec 2016
  968. Source: Cladistics [edited]
  969. <http://onlinelibrary.wiley.com/wol1/doi/10.1111/cla.12178/abstract>
  970.  
  971.  
  972. Schneider AB, Malone RW, Guo JT, et al. Molecular evolution of Zika
  973. virus as it crossed the Pacific to the Americas. Cladistics
  974. 2017;33(1):1-20, DOI: 10.1111/cla.12178.
  975.  
  976. Abstract
  977. --------
  978. Zika virus was previously considered to cause only a benign infection
  979. in humans. Studies of recent outbreaks of Zika virus in the Pacific,
  980. South America, Mexico and the Caribbean have associated the virus with
  981. severe neuropathology. Viral evolution may be one factor contributing
  982. to an apparent change in Zika disease as it spread from South East
  983. Asia across the Pacific to the Americas. To address this possibility,
  984. we have employed computational tools to compare the phylogeny,
  985. geography, immunology and RNA structure of Zika virus isolates from
  986. Africa, Asia, the Pacific and the Americas. In doing so, we compare
  987. and contrast methods and results for tree search and rooting of Zika
  988. virus phylogenies. In some phylogenetic analyses we find support for
  989. the hypothesis that there is a deep common ancestor between African
  990. and Asian clades (the "Asia/Africa" hypothesis). In other phylogenetic
  991. analyses, we find that Asian lineages are descendent from African
  992. lineages (the "out of Africa" hypothesis). In addition, we identify
  993. and evaluate key mutations in viral envelope protein coding and
  994. untranslated terminal RNA regions. We find stepwise mutations that
  995. have altered both immunological motif sets and regulatory sequence
  996. elements. Both of these sets of changes distinguish viruses found in
  997. Africa from those in the emergent Asia-Pacific-Americas lineage. These
  998. findings support the working hypothesis that mutations acquired by
  999. Zika virus in the Pacific and Americas contribute to changes in
  1000. pathology. These results can inform experiments required to elucidate
  1001. the role of viral genetic evolution in changes in neuropathology,
  1002. including microcephaly and other neurological and skeletomuscular
  1003. issues in infants, and Guillain-Barré syndrome in adults.
  1004.  
  1005. --
  1006. communicated by:
  1007. ProMED-mail
  1008. <promed@promedmail.org>
  1009. and
  1010. Roland Hübner
  1011. Superior Health Council
  1012. Brussels
  1013. Belgium
  1014. <roland.hubner@sante.belgique.be>
  1015.  
  1016. [Interviews with the authors and scientists working in this area are
  1017. quoted in the 13 Dec 2016 issue of the Medical Express
  1018. (<http://medicalxpress.com/news/2016-12-mutations-trans-pacific-key-zika-severity.html>).
  1019. The analysis provides the most complete study of the virus's history
  1020. to date and reveals specific genetic changes that occurred as the
  1021. virus crossed the Pacific Ocean on its way to the Americas. An
  1022. analysis of the genes involved also suggests new hypotheses to explain
  1023. the virus's association with microcephaly and GBS.
  1024.  
  1025. "We looked at the viral changes that correspond to the 1st reports of
  1026. microcephaly and we saw the origins of these changes in the Pacific
  1027. lineages," Janies noted. "There are mutations that occurred in the
  1028. part of the viral genome that codes the viral envelope protein and the
  1029. ends of the viral genome that are called untranslated regions. We
  1030. focused on the envelope protein because that's the part responsible
  1031. for the entry of the virus to host's cells. We studied the
  1032. untranslated regions since they mediate the types of tissues the virus
  1033. attacks and viral replication."
  1034.  
  1035. Both sets of mutations suggested potential relationships to the
  1036. virus's new association with neurological and developmental problems
  1037. in adults and infants.
  1038.  
  1039. "Members of our team found that Zika has recently started making its
  1040. envelope proteins with features, called epitopes, that are similar to
  1041. human proteins, which could cause a human host immune response to the
  1042. virus to be diluted," Janies said. "The theory underlying this idea is
  1043. called epitope mimicry. The similarity is advantageous to the virus
  1044. because it confuses the host's immune system and blunts the immune
  1045. reaction to the virus."
  1046.  
