Zika virus outbreak report

ZIKA VIRUS (01): AMERICAS, ASIA, AFRICA, RESEARCH
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] PAHO/WHO epidemiological update
[2] Cases in various countries:
Americas
Americas cumulative case numbers

North America
---
USA
- National
- Florida (Miami-Dade county)
- Georgia
- Texas (Travis county)
- Rhode Island

Mexico and Central America
---
Mexico (national)
Costa Rica (national)
Honduras (national)

Caribbean
---
St Lucia (national)
Turks and Caicos (national)
Martinique blood donors, 2016

South America
---
Bolivia (national)
Brazil
- Microcephaly, national
- Eye involvement
Colombia (national)

Asia
---
Philippines (national)
Viet Nam (national)
Singapore (national)
Malaysia (Petaling Jaya, Selangor)

Africa
---
Angola (national)

Imported cases with no possibility of ongoing mosquito transmission
---
Canada
Israel
South Korea
USA
- Case numbers mainland
- New York City, New York
- Territories and Commonwealth

[3] Brazil: fetal infections, Brazil
[4] USA: birth defects
[5] Prolonged viremia
[6] Virus protein and neurological defects
[7] Virus molecular evolution
[8] Antibody-dependent enhancement
[9] False positive test
[10] Mosquito vectors
[11] Severe thrombocytopenia

******
[1] PAHO/WHO epidemiological update
Date: Thu 12 Jan 2017
Source: PAHO/WHO Zika - epidemiological update [edited]
<http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=37671>


Zika virus - incidence and trends
---------------------------------
Since epidemiological week (EW) 44 of 2016 [29 Oct-4 Nov 2016], no
additional countries or territories of the Americas have confirmed
autochthonous, vectorborne transmission of Zika virus disease. To
date, 48 countries and territories in the Americas (1) have confirmed
autochthonous, vectorborne transmission of Zika virus disease since
2015 (figure 1). In addition, 5 countries in the Americas have
reported sexually transmitted Zika cases (2).

Figure 1. [available at the source URL above] Countries and
territories in the Americas with confirmed autochthonous (vectorborne)
Zika virus cases, 2015-2017

(1) Anguilla; Antigua and Barbuda; Argentina; Aruba; the Bahamas;
Barbados; Belize; Bolivia (Plurinational State of); Bonaire, Sint
Eustatius, and Saba; Brazil; the British Virgin Islands; Cayman
Islands; Colombia; Costa Rica; Cuba; Curaçao; Dominica; the Dominican
Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe;
Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico;
Montserrat; Nicaragua; Panama; Paraguay; Peru; Puerto Rico; Saint
Barthélemy; Saint Kitts and Nevis; Saint Lucia; Saint Martin; Saint
Vincent and the Grenadines; Sint Maarten; Suriname; Trinidad and
Tobago; Turks and Caicos Islands; the United States of America; the
United States Virgin Islands; and Venezuela (Bolivarian Republic of).

(2) Argentina, Canada, Chile, Peru, and the USA.

Highlighted below is a summary of the epidemiological situation by
sub-regions of the Americas.

North America
In the United States, since 30 Dec 2016, the US Centers for Disease
Control and Prevention (CDC) has not reported new locally-acquired
cases of Zika virus disease.

Central America
In Panama, a growing trend of suspected and confirmed cases continued
to be observed between EW 30 to EW 49. In the other countries of the
sub region, the number of cases continues a downward trend.

Caribbean
In the countries and territories in the Caribbean, the downward trend
in the number of Zika cases continues.

South America
In Peru, between EW 40 and 50 of 2016 [1 Oct-16 Dec 2016], an increase
in the number of suspected and confirmed cases was observed,
particularly in the 4 districts of the city of Iquitos.

All the other countries and territories in South America continue to
report decreasing numbers of Zika cases.

Congenital syndrome associated with Zika virus infection
--------------------------------------------------------
To date, 22 countries and territories in the Americas have reported
confirmed cases of congenital syndrome associated with Zika virus
infection. Since December of 2016, no additional countries or
territories have reported confirmed cases of congenital syndrome
associated with Zika virus infection for the 1st time. In the last 2
weeks, Brazil, Colombia, and the United States of America updated
their number of cases of congenital syndrome associated with Zika
virus infection.
As of 1 Sep 2016, the table with the number of confirmed cases of
congenital syndrome is published on a weekly basis on the PAHO/WHO
website and is available on the Zika Cumulative Cases website
[<http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090>].

Guillain-Barré syndrome (GBS) and other neurological disorders
--------------------------------------------------------------
Since December 2016, no additional countries or territories have
reported cases of Guillain-Barré syndrome (GBS) associated with Zika
virus infection.

Following is a list of countries and territories in the Americas
reporting increased cases of Guillain-Barré syndrome (GBS) and/or
laboratory confirmation of Zika virus in at least one GBS case.

Table 1. Countries and territories in the Americas with GBS in the
context of Zika virus circulation.
Increase in GBS with Zika virus lab confirmation in at least one case
of GBS:
Brazil
Colombia
Dominican Republic
El Salvador
French Guiana
Guadeloupe
Guatemala
Honduras
Jamaica
Martinique
Puerto Rico
Suriname
Venezuela

Zika virus infection laboratory confirmation in at least one case of
GBS:
Bolivia
Costa Rica
Grenada
Haiti
Mexico
Panama
St. Martin

Increase in GBS with no Zika virus lab confirmation in any of the
cases:
Paraguay
Saint Vincent and the Grenadines

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[It will be interesting to see if the case numbers begin to increase
in South America with the onset of warmer, summer weather. - Mod.TY]

******
[2] Cases in various countries
Americas
---
Americas cumulative case numbers
As of 12 Jan 2017
<http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090>
Country / Locally acquired: suspected / confirmed / Imported / Deaths
/ Conf. Congenital Syndrome
North America:
Bermuda / 0 / 0 / 5 / 0 / 0
Canada / 0 / 0 / 439 / 0 / 1
USA / 0 / 217 / 46449 / 0 / 41

Latin America:
Mexico / 0 / 7575 / 15 / 0 / 0

Central American Isthmus:
Belize / 756 / 68 / 0 / 0 / 0
Costa Rica / 5737 / 1649 / 32 / 0 / 2
El Salvador / 11 434 / 51 / 0 / 0 / 4
Guatemala / 3343 / 788 / 0 / 0 / 15
Honduras / 31 936 / 298 / 0 / 0 / 2
Nicaragua / 0 / 2053 / 3 / 0 / 2
Panama / 2663 / 676 / 42 / 0 / 5

Latin Caribbean:
Cuba / 0 / 3 / 30 / 0 / 0
Dominican Republic / 4908 / 322 / 0 / 0 / 22
French Guiana / 9700 / 483 / 10 / 0 / 16
Guadeloupe / 30 845 / 379 / 0 / 0 / 6
Haiti / 2955 / 5 / 0 / 0 / 1
Martinique / 36 680 / 12 / 0 / 0 / 18
Puerto Rico / 0 / 36 375 / 1 / 5 / 10
Saint Barthélemy / 975 / 61 / 0 / 0 / 0
Saint Martin / 3115 / 200 / 0 / 0 / 0