  1047. However, the researchers suspect that the human proteins being
  1048. mimicked may be significant for reasons besides providing immune
  1049. system "cover" for the attacking virus.
  1050.  
  1051. An important element of the envelope protein mutation, Janies points
  1052. out, is not only in the mimicry itself, but also, in the specific
  1053. genes being mimicked: "Our team members found that 2 of the human
  1054. proteins that Zika is mimicking are involved in the signaling that
  1055. goes on when the sensory organs are being formed in the fetus. These
  1056. genes are called 'Neuron Navigator Protein 2' and 'Human Neurogenic
  1057. Differentiation Factor 4'," he said. "Because these are the proteins
  1058. are being mimicked, a hypothesis is that the developmental pathways
  1059. that rely on the proteins may be being disrupted by the immune
  1060. system," Janies said.
  1061.  
  1062. The other mutations, on the untranslated regions, suggest other
  1063. possible effects that might change where Zika virus infects in the
  1064. body.
  1065.  
  1066. "Although epitope mimicry hypothesis helps clarify the protein-immune
  1067. interaction, the mutations in the untranslated regions may explain the
  1068. types of tissues Zika attacks" UNC Charlotte Bioinformatics and
  1069. Genomics graduate student Adriano de Bernardi Schneider said. "The
  1070. presence of specific binding regions on untranslated regions of the
  1071. Zika viral genome, called "Musashi Binding Elements" provides bases
  1072. for the study of changes in tissue preference of the virus."
  1073.  
  1074. In this part of the study, the authors evaluated the changes in the
  1075. virus' Musashi Binding Elements and found that they increased the
  1076. efficiency of the Zika virus that is circulating in the Americas in
  1077. hijacking human cells. Musashi is a family of RNA-binding proteins in
  1078. the host cells that control gene expression and the development of
  1079. stem cells. The finding that Zika has mutated to be better at binding
  1080. to human Musashi proteins, leads to the hypothesis that Zika is
  1081. adapting to be more efficient at attacking human cells. Moreover, the
  1082. role of Musashi proteins in stem cells provides another possible
  1083. target for the study of developmental defects in the fetus associated
  1084. with Zika infection in pregnancy. - Mod.TY]
  1085.  
  1086. ******
  1087. [8] Antibody-dependent enhancement
  1088. Date: Fri 16 Dec 2016
  1089. Source: Clinical & Translational Immunology [edited]
  1090. <http://www.nature.com/cti/journal/v5/n12/full/cti201672a.html>
  1091.  
  1092.  
  1093. Paul LM, Carlin ER, Jenkins MM, et al. Dengue virus antibodies enhance
  1094. Zika virus infection. Clin Transl Immunology. 2016;5(12):e117. doi:
  1095. 10.1038/cti.2016.72, PMID: 28090318
  1096.  
  1097. Abstract
  1098. -------
  1099. For decades, human infections with Zika virus (ZIKV), a
  1100. mosquito-transmitted flavivirus, were sporadic, associated with mild
  1101. disease, and went underreported since symptoms were similar to other
  1102. acute febrile diseases. Recent reports of severe disease associated
  1103. with ZIKV have greatly heightened awareness. It is anticipated that
  1104. ZIKV will continue to spread in the Americas and globally where
  1105. competent aedes mosquito vectors are found. Dengue virus (DENV), the
  1106. most common mosquito-transmitted human flavivirus, is both
  1107. well-established and the source of outbreaks in areas of recent ZIKV
  1108. introduction. DENV and ZIKV are closely related, resulting in
  1109. substantial antigenic overlap. Through antibody-dependent enhancement
  1110. (ADE), anti-DENV antibodies can enhance the infectivity of DENV for
  1111. certain classes of immune cells, causing increased viral production
  1112. that correlates with severe disease outcomes. Similarly, ZIKV has been
  1113. shown to undergo ADE in response to antibodies generated by other
  1114. flaviviruses. We tested the neutralizing and enhancing potential of
  1115. well-characterized broadly neutralizing human anti-DENV monoclonal
  1116. antibodies (HMAbs) and human DENV immune sera against ZIKV using
  1117. neutralization and ADE assays. We show that anti-DENV HMAbs,
  1118. cross-react, do not neutralize, and greatly enhance ZIKV infection in
  1119. vitro. DENV immune sera had varying degrees of neutralization against
  1120. ZIKV and similarly enhanced ZIKV infection. Our results suggest that
  1121. pre-existing DENV immunity may enhance ZIKV infection in vivo and may
  1122. lead to increased disease severity. Understanding the interplay
  1123. between ZIKV and DENV will be critical in informing public health
  1124. responses and will be particularly valuable for ZIKV and DENV vaccine
  1125. design and implementation strategies.