Non-Latin Caribbean:
Anguilla / 28 / 16 / 1 / 0 / 0
Antigua and Barbuda / 465 / 14 / 2 / 0 / 0
Aruba / 676 / 28 / 7 / 0 / 0
Bahamas / 0 / 22 / 3 / 0 / 0
Barbados / 699 / 46 / 0 / 0 / 0
Bonaire, St Eustatius, and Saba / 0 / 85 / 0 / 0 / 0
Caymans / 211 / 30 / 10 / 0 / 0
Curacao / 0 / 820 / 0 / 0 / 0
Dominica / 1150 / 79 / 0 / 0 / 0
Grenada / 316 / 111 / 0 / 0 / 1
Guyana / 0 / 37 / 0 / 0 / 0
Jamaica / 7052 / 186 / 0 / 0 / 0
Montserrat / 2 / 5 / 0 / 0 / 0
Saint Kits and Nevis / 549 / 33 / 0 / 0 / 0
Saint Lucia / 822 / 50 / 0 / 0 / 0
Saint Vincent and the Grenadines / 508 / 83 / 0 / 0 / 0
Sint Maarten / 367 / 143 / 0 / 0 / 0
Suriname / 2760 / 723 / 0 / 4 / 2
Trinidad and Tobago / 0 / 643 / 1 / 0 / 1
Turks and Caicos / 179 / 17 / 3 / 0 / 0
Virgin Islands (UK) / 74 / 52 / 0 / 0 / 0
Virgin Islands (USA) / 1034 / 917 / 0 / 0 / 0

Andean Area:
Bolivia / 741 / 156 / 4 / 0 / 14
Colombia / 96 860 / 9799 / 0 / 0 / 77
Ecuador / 2680 / 875 / 15 / 0 / 0
Peru / 1767 / 389 / 21 / 0 / 0
Venezuela / 59 235 / 2380 / 0 / 0 / 0

[Brazil and] Southern Cone:
Brazil / 214 193 / 128 266 / 0 / 9 / 2366
Argentina / 1821 / 26 / 29 / 0 / 1
Chile / 0 / 0 / 33 / 0 / 0
Paraguay / 555 / 14 / 0 / 0 / 2
Uruguay / 0 / 0 / 1 / 0 / 0

Totals, Americas / 539 791 / 197 271 / 5356 / 18 / 2609

[Maps showing the location of the affected islands and countries in
the Americas mentioned above and below
can be accessed at
<http://healthmap.org/promed/p/35574>;
North America at http://healthmap.org/promed/p/106;
Central America <http://healthmap.org/promed/p/39455>;
Caribbean <http://www.mapsofworld.com/caribbean-islands/>, and
South America at <http://healthmap.org/promed/p/6186>. - Mod.TY]

North America
---
USA
- National. 6 Jan 2017. 2 more babies have been born in the United
States with Zika-related birth defects, raising the total to 36, the
Centers for Disease Control and Prevention (CDC) said yesterday [5 Jan
2016] in an update. The number of Zika-related pregnancy losses
remained at 5; of 1292 women who were included in the US Zika
Pregnancy Registry as of 27 Dec 2016, 875 pregnancies have been
completed with or without birth defects.
<http://www.cidrap.umn.edu/news-perspective/2017/01/news-scan-jan-06-2017>

[A 13 Jan 2017 study in the USA reported a study reporting that out of
442 cases, 271 pregnant were asymptomatic, 167 had symptoms related to
Zika, and symptoms were missing in 4 cases. 26 fetuses or infants (6
percent) had birth defects, 22 had a brain anomaly, while 4 had other
malformations. Among the 22 cases, where the brain was affected, 14
had microcephaly and other brain abnormalities together, 4 had only
microcephaly, while 4 had only other brain malformations. Among the 4
cases, where brain abnormalities were not detected, 2 had
encephalocele (a protrusion of the brain), 1 had eye and 1 had hearing
anomalies. The risk of abnormalities was the same in both symptomatic
and asymptomatic cases (6 per cent). In cases where pregnant women
were only exposed in the first trimester, 11 per cent had birth
defects, while in cases where exposure took place in multiple
trimesters including the 1st trimester, 7 per cent of the fetuses or
infants presented with birth defects. However, exposure in only the
2nd trimester did not result in birth defects
(<https://www.medicalnewsbulletin.com/birth-defects-zika-related-pregnancies-us/>)]

- Florida (Miami-Dade county). 12 Jan 2017. (confirmed [conf]) 1 new
locally acquired case in Miami-Dade County, bringing the total of
locally acquired cases to 257.
<http://www.floridahealth.gov/newsroom/2017/01/011217-zika-update.html>

- Georgia. 11 Jan 2017. (conf) A Zika-related birth defect has been
documented in Georgia, public health officials reported.
<http://savannahnow.com/news/2017-01-11/zika-related-birth-defect-reported-georgia-health-officials-say>

- Texas (Travis county). 7 Jan 2017. (conf) Health officials say a
child born in Travis County with microcephaly has a Zika virus
infection.
<http://www.kbtx.com/content/news/Child-born-in-Austin-has-Zika-virus-409982215.html>

[A 22 Dec 2016 reports the occurrence of the 6th locally acquired case
in Texas, in Cameron county
(<http://www.krgv.com/story/34117108/cameron-co-health-officials-confirm-sixth-locally-transmitted-zika-case>)

On 14 Dec 2016, CDC issued guidance related to Zika for people living
in or traveling to Brownsville, Cameron County, Texas
(<https://www.cdc.gov/zika/intheus/texas-update.html>). - Mod.TY]

- Rhode Island. 21 Dec 2016. (conf) 1st infant born with the virus in
state, had no defects, mother traveled to a Zika prevalent area while
pregnant.
<http://www.abc6.com/story/34107190/first-rhode-island-baby-born-with-zika-virus>

Mexico and Central America
---
Mexico (national). 17 Dec 2016. (reported) 347 cases.
<http://sipse.com/novedades/cancun-zika-microcefalia-chikungunya-gestacion-embarazo-serviciosm-agua-hombres-busquedas-234987.html>
[in Spanish]

Costa Rica (national). 2 Jan 2017. (conf) in 2016, 1581 cases. Cantons
most affected: Orotina 159 cases for each 10 000 residents, Nandayure,
Liberia, Santa Cruz, Nicoya and Abangares each ranked within the top
20 cantons.
<http://www.vozdeguanacaste.com/en/articles/2017/01/02/canas-reports-2nd-highest-number-zika-cases-2016>

Honduras (national). 30 Dec 2016. (reported) 623 pregnant women under
surveillance, 127 cases of microencephaly of which 13 recently;
Guillain-Barré syndrome 164 cases.
<http://www.radiohrn.hn/l/noticias/salud-reporta-13-casos-de-microcefalia-en-las-%C3%BAltimas-semanas>

Caribbean
---
St Lucia (national). 16 Dec 2016. (reported) 50 pregnant women have
tested positive for Zika virus infections and are bing monitored due
to concerns about microcephaly.
<http://www.jamaicaobserver.com/latestnews/St-Lucia-Gov-t-moves-to-decrease-impact-of-ZikV-on-pregnant-women>

Turks and Caicos (national). 6 Jan 2017. (conf) 24 cases, of which 8
are new cases, 7 on Grand Turk.
<http://tcweeklynews.com/eight-new-zika-cases-brings-total-to-p7599-127.htm>

Martinique blood donors, 2016. 12 Jan 2017. (conf.) between 19 Jan-10
Jun 2016, 4129 consecutive blood donations were tested (mean age, 41.9
years; sex ratio [M/F], 0.88). Positive individual nucleic acid
testing detection occurred in 76 blood donations (1.8 per cent), with
the most intense detection rate (3 per cent) during weeks 17-20 (mean
age, 41.8 years; sex ratio, 1.2). Inquiry consisted of a telephone
call at day 7 post-donation to identify symptoms compatible with ZIKV
infection. When the donor declared no sign, a new call was 14 days
after donation. This information was obtained from 75 viremic donors:
34 (45.3 per cent) remained asymptomatic, and 41 (54.7 per cent)
reported symptoms (1-6 days post-donation).
<http://www.bloodjournal.org/content/129/2/263>

South America
---
Bolivia (national). 20 Dec 2016. (conf) 2 new cases of microcephaly,
bringing the total to 13, of these, 12 in Santa Cruz and 1 in
Chuquisaca.
<http://www.eldeber.com.bo/santacruz/Confirman-otros-dos-casos-de-microcefalia-20161220-0047.html>
[in Spanish]

Brazil
- Microcephaly, national. 12 Jan 2017. Microcephaly (conf) 2289 cases,
with 3144 other suspected cases pending confirmation.
<https://www.yahoo.com/news/mothers-brazils-zika-babies-struggle-071456132.html>

- Eye involvement. 11 Jan 2017. (reported) 2 cases of blindness in
babies born Greater São Paulo -- one in Guarulhos and another in the
capital -- because of the Zika virus infections in utero.
<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>

Colombia (national). 31 Dec 2016. (reported) week 32 of 2015-week 52
of 2016 [9 Aug 2015-31 Dec 2016], (suspected [susp]) 3578 cases, (susp
clinically) 93 262 cases, (conf laboratory) 9799 cases.
<http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2016%20Bolet%C3%ADn%20epidemiológico%20semana%2052%20-.pdf>

[AC Jaramillo MD is thanked for sending in this bulletin. - Mod.TY]

Asia
---
[A good summary of Zika virus infections in Asia 1952-2016 is
available at
<http://www.ijidonline.com/article/S1201-9712(16)31640-X/fulltext>. -
Mod.TY]

Philippines (national). 28 Dec 2016. (conf) 52 cases, 4 of whom are
pregnant (1 of them already gave birth to a normal baby).
<http://www.rappler.com/nation/156836-december-update-zika-cases-philippines>

[Maps of the Philippines can be accessed at
<http://www.charleskeng.com/images-map/philmap.jpg> and
<http://healthmap.org/promed/p/158>. - Mod.TY]

Viet Nam (national). 15 Jan 2017. (conf) since the 1st cases were
detected, 212 cases. Most affected locality: Ho Chi Minh city 186
cases with 12 pregnant. From December 2016 to early January 2017, 4
cases of Zika infections in Vinh Thanh commune, Nhon Trach district, 1
case in Ben Tri province.
<http://outbreaknewstoday.com/vietnam-zika-news-epidemic-dong-nai-1st-case-ben-tre-26233/>

[Maps of Viet Nam can be accessed at
<http://www.onlineasiatravel.com/images/vn/vietnam-map.png> and
<http://healthmap.org/promed/p/152>. - Mod.TY]

Singapore (national). 27 Dec 2016. (conf) no new cases since 11 Dec
2016. Zika virus infected pregnant women 17 as of 21 Dec 2016, 3 have
given birth to babies without microcephaly, all babies to be monitored
until age 3 for development progress.
<http://www.channelnewsasia.com/news/singapore/babies-born-to-zika-patients-to-be-monitored-until-age-3-moh/3396876.html>

[Maps of Singapore can be accessed at
<http://sunsite.nus.edu.sg/SEAlinks/maps/singapore.gif> and
<http://healthmap.org/promed/p/150>. - Mod.TY]

Malaysia (Petaling Jaya, Selangor). 18 Dec 2016. (conf) 8th case in a
67 year old man from Petaling Jaya, Selangor.
<http://www.nst.com.my/news/2016/12/197763/eighth-confirmed-zika-case-malaysia-67-year-old-man-petaling-jaya-infected>

[Maps of Malaysia can be accessed at
<http://www.ezilon.com/maps/images/asia/political-map-of-Malaysian.gif>
and <http://healthmap.org/promed/p/2293>. - Mod.TY]

Africa
---
Angola (national). 9 Jan 2017. (conf). 2 cases, one a French tourist,
another local Luanda resident.
<https://www.yahoo.com/news/angola-records-first-zika-cases-155335367.html>

[Maps of Angola can be accessed at
<http://www.un.org/Depts/Cartographic/map/profile/angola.pdf> and
<http://healthmap.org/promed/p/165>. - Mod.TY]

Imported cases with no possibility of ongoing mosquito transmission
(except USA Florida and Texas)
---
Canada. 5 Jan 2017. (conf.) As of 13 Dec 2016, 421 cases of whom 20
pregnant with 2 Zika-related abnormalities in fetuses and newborns; 3
cases sexually transmitted.
<http://globalnews.ca/news/3163257/zika-virus-update-canadian-cases-what-to-do-to-prevent-it/>

[A HealthMap/ProMED-mail map of Canada can be accessed at
<http://healthmap.org/promed/p/12>. - Mod.TY]

Israel. 22 Dec 2016. (conf) 20 cases in recent months, all imported.
<http://www.jpost.com/Israel-News/New-Zika-case-identified-in-central-Israel-resident-476194>

[A HealthMap/ProMED-mail map of Israel can be accessed at
<http://healthmap.org/promed/p/90>. - Mod.TY]

South Korea. 6 Jan 2017. (conf) 17 cases of which 13 ex South East
Asia, 4 ex Latin America.
<http://world.kbs.co.kr/english/news/news_Dm_detail.htm?No=124448&id=Dm>

[A HealthMap/ProMED-mail map of South Korea can be accessed at
<http://healthmap.org/promed/p/195>. - Mod.TY]