  1126.  
  1127. --
  1128. communicated by:
  1129. ProMED-mail
  1130. <promed@promedmail.org>
  1131. and
  1132. Roland Hübner
  1133. Superior Health Council
  1134. Brussels
  1135. Belgium
  1136. <roland.hubner@sante.belgique.be>
  1137.  
  1138. [This report again raises questions about DENV vaccines resulting in
  1139. ADE for Zika virus infections, and vice versa. With a tetravalent
  1140. dengue vaccine now in use in several countries, one hopes that
  1141. prospective monitoring for ADE in Zika virus infections is being
  1142. carried out. - Mod.TY]
  1143.  
  1144. ******
  1145. [9] False positive test
  1146. Date: Wed 28 Dec 2016
  1147. Source: Infection Control and Clinical Quality [edited]
  1148. <http://www.beckershospitalreview.com/quality/fda-issues-safety-alert-for-zika-tests-due-to-false-positives.html>
  1149.  
  1150.  
  1151. The Food and Drug Administration issued a safety alert on [23 Dec
  1152. 2016] warning physicians who care for pregnant women to not make
  1153. healthcare decisions for their patients based on test results from a
  1154. commercial Zika test.
  1155.  
  1156. The alert was issued after the regulatory agency received reports from
  1157. the Laboratory Corporation of America of the ZIKV Detect IgM Capture
  1158. ELISA assay (manufactured by InBios International) producing false
  1159. positives. The FDA has not yet determined if the false positives are
  1160. attributable to the Zika test or potential missteps on the part of the
  1161. testing facility.
  1162.  
  1163. In August [2016], the FDA authorized commercial use of the test. Since
  1164. the approval, several commercial laboratories have moved their
  1165. serological testing away from the CDC's assay to the new commercial
  1166. assay. After that transition, LabCorp began identifying higher rates
  1167. of false positives than expected.
  1168.  
  1169. The FDA now recommends results of the commercial test be considered
  1170. presumptive and that these results need to be confirmed by the CDC or
  1171. another qualified laboratory. The regulatory agency is also urging
  1172. providers to communicate the test's presumptive status to their
  1173. patients.
  1174.  
  1175. [byline: Brian Zimmerman]
  1176.  
  1177. --
  1178. communicated by:
  1179. ProMED-mail
  1180. <promed@promedmail.org>
  1181.  
  1182. [It is important that the doubt about the reliability of this test has
  1183. emerged relatively quickly from both the FDA and the manufacturer.
  1184. False positives pose a difficult problem for pregnant women, given the
  1185. concern about teratogenic effects for the developing fetuses. False
  1186. positives could lead to the parents deciding to terminate the
  1187. pregnancy when there is no risk of their fetuses becoming infected by
  1188. the virus.
  1189.  
  1190. Interestingly, a 15 Dec 2016 report in Eurosurveillance indicated the
  1191. development of a serological test providing high specificity and low
  1192. cross-reactivity. This NS1-based ELISA has the potential to aid in
  1193. counseling patients, pregnant women and travellers after returning
  1194. from ZIKV-endemic areas
  1195. (<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22670>).
  1196. This report was sent in by Roland Hübner.
  1197.  
  1198. In a 28 Dec 2016 paper, researchers in China reported on the isolation
  1199. of 2 antibodies that can neutralize the Zika virus without
  1200. cross-reactivity to dengue viruses. Their results, published in
  1201. Science Translational Medicine, demonstrate the therapeutic potential
  1202. of monoclonal antibodies against Zika and provide a structure-based
  1203. rationale for the design of future specific antivirals. These
  1204. monoclonal antibodies cold be useful for development of specific
  1205. diagnostic tests.
  1206. (<http://www.asianscientist.com/2016/12/in-the-lab/zika-neutralizing-antibodies/>).