USA
- Case numbers mainland. Zika virus disease in the United States,
2015-2016 as of 11 Jan 2017
<http://www.cdc.gov/zika/geo/united-states.html>
State / no. imported cases / no. locally acquired cases
Alabama / 30 / 0
Arizona / 52 / 0
Arkansas / 15 / 0
California / 393 / 0
Colorado / 49 / 0
Connecticut / 58 / 0
Delaware / 17 / 0
District of Columbia / 31
Florida / 833 / 210
Georgia / 106 / 0
Hawaii / 16 / 0
Idaho / 4 / 0
Illinois / 90 / 0
Indiana / 50 / 0
Iowa / 21 / 0
Kansas / 19 / 0
Kentucky / 31 / 0
Louisiana / 35 / 0
Maine / 13 / 0
Maryland / 129 / 0
Massachusetts / 117 / 0
Michigan / 65 / 0
Minnesota / 64 / 0
Mississippi / 23 / 0
Missouri / 35 / 0
Montana / 7 / 0
Nebraska / 13 / 0
Nevada / 19 / 0
New Hampshire / 12 / 0
New Jersey / 173 / 0
New Mexico / 9 / 0
New York / 997 / 0
North Carolina / 86 / 0
North Dakota / 2 / 0
Ohio / 82 / 0
Oklahoma / 29 / 0
Oregon / 42 / 0
Pennsylvania / 167 / 0
Rhode Island / 50 / 0
South Carolina / 54 / 0
South Dakota / 2 / 0
Tennessee / 59 / 0
Texas / 290 / 6
Utah / 20 / 0
Vermont / 11 / 0
Virginia / 107 / 0
Washington / 62 / 0
West Virginia / 11 / 0
Wisconsin / 48 / 0
Wyoming / 2
Total / 4650 / 216

- New York City, New York. 7 Dec 2016. (conf) The city has 4 new cases
of congenital Zika virus syndrome.
<https://abc7.com/news/4-more-infants-in-nyc-reported-to-have-zika-related-birth-defects/1644318/>

- Territories and Commonwealth:
American Samoa: 1 imported, 114 locally acquired
Puerto Rico: 132 imported, 34 249 locally acquired
US Virgin Islands: 2 imported, 917 locally acquired

Total locally acquired 35 280

[A map of the USA showing the states and territories mentioned above
can be accessed at <http://www.mapsofworld.com/usa/>]

--
communicated by:
ProMED-mail
<promed@promedmail.org>
and
Roland Hübner
Superior Health Council
Brussels
Belgium
<roland.hubner@sante.belgique.be>

******
[3] Brazil: fetal infections
Date: Tue 13 Dec 2016
Source: Stat [edited]
<https://www.statnews.com/2016/12/13/zika-abnormal-pregnancy-rates/>


The toll that Zika virus takes on pregnancies appears to be even
higher than was previously estimated, with a newly updated study from
Brazil suggesting that 42 per cent of infants infected in the womb may
have significant birth defects. When the authors factored in
stillbirths and miscarriages suffered by women who had been infected
with Zika, 46 per cent of pregnancies were affected. Microcephaly (a
condition in which babies are born with smaller than normal heads) was
seen in only about 3 per cent of babies in the study.

"Microcephaly is just the tip of the iceberg. It's definitely not
where the focus should be," said Dr Karin Nielsen-Saines, the paper's
senior author. "For every case of microcephaly you're probably going
to have 10 cases of other problems that haven't been recognized."
Nielsen-Saines is a professor in the division of pediatric infectious
diseases at the University of California, Los Angeles. Her co-authors
are from Brazil and the US.

The group reported adverse outcomes (pregnancy losses or birth
defects) in 55 per cent of pregnancies in which infection occurred in
the 1st trimester, 52 per cent of pregnancies in which infection
occurred in the 2nd trimester, and 29 per cent in which infection
occurred in the 3rd trimester.

Nielsen-Saines told STAT on [Tue 13 Dec 2016] that she'd been
surprised by the 29 per cent figure and is more surprised still by the
updated estimates. But on the issue of the danger the virus poses to
developing fetuses, she is now clear. "I actually don't think there's
anything more harmful to a fetus than Zika [virus]," she said. "It's
probably the most teratogenic virus that exists." The March study and
the update are published in the New England Journal of Medicine.

An unrelated study, from scientists at the Centers for Disease Control
and Prevention, may shed some light on why Zika is so harmful to
developing brains. That study, published in the journal Emerging
Infectious Diseases, found levels of virus in the brains of infected
infants (who died after birth) were 1000 times higher than in viral
levels in women's placentas.

"Our findings show that Zika virus can continue to replicate in
infants' brains even after birth, and that the virus can persist in
placentas for months; much longer than we expected," said Julu
Bhatnagar, head of the molecular pathology team at CDC's Infectious
Diseases Pathology Branch and the study's lead author. "We don't know
how long the virus can persist, but its persistence could have
implications for babies born with microcephaly and for apparently
healthy infants whose mothers had Zika [virus infections] during their
pregnancies."

Women who developed a fever and a rash were enrolled in the study and
tested to see if they had Zika [virus]. The study, which is ongoing,
follows both women who tested positive for the virus and women who
didn't. The latter group is used as a comparator.

Several scientists not involved in the study noted that the effect it
recorded might be artificially high, because all women who had Zika
[virus] had a symptomatic infection. It's known that most people who
contract Zika [virus] don't have symptoms, and women with those milder
infections may not give birth to babies with birth defects at the same
rate, suggested Dave O'Connor, a professor of pathology and laboratory
medicine at the University of Wisconsin-Madison who has been studying
Zika in non-human primates. "Asymptomatic infections certainly carry
risk too, but symptomatic infections may have disproportionately high
risk. This is still speculative, but an important caveat on their
results," O'Connor said in an email.

It is known that women who have asymptomatic Zika infections do
sometimes give birth to babies with microcephaly. Scientists from
Colombia and the Centers for Disease Control and Prevention reported
on 4 such cases in June [2016].

In the Brazilian study, researchers reported on 125 pregnant women who
were infected with Zika [virus] and had given birth or lost their
pregnancy between 1 Jan and 31 Jul [2016]. They compared them to 61
women who were not infected with Zika [virus] during their
pregnancies. Cases of microcephaly were actually rare in the study; 4
babies born to Zika-infected mothers had microcephaly, but 2 of those
babies were small and their heads were proportionate to their bodies.
There would have been at least 1 more case. But a woman whose
ultrasound showed a profoundly affected fetus dropped out of the
study; Nielsen-Saines said multiple attempts to find her failed.

The range of other birth defects was substantial, including seizure
activity, visual and hearing impairment, spasticity, contracted limbs,
and difficulty swallowing and feeding. All these are signs of brain
damage, Nielson-Saines said, adding she expects with time that more
developmental problems will become apparent. "The newborns may appear
to be normal, but they may not be normal at 6 months, and there's a
whole gradient of problems," she said. The researchers plan to track
these babies for 2 years, if their mothers will allow it.
Nielsen-Saines admitted some mothers are reluctant to bring the babies
back for medical assessment. "They don't want to know."

While infection early in pregnancy appeared to carry the highest risk,
infection as late as 39 weeks was associated with problems in some
cases. This is unlike rubella (another virus infamous for causing
birth defects) where the danger period for infection is in the first
20 weeks of pregnancy, the authors noted. Note: paper said 16 [weeks]
but she said 20 and multiple websites say 20.

The women who were not infected with Zika also had an unusually high
percentage of problems; 11.5 per cent. But 42 per cent of them were
infected during their pregnancy with chikungunya, another virus that
has also been associated with pregnancy losses (stillbirths and
miscarriages).