  1207. - Mod.TY]
  1208.  
  1209. ******
  1210. [10] Mosquito vectors
  1211. Date: Thu 12 Jan 2017
  1212. Source: Euro Surveillance [edited]
  1213. <http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22684>
  1214.  
  1215.  
  1216. Heitmann A, Jansen S, Lühken R, et al. Experimental transmission of
  1217. Zika virus by mosquitoes from central Europe. Euro Surveill.
  1218. 2017;22(2):pii=30437. DOI:
  1219. http://dx.doi.org/10.2807/1560-7917.ES.2017.22.2.30437.
  1220.  
  1221. Mosquitoes collected in Germany in 2016, including _Culex pipiens
  1222. pipiens_ biotype _pipiens_, _Culex torrentium_ and _Aedes albopictus_,
  1223. as well as _Culex pipiens pipiens_ biotype _molestus_ (in colony since
  1224. 2011) were experimentally infected with Zika virus (ZIKV) at 18 C
  1225. [approx. 64 F] or 27 C [approx. 80 F]. None of the _Culex_ taxa
  1226. showed vector competence for ZIKV. In contrast, _Aedes albopictus_
  1227. were susceptible for ZIKV but only at 27 C [approx. 80 F], with
  1228. transmission rates similar to an _Aedes aegypti_ laboratory colony
  1229. tested in parallel.
  1230.  
  1231. --
  1232. communicated by:
  1233. ProMED-mail
  1234. <promed@promedmail.org>
  1235. and
  1236. Roland Hübner
  1237. Superior Health Council
  1238. Brussels
  1239. Belgium
  1240. <roland.hubner@sante.belgique.be>
  1241.  
  1242. [Several previous studies agree with _Culex_ spp as refractory or
  1243. inefficient vector mosquitoes. These studies stand in contrast to a
  1244. study in China that indicated that _Culex quinquefasciatus_ were
  1245. susceptible to the virus and transmitted it efficiently. It is
  1246. difficult to explain the discrepancy, and indicates that additional
  1247. experiments with _Culex_ spp. from various geographically different
  1248. populations are needed before final conclusions can be reached.
  1249.  
  1250. In December 2016, The USA National Science and Technology Council
  1251. Committee issued a report from their Science Task Force on Science and
  1252. Technology for Zika Vector Control (<http://bit.ly/2j6rpyP>). This
  1253. report addresses control of _Aedes_ vector mosquitoes that transmit
  1254. not only Zika virus, but dengue, chikungunya and yellow fever viruses
  1255. as well. Interested ProMED readers may wish to read this report. -
  1256. Mod.TY]
  1257.  
  1258. ******
  1259. [11] Severe thrombocytopenia
  1260. Date: 15 Apr 2017 [Epub ahead of print]
  1261. Source: CDC, Emerging Infectious Diseases [edited]
  1262. <https://wwwnc.cdc.gov/eid/article/23/4/16-1967_article#suggestedcitation>
  1263.  
  1264.  
  1265. Boyer Chammard TH, Schepers K, Breurec S, et al. Severe
  1266. thrombocytopenia after Zika virus infection, Guadeloupe, 2016. Emerg
  1267. Infect Dis. 2017;23(4). doi: 10.3201/eid2304.161967, PMID: 27997330.
  1268.  
  1269. Abstract
  1270. --------
  1271. Severe thrombocytopenia during or after the course of Zika virus
  1272. infection has been rarely reported. We report 7 cases of severe
  1273. thrombocytopenia and hemorrhagic signs and symptoms in Guadeloupe
  1274. after infection with this virus. Clinical course and laboratory
  1275. findings strongly suggest a causal link between Zika virus infection
  1276. and immune-mediated thrombocytopenia.
  1277.  
  1278. --
  1279. communicated by:
  1280. ProMED-mail
  1281. <promed@promedmail.org>
  1282.  
  1283. [Zika virus infections provide another surprise. In cases of severe
  1284. thrombocytopenia, one usually thinks of severe dengue virus infections
  1285. and DHF. Clinicians treating individuals infected by Zika virus should
  1286. be aware that rare cases of thrombocytopenia may occur. - Mod.TY]
  1287.  
  1288. [
  1289.  