Two of the leaders of the Zika response team at the Centers for
Disease Control and Prevention said the findings suggest the Zika
virus will have a large effect where it spreads. "The scope of the
ZIKV outbreak in the Americas suggests that ZIKV infections will have
a profound impact on the cohort of infants delivered in the 9 months
after the outbreak peak in each country," Margaret Honein and Dr
Denise Jamieson wrote in an editorial published by the journal.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Zika virus infections of mothers and their fetuses continue to
provide unpleasant surprises. Those surprises may continue as the
status of apparently normal but infected neonates is studied
prospectively over 2 or more years. The adverse social and economic
consequences of Zika virus infected newborns and their families are
certain to be significant.

Readers interested in seeing the original 13 Dec 2016 New England
Journal of Medicine can find it at
<http://www.nejm.org/doi/full/10.1056/NEJMoa1602412> and the 13 Dec
2016 Emerging Infectious Diseases at
<https://wwwnc.cdc.gov/eid/article/23/3/16-1499_article#suggestedcitation>.

A 3 Jan 2017 review of more than 100 studies in various reporting
sources found sufficient evidence to conclude that Zika virus is a
cause of congenital abnormalities and is a trigger of GBS
(Guillain-Barré Syndrome)
<http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002203>.
- Mod.TY]

******
[4] USA: birth defects
Date: Tue 13 Dec 2016
Source: JAMA [edited]
<http://jamanetwork.com/journals/jama/fullarticle/2593702>


Honein MA, Dawson AL, Petersen EE, et al. Birth defects among fetuses
and infants of US women with evidence of possible Zika virus infection
during pregnancy. JAMA. 2017;317(1):59-68. doi:
10.1001/jama.2016.19006, PMID: 27960197.

Key Points
Question: What proportion of fetuses and infants of women in the
United States with laboratory evidence of possible Zika virus
infection during pregnancy have birth defects?
Findings: Based on preliminary data from the US Zika Pregnancy
Registry, among 442 completed pregnancies, 6 per cent overall had a
fetus or infant with evidence of a Zika virus-related birth defect,
primarily microcephaly with brain abnormalities, whereas among women
with possible Zika virus infection during the first trimester, 11 per
cent had a fetus or infant with a birth defect.

Meaning: These findings support the importance of screening pregnant
women for Zika virus exposure.

Abstract
--------
Importance: Understanding the risk of birth defects associated with
Zika virus infection during pregnancy may help guide communication,
prevention, and planning efforts. In the absence of Zika virus,
microcephaly occurs in approximately 7 per 10 000 live births.

Objective: To estimate the preliminary proportion of fetuses or
infants with birth defects after maternal Zika virus infection by
trimester of infection and maternal symptoms.

Design, setting, and participants: Completed pregnancies with
maternal, fetal, or infant laboratory evidence of possible recent Zika
virus infection and outcomes reported in the continental United States
and Hawaii from 15 Jan to 22 Sep 2016, in the US Zika Pregnancy
Registry, a collaboration between the CDC and state and local health
departments.

Exposures: Laboratory evidence of possible recent Zika virus infection
in a maternal, placental, fetal, or infant sample.

Main outcomes and measures: Birth defects potentially Zika associated:
brain abnormalities with or without microcephaly, neural tube defects
and other early brain malformations, eye abnormalities, and other
central nervous system consequences.

Results: Among 442 completed pregnancies in women (median age, 28
years; range, 15-50 years) with laboratory evidence of possible recent
Zika virus infection, birth defects potentially related to Zika virus
were identified in 26 (6 per cent; 95 per cent confidence interval
[CI] 4-8 per cent) fetuses or infants. There were 21 infants with
birth defects among 395 live births and 5 fetuses with birth defects
among 47 pregnancy losses. Birth defects were reported for 16 of 271
(6 per cent; CI 4-9 per cent) pregnant asymptomatic women and 10 of
167 (6 per cent; CI 3-11 per cent) symptomatic pregnant women. Of the
26 affected fetuses or infants, 4 had microcephaly and no reported
neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had
brain abnormalities without microcephaly; reported brain abnormalities
included intracranial calcifications, corpus callosum abnormalities,
abnormal cortical formation, cerebral atrophy, ventriculomegaly,
hydrocephaly, and cerebellar abnormalities. Infants with microcephaly
(18/442) represent 4 per cent of completed pregnancies. Birth defects
were reported in 9 of 85 (11 per cent; CI 6-19 per cent) completed
pregnancies with maternal symptoms or exposure exclusively in the 1st
trimester (or 1st trimester and periconceptional period), with no
reports of birth defects among fetuses or infants with prenatal
exposure to Zika virus infection only in the 2nd or 3rd trimesters.

Conclusions and relevance: Among pregnant women in the United States
with completed pregnancies and laboratory evidence of possible recent
Zika infection, 6 per cent of fetuses or infants had evidence of
Zika-associated birth defects, primarily brain abnormalities and
microcephaly, whereas among women with 1st-trimester Zika infection,
11 per cent of fetuses or infants had evidence of Zika-associated
birth defects. These findings support the importance of screening
pregnant women for Zika virus exposure.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[5] Prolonged viremia
Date: Thu 29 Dec 2016
Source: N Engl J Med [edited]
<http://www.nejm.org/doi/full/10.1056/NEJMc1607580#t=article>


Suy A, Sulleiro E, Rodó C, et al. Prolonged Zika virus viremia during
pregnancy. N Engl J Med. 2016;375(26):2611-2613. doi:
10.1056/NEJMc1607580, PMID: 27959695.

We describe a case of Zika virus (ZIKV) infection during pregnancy in
a Colombian woman. She was infected in December 2015 while she was
visiting her home country. At 9 weeks' gestation, she had a
self-limited maculopapular, nonconfluent rash for 3 days that affected
her trunk, arms, and legs; she had no fever or other concurrent
symptoms. She was screened for ZIKV and other flaviviruses.

A reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay
(RealStar Zika Virus RT-PCR Kit 1.0, Altona Diagnostics) of a serum
sample was positive for ZIKV, and testing remained positive for 89
days (or 107 days after the onset of symptoms, until 29 weeks'
gestation), in 6 consecutive blood samples. Testing for ZIKV in the
urine, vagina, and endocervix was negative. No fetal brain
abnormalities were observed on scans obtained at 12 and 15 weeks'
gestation. Neurosonography performed at 20, 24, and 29 weeks'
gestation revealed bilateral mild ventriculomegaly and a shortened
corpus callosum. The posterior fossa was normal. The brain parenchyma
had calcifications and severe atrophy. Similar findings were seen on
magnetic resonance imaging (MRI). No other anomalies were found in the
fetus or the placenta. An RT-PCR assay of the amniotic fluid was
positive for ZIKV, and screening was negative for dengue virus,
chikungunya virus, cytomegalovirus, varicella-zoster virus, parvovirus
B19, _Toxoplasma gondii_, and sexually transmitted infectious agents
(_Chlamydia trachomatis_, _Neisseria gonorrhoeae_, _Mycoplasma
hominis_, _Ureaplasma parvum_, _M. genitalium_, _U. urealiticum_, and
_Trichomonas vaginalis_). The ZIKV viral load in the amniotic fluid
was higher than that in the maternal serum (cycle threshold values, 28
vs. 35; RT-PCR cycle threshold values were used as an indirect marker
of viral load). Results of targeted genetic testing of the amniotic
fluid by means of microarray-based comparative genomic hybridization
(SurePrint G3 Unrestricted CGH ISCA v2 Microarray Kit, 8x60K, Agilent
Technologies) were normal.

The baby was delivered at 37 weeks' gestation because of suspected
growth restriction. At this time, RT-PCR assays of the maternal serum,
urine, amniotic fluid, placenta, membranes, and umbilical cord were
negative for ZIKV. RT-PCR assays of the neonatal serum, urine, and
cerebrospinal fluid were also negative. Postnatal ultrasonography and
MRI studies confirmed the presence of microcephaly with a thinned
corpus callosum and brain atrophy with parenchymal calcifications.
(Table 1.shows the evolution of laboratory and ultrasonographic
findings in the mother and the baby.) [see in the URL].

ZIKV has been documented to be detectable in maternal blood by means
of molecular techniques during the acute phase of the infection (the
first 5 days after the onset of clinical symptoms). Driggers et al. (2
Jun 2016 issue) detected ZIKV RNA in maternal serum 8 weeks after the
onset of clinical symptoms. They suggested that persistent viremia may
occur as a consequence of viral replication in the fetus or placenta.
In our case, certain findings would support this hypothesis. 1st, the
viral load in the amniotic fluid was higher than that in the maternal
serum. 2nd, the viral load in the maternal serum remained stable
(cycle threshold value, approximately 35) for 14 weeks and then became
negative, instead of decreasing progressively, as would be expected.
3rd, neutralizing antibodies and ZIKV RNA were present in the maternal
serum. In addition, RT-PCR assays of the maternal urine were negative,
while testing of the maternal serum was positive. According to
previous studies, ZIKV RNA would be detectable in urine longer than in
serum, so an RT-PCR assay of the maternal urine would be expected to
be positive in the presence of maternal viremia. For all these
reasons, we would hypothesize that the persistent viremia that was
detected in the mother could be the result of viral replication in the
fetus or placenta, which thus acts as a reservoir.

We presume that the RT-PCR testing of neonatal samples was negative
because the clinical infection occurred during prenatal life; hence,
it is possible that ZIKV antibodies developed in the baby's immune
system before birth. In summary, persistent ZIKV RNA in maternal serum
could be a sign of fetal infection, and thus the fetus may play a role
in persistent maternal viremia.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[This report provides some further insight into the
maternal-fetal-placenta dynamics of Zika virus infection. A maternal
viremia of 89 days is remarkable. - Mod.TY]

******
[6] Virus protein and neurological defects
Date: Thu 1 Dec 2016
Source: PNAS [edited]
<http://www.pnas.org/content/early/2017/01/01/1619735114.abstract>


Li G, Poulsen M, Fenyvuesvolgyi C, et al. Characterization of
cytopathic factors through genome-wide analysis of the Zika viral
proteins in fission yeast. Proc Natl Acad Sci U S A. 2017. pii:
201619735. doi: 10.1073/pnas.1619735114, PMID: 28049830.

Significance
The Zika virus (ZIKV) causes various neurologic defects including
microcephaly and the Guillain-Barré syndrome. However, little is
known about how ZIKV causes those diseases or which viral protein(s)
is responsible for the observed cytopathic effects involved in
restricted neuronal cellular growth, dysregulation of the cell cycle,
and induction of cell hypertrophy or cell death. A genome-wide
analysis of ZIKV proteins and peptides was conducted using fission
yeast as a surrogate host. Seven ZIKV proteins conferred various
cytopathic effects in which NS4A-induced cellular hypertrophy and
growth restriction were mediated through the target of rapamycin (TOR)
cellular stress-response pathway. These findings provide a foundation
for identifying viral pathogenicity factors associated with the ZIKV
diseases.

Abstract
--------
The Zika virus (ZIKV) causes microcephaly and the Guillain-Barré
syndrome. Little is known about how ZIKV causes these conditions or
which ZIKV viral protein(s) is responsible for the associated
ZIKV-induced cytopathic effects, including cell hypertrophy, growth
restriction, cell-cycle dysregulation, and cell death. We used fission
yeast for the rapid, global functional analysis of the ZIKV genome.
All 14 proteins or small peptides were produced under an inducible
promoter, and we measured the intracellular localization and the
specific effects on ZIKV-associated cytopathic activities of each
protein. The subcellular localization of each ZIKV protein was in
overall agreement with its predicted protein structure. Five
structural and 2 nonstructural ZIKV proteins showed various levels of
cytopathic effects. The expression of these ZIKV proteins restricted
cell proliferation, induced hypertrophy, or triggered cellular
oxidative stress leading to cell death. The expression of premembrane
protein (prM) resulted in cell-cycle G1 accumulation, whereas
membrane-anchored capsid (anaC), membrane protein (M), envelope
protein (E), and nonstructural protein 4A (NS4A) caused cell-cycle
G2/M accumulation. A mechanistic study revealed that NS4A-induced
cellular hypertrophy and growth restriction were mediated specifically
through the target of rapamycin (TOR) cellular stress pathway
involving Tor1 and type 2A phosphatase activator Tip41. These findings
should provide a reference for future research on the prevention and
treatment of ZIKV diseases.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[A 10 Jan 2017 report in MBio
(<http://mbio.asm.org/content/8/1/e02150-16>) identified that the
p38-Mnk1 cascade regulating phosphorylation of eIF4E is a target of
DENV infection and plays an important role in virus production. "Our
results define several molecular interfaces by which flaviviruses,
which include Zika virus, hijack host cell translation and interfere
with stress responses to optimize the production of new virus
particles. Unlike other RNA viruses, these flaviviruses concomitantly
suppress host cell stress responses, thereby uncoupling translation
suppression from stress granule formation." This suppression likely
contributes to pathogenesis. Roland Hübner is thanked for sending in
this report. - Mod.TY]

******
[7] Virus molecular evolution
Date: Mon 12 Dec 2016
Source: Cladistics [edited]
<http://onlinelibrary.wiley.com/wol1/doi/10.1111/cla.12178/abstract>


Schneider AB, Malone RW, Guo JT, et al. Molecular evolution of Zika
virus as it crossed the Pacific to the Americas. Cladistics
2017;33(1):1-20, DOI: 10.1111/cla.12178.