  1290. A HealthMap/ProMED-mail map can be accessed at:
  1291. <http://healthmap.org/promed/p/6075>.]
  1292.  
  1293. [See Also:
  1294. 2016
  1295. ---
  1296. Zika virus (63): Americas, Asia, research, observations
  1297. http://promedmail.org/post/20161212.4693852
  1298. Zika virus (62): Americas, Asia, Europe, research, observations
  1299. http://promedmail.org/post/20161207.4680914
  1300. Zika virus (61): Americas, Asia, Pacific, research
  1301. http://promedmail.org/post/20161124.4650886
  1302. Zika virus (60) - Americas, Asia, research, observations
  1303. http://promedmail.org/post/20161121.4644809
  1304. Zika virus (59) - Americas, Asia, research, comment
  1305. http://promedmail.org/post/20161113.4625265
  1306. Zika virus (58): Americas, Asia, Pacific, Africa, research
  1307. http://promedmail.org/post/20161110.4618543
  1308. Zika virus (57): Americas, Asia, Pacific, Europe, research,
  1309. observations http://promedmail.org/post/20161104.4606432
  1310. Zika virus (56): Americas, Asia, Pacific, Europe, research,
  1311. observations http://promedmail.org/post/20161023.4578711
  1312. Zika virus (55) - Americas, Asia, Europe, research, observations
  1313. http://promedmail.org/post/20161019.4571149
  1314. Zika virus (54): Americas, PAHO/WHO
  1315. http://promedmail.org/post/20161007.4542586
  1316. Zika virus (53): Americas, Asia, Pacific, research, observations
  1317. http://promedmail.org/post/20161006.4541952
  1318. Zika & chikungunya viruses: comparative transmission
  1319. http://promedmail.org/post/20161005.4539231
  1320. Zika virus (52)f: Americas, Asia, Europe, research, observations
  1321. http://promedmail.org/post/20161001.4529740
  1322. Zika virus (51): Americas, PAHO/WHO
  1323. http://promedmail.org/post/20160923.4511356
  1324. Zika virus (50): Americas, Asia, Europe, Pacific, research,
  1325. observations http://promedmail.org/post/20160922.4506931
  1326. Zika virus (49): Americas, Asia, Europe, Middle East, research, notes
  1327. http://promedmail.org/post/20160915.4491053
  1328. Zika virus (48): Americas, PAHO/WHO
  1329. http://promedmail.org/post/20160909.4477370
  1330. Zika virus (47): Americas, Asia, research, observations
  1331. http://promedmail.org/post/20160908.4475100
  1332. Zika virus (46): Americas, Asia, Europe, research, observations
  1333. http://promedmail.org/post/20160905.4467034
  1334. Zika virus (45): worldwide, WHO, research, comment
  1335. http://promedmail.org/post/20160904.4464015
  1336. Zika virus (43): Americas, Europe: Tampa Florida area, research
  1337. http://promedmail.org/post/20160823.4436991.
  1338. Zika virus (45): worldwide, WHO, research, comment
  1339. http://promedmail.org/post/20160904.4464015
  1340. Zika virus (42): Americas, Europe
  1341. http://promedmail.org/post/20160821.4430310
  1342. Zika virus (41): Americas, Asia, Europe
  1343. http://promedmail.org/post/20160812.4412646
  1344. Zika virus (40) - Americas
  1345. http://promedmail.org/post/20160810.4407318
  1346. Zika virus (39): Americas, Europe
  1347. http://promedmail.org/post/20160729.4378060
  1348. Zika virus (38) - Americas, Africa, Europe
  1349. http://promedmail.org/post/20160725.4368191
  1350. Zika virus (37): Americas http://promedmail.org/post/20160722.4361791
  1351. Zika virus (36) - Americas: USA (FL, UT) RFI
  1352. http://promedmail.org/post/20160720.4356276
  1353. Zika virus (34): Americas, Asia, Africa, Europe
  1354. http://promedmail.org/post/20160707.4331999
  1355. Zika virus (33): Americas, Asia, Europe
  1356. http://promedmail.org/post/20160701.4321150
  1357. Zika virus (32): Americas, Asia, Pacific, Europe
  1358. http://promedmail.org/post/20160622.4303191
  1359. Zika virus (31): worldwide, WHO
  1360. http://promedmail.org/post/20160617.4290853
  1361. Zika virus (30): Americas, Asia, Atlantic, Europe
  1362. http://promedmail.org/post/20160616.4292221