Abstract
--------
Zika virus was previously considered to cause only a benign infection
in humans. Studies of recent outbreaks of Zika virus in the Pacific,
South America, Mexico and the Caribbean have associated the virus with
severe neuropathology. Viral evolution may be one factor contributing
to an apparent change in Zika disease as it spread from South East
Asia across the Pacific to the Americas. To address this possibility,
we have employed computational tools to compare the phylogeny,
geography, immunology and RNA structure of Zika virus isolates from
Africa, Asia, the Pacific and the Americas. In doing so, we compare
and contrast methods and results for tree search and rooting of Zika
virus phylogenies. In some phylogenetic analyses we find support for
the hypothesis that there is a deep common ancestor between African
and Asian clades (the "Asia/Africa" hypothesis). In other phylogenetic
analyses, we find that Asian lineages are descendent from African
lineages (the "out of Africa" hypothesis). In addition, we identify
and evaluate key mutations in viral envelope protein coding and
untranslated terminal RNA regions. We find stepwise mutations that
have altered both immunological motif sets and regulatory sequence
elements. Both of these sets of changes distinguish viruses found in
Africa from those in the emergent Asia-Pacific-Americas lineage. These
findings support the working hypothesis that mutations acquired by
Zika virus in the Pacific and Americas contribute to changes in
pathology. These results can inform experiments required to elucidate
the role of viral genetic evolution in changes in neuropathology,
including microcephaly and other neurological and skeletomuscular
issues in infants, and Guillain-Barré syndrome in adults.

--
communicated by:
ProMED-mail
<promed@promedmail.org>
and
Roland Hübner
Superior Health Council
Brussels
Belgium
<roland.hubner@sante.belgique.be>

[Interviews with the authors and scientists working in this area are
quoted in the 13 Dec 2016 issue of the Medical Express
(<http://medicalxpress.com/news/2016-12-mutations-trans-pacific-key-zika-severity.html>).
The analysis provides the most complete study of the virus's history
to date and reveals specific genetic changes that occurred as the
virus crossed the Pacific Ocean on its way to the Americas. An
analysis of the genes involved also suggests new hypotheses to explain
the virus's association with microcephaly and GBS.

"We looked at the viral changes that correspond to the 1st reports of
microcephaly and we saw the origins of these changes in the Pacific
lineages," Janies noted. "There are mutations that occurred in the
part of the viral genome that codes the viral envelope protein and the
ends of the viral genome that are called untranslated regions. We
focused on the envelope protein because that's the part responsible
for the entry of the virus to host's cells. We studied the
untranslated regions since they mediate the types of tissues the virus
attacks and viral replication."

Both sets of mutations suggested potential relationships to the
virus's new association with neurological and developmental problems
in adults and infants.

"Members of our team found that Zika has recently started making its
envelope proteins with features, called epitopes, that are similar to
human proteins, which could cause a human host immune response to the
virus to be diluted," Janies said. "The theory underlying this idea is
called epitope mimicry. The similarity is advantageous to the virus
because it confuses the host's immune system and blunts the immune
reaction to the virus."

However, the researchers suspect that the human proteins being
mimicked may be significant for reasons besides providing immune
system "cover" for the attacking virus.

An important element of the envelope protein mutation, Janies points
out, is not only in the mimicry itself, but also, in the specific
genes being mimicked: "Our team members found that 2 of the human
proteins that Zika is mimicking are involved in the signaling that
goes on when the sensory organs are being formed in the fetus. These
genes are called 'Neuron Navigator Protein 2' and 'Human Neurogenic
Differentiation Factor 4'," he said. "Because these are the proteins
are being mimicked, a hypothesis is that the developmental pathways
that rely on the proteins may be being disrupted by the immune
system," Janies said.

The other mutations, on the untranslated regions, suggest other
possible effects that might change where Zika virus infects in the
body.

"Although epitope mimicry hypothesis helps clarify the protein-immune
interaction, the mutations in the untranslated regions may explain the
types of tissues Zika attacks" UNC Charlotte Bioinformatics and
Genomics graduate student Adriano de Bernardi Schneider said. "The
presence of specific binding regions on untranslated regions of the
Zika viral genome, called "Musashi Binding Elements" provides bases
for the study of changes in tissue preference of the virus."

In this part of the study, the authors evaluated the changes in the
virus' Musashi Binding Elements and found that they increased the
efficiency of the Zika virus that is circulating in the Americas in
hijacking human cells. Musashi is a family of RNA-binding proteins in
the host cells that control gene expression and the development of
stem cells. The finding that Zika has mutated to be better at binding
to human Musashi proteins, leads to the hypothesis that Zika is
adapting to be more efficient at attacking human cells. Moreover, the
role of Musashi proteins in stem cells provides another possible
target for the study of developmental defects in the fetus associated
with Zika infection in pregnancy. - Mod.TY]

******
[8] Antibody-dependent enhancement
Date: Fri 16 Dec 2016
Source: Clinical & Translational Immunology [edited]
<http://www.nature.com/cti/journal/v5/n12/full/cti201672a.html>


Paul LM, Carlin ER, Jenkins MM, et al. Dengue virus antibodies enhance
Zika virus infection. Clin Transl Immunology. 2016;5(12):e117. doi:
10.1038/cti.2016.72, PMID: 28090318

Abstract
-------
For decades, human infections with Zika virus (ZIKV), a
mosquito-transmitted flavivirus, were sporadic, associated with mild
disease, and went underreported since symptoms were similar to other
acute febrile diseases. Recent reports of severe disease associated
with ZIKV have greatly heightened awareness. It is anticipated that
ZIKV will continue to spread in the Americas and globally where
competent aedes mosquito vectors are found. Dengue virus (DENV), the
most common mosquito-transmitted human flavivirus, is both
well-established and the source of outbreaks in areas of recent ZIKV
introduction. DENV and ZIKV are closely related, resulting in
substantial antigenic overlap. Through antibody-dependent enhancement
(ADE), anti-DENV antibodies can enhance the infectivity of DENV for
certain classes of immune cells, causing increased viral production
that correlates with severe disease outcomes. Similarly, ZIKV has been
shown to undergo ADE in response to antibodies generated by other
flaviviruses. We tested the neutralizing and enhancing potential of
well-characterized broadly neutralizing human anti-DENV monoclonal
antibodies (HMAbs) and human DENV immune sera against ZIKV using
neutralization and ADE assays. We show that anti-DENV HMAbs,
cross-react, do not neutralize, and greatly enhance ZIKV infection in
vitro. DENV immune sera had varying degrees of neutralization against
ZIKV and similarly enhanced ZIKV infection. Our results suggest that
pre-existing DENV immunity may enhance ZIKV infection in vivo and may
lead to increased disease severity. Understanding the interplay
between ZIKV and DENV will be critical in informing public health
responses and will be particularly valuable for ZIKV and DENV vaccine
design and implementation strategies.

--
communicated by:
ProMED-mail
<promed@promedmail.org>
and
Roland Hübner
Superior Health Council
Brussels
Belgium
<roland.hubner@sante.belgique.be>

[This report again raises questions about DENV vaccines resulting in
ADE for Zika virus infections, and vice versa. With a tetravalent
dengue vaccine now in use in several countries, one hopes that
prospective monitoring for ADE in Zika virus infections is being
carried out. - Mod.TY]

******
[9] False positive test
Date: Wed 28 Dec 2016
Source: Infection Control and Clinical Quality [edited]
<http://www.beckershospitalreview.com/quality/fda-issues-safety-alert-for-zika-tests-due-to-false-positives.html>


The Food and Drug Administration issued a safety alert on [23 Dec
2016] warning physicians who care for pregnant women to not make
healthcare decisions for their patients based on test results from a
commercial Zika test.