  1363. Zika virus (29): Americas, Asia, Europe
  1364. http://promedmail.org/post/20160529.4253278
  1365. Zika virus (28): Americas, Asia, Pacific, Atlantic, Europe
  1366. http://promedmail.org/post/20160524.4240474
  1367. Zika virus (27): Americas, Asia, Europe
  1368. http://promedmail.org/post/20160511.4214303
  1369. Zika virus (26): Americas, Asia, Europe, Indian Ocean
  1370. http://promedmail.org/post/20160504.4202525
  1371. Zika virus (25): Americas http://promedmail.org/post/20160501.4195452
  1372. Zika virus (24): Americas http://promedmail.org/post/20160422.4177323
  1373. Zika virus (23): Americas http://promedmail.org/post/20160419.4168370
  1374. Zika virus (22): sexual transmission
  1375. http://promedmail.org/post/20160416.4162854
  1376. Zika virus (21): Americas (Brazil) diagnostic imaging
  1377. http://promedmail.org/post/20160415.4160993
  1378. Zika virus (20): Americas, Pacific, Asia, Europe
  1379. http://promedmail.org/post/20160414.4160595
  1380. Zika virus (19): Americas http://promedmail.org/post/20160411.4152933
  1381. Zika virus (18): Americas http://promedmail.org/post/20160402.4134955
  1382. Zika virus (17): Americas, Pacific
  1383. http://promedmail.org/post/20160401.4129524
  1384. Zika virus (16): Americas, Asia, Pacific, Atlantic
  1385. http://promedmail.org/post/20160325.4118019
  1386. Zika virus (15): Americas http://promedmail.org/post/20160321.4109160
  1387. Zika virus (14): Americas, Europe, Atlantic Ocean
  1388. http://promedmail.org/post/20160317.4102468
  1389. Zika virus (13): Americas, Asia, Europe, Pacific
  1390. http://promedmail.org/post/20160311.4086075
  1391. Zika virus (12): Brazil, microcephaly
  1392. http://promedmail.org/post/20160305.4070601
  1393. Zika virus (11): Americas, Europe, Asia
  1394. http://promedmail.org/post/20160301.4059896
  1395. Zika virus (10): Americas, Asia, Europe, Pacific
  1396. http://promedmail.org/post/20160229.4058161
  1397. Zika virus (09): Americas, Africa, Europe, Pacific
  1398. http://promedmail.org/post/20160223.4042828
  1399. Zika virus (08): Americas, Asia, Europe, Pacific
  1400. http://promedmail.org/post/20160217.4026836
  1401. Zika virus (07): update http://promedmail.org/post/20160216.4023810
  1402. ProMED-mail endorses sharing of Zika virus data
  1403. http://promedmail.org/post/20160211.4012212
  1404. Zika virus (06): overview http://promedmail.org/post/20160209.4007411
  1405. Zika virus (05): Americas, Asia, Pacific
  1406. http://promedmail.org/post/20160203.3990632
  1407. Zika virus (04): WHO declares worldwide PHEIC
  1408. http://promedmail.org/post/20160201.3985366
  1409. Zika virus (03): Americas, Asia
  1410. http://promedmail.org/post/20160128.3974426
  1411. Zika virus - Americas (02)
  1412. http://promedmail.org/post/20160111.3925377
  1413. Zika virus - Americas (01)
  1414. http://promedmail.org/post/20160108.3921447]
  1415. .................................................sb/lm/mpp/jh/dk/sh/ty/mj/ao/sh
  1416. *##########################################################*
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  1419. are  posted,  but  the  accuracy  and  completeness  of  the
  1420. information,   and  of  any  statements  or  opinions  based
  1421. thereon, are not guaranteed. The reader assumes all risks in
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  1426. or archived material.
  1427. ************************************************************
  1428. Donate to ProMED-mail. Details available at:
  1429. <http://www.isid.org/donate/>
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  1432. Send all items for posting to: promed@promedmail.org (NOT to
  1433. an individual moderator).  If you do not give your full name
  1434. name and affiliation,  it may not be posted.  You may unsub-
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