The alert was issued after the regulatory agency received reports from
the Laboratory Corporation of America of the ZIKV Detect IgM Capture
ELISA assay (manufactured by InBios International) producing false
positives. The FDA has not yet determined if the false positives are
attributable to the Zika test or potential missteps on the part of the
testing facility.

In August [2016], the FDA authorized commercial use of the test. Since
the approval, several commercial laboratories have moved their
serological testing away from the CDC's assay to the new commercial
assay. After that transition, LabCorp began identifying higher rates
of false positives than expected.

The FDA now recommends results of the commercial test be considered
presumptive and that these results need to be confirmed by the CDC or
another qualified laboratory. The regulatory agency is also urging
providers to communicate the test's presumptive status to their
patients.

[byline: Brian Zimmerman]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[It is important that the doubt about the reliability of this test has
emerged relatively quickly from both the FDA and the manufacturer.
False positives pose a difficult problem for pregnant women, given the
concern about teratogenic effects for the developing fetuses. False
positives could lead to the parents deciding to terminate the
pregnancy when there is no risk of their fetuses becoming infected by
the virus.

Interestingly, a 15 Dec 2016 report in Eurosurveillance indicated the
development of a serological test providing high specificity and low
cross-reactivity. This NS1-based ELISA has the potential to aid in
counseling patients, pregnant women and travellers after returning
from ZIKV-endemic areas
(<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22670>).
This report was sent in by Roland Hübner.

In a 28 Dec 2016 paper, researchers in China reported on the isolation
of 2 antibodies that can neutralize the Zika virus without
cross-reactivity to dengue viruses. Their results, published in
Science Translational Medicine, demonstrate the therapeutic potential
of monoclonal antibodies against Zika and provide a structure-based
rationale for the design of future specific antivirals. These
monoclonal antibodies cold be useful for development of specific
diagnostic tests.
(<http://www.asianscientist.com/2016/12/in-the-lab/zika-neutralizing-antibodies/>).
- Mod.TY]

******
[10] Mosquito vectors
Date: Thu 12 Jan 2017
Source: Euro Surveillance [edited]
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22684>


Heitmann A, Jansen S, Lühken R, et al. Experimental transmission of
Zika virus by mosquitoes from central Europe. Euro Surveill.
2017;22(2):pii=30437. DOI:
http://dx.doi.org/10.2807/1560-7917.ES.2017.22.2.30437.

Mosquitoes collected in Germany in 2016, including _Culex pipiens
pipiens_ biotype _pipiens_, _Culex torrentium_ and _Aedes albopictus_,
as well as _Culex pipiens pipiens_ biotype _molestus_ (in colony since
2011) were experimentally infected with Zika virus (ZIKV) at 18 C
[approx. 64 F] or 27 C [approx. 80 F]. None of the _Culex_ taxa
showed vector competence for ZIKV. In contrast, _Aedes albopictus_
were susceptible for ZIKV but only at 27 C [approx. 80 F], with
transmission rates similar to an _Aedes aegypti_ laboratory colony
tested in parallel.

--
communicated by:
ProMED-mail
<promed@promedmail.org>
and
Roland Hübner
Superior Health Council
Brussels
Belgium
<roland.hubner@sante.belgique.be>

[Several previous studies agree with _Culex_ spp as refractory or
inefficient vector mosquitoes. These studies stand in contrast to a
study in China that indicated that _Culex quinquefasciatus_ were
susceptible to the virus and transmitted it efficiently. It is
difficult to explain the discrepancy, and indicates that additional
experiments with _Culex_ spp. from various geographically different
populations are needed before final conclusions can be reached.

In December 2016, The USA National Science and Technology Council
Committee issued a report from their Science Task Force on Science and
Technology for Zika Vector Control (<http://bit.ly/2j6rpyP>). This
report addresses control of _Aedes_ vector mosquitoes that transmit
not only Zika virus, but dengue, chikungunya and yellow fever viruses
as well. Interested ProMED readers may wish to read this report. -
Mod.TY]

******
[11] Severe thrombocytopenia
Date: 15 Apr 2017 [Epub ahead of print]
Source: CDC, Emerging Infectious Diseases [edited]
<https://wwwnc.cdc.gov/eid/article/23/4/16-1967_article#suggestedcitation>


Boyer Chammard TH, Schepers K, Breurec S, et al. Severe
thrombocytopenia after Zika virus infection, Guadeloupe, 2016. Emerg
Infect Dis. 2017;23(4). doi: 10.3201/eid2304.161967, PMID: 27997330.

Abstract
--------
Severe thrombocytopenia during or after the course of Zika virus
infection has been rarely reported. We report 7 cases of severe
thrombocytopenia and hemorrhagic signs and symptoms in Guadeloupe
after infection with this virus. Clinical course and laboratory
findings strongly suggest a causal link between Zika virus infection
and immune-mediated thrombocytopenia.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Zika virus infections provide another surprise. In cases of severe
thrombocytopenia, one usually thinks of severe dengue virus infections
and DHF. Clinicians treating individuals infected by Zika virus should
be aware that rare cases of thrombocytopenia may occur. - Mod.TY]

[

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/6075>.]

[See Also:
2016
---
Zika virus (63): Americas, Asia, research, observations
http://promedmail.org/post/20161212.4693852
Zika virus (62): Americas, Asia, Europe, research, observations
http://promedmail.org/post/20161207.4680914
Zika virus (61): Americas, Asia, Pacific, research
http://promedmail.org/post/20161124.4650886
Zika virus (60) - Americas, Asia, research, observations
http://promedmail.org/post/20161121.4644809
Zika virus (59) - Americas, Asia, research, comment
http://promedmail.org/post/20161113.4625265
Zika virus (58): Americas, Asia, Pacific, Africa, research
http://promedmail.org/post/20161110.4618543
Zika virus (57): Americas, Asia, Pacific, Europe, research,
observations http://promedmail.org/post/20161104.4606432
Zika virus (56): Americas, Asia, Pacific, Europe, research,
observations http://promedmail.org/post/20161023.4578711
Zika virus (55) - Americas, Asia, Europe, research, observations
http://promedmail.org/post/20161019.4571149
Zika virus (54): Americas, PAHO/WHO
http://promedmail.org/post/20161007.4542586
Zika virus (53): Americas, Asia, Pacific, research, observations
http://promedmail.org/post/20161006.4541952
Zika & chikungunya viruses: comparative transmission
http://promedmail.org/post/20161005.4539231
Zika virus (52)f: Americas, Asia, Europe, research, observations
http://promedmail.org/post/20161001.4529740
Zika virus (51): Americas, PAHO/WHO
http://promedmail.org/post/20160923.4511356
Zika virus (50): Americas, Asia, Europe, Pacific, research,
observations http://promedmail.org/post/20160922.4506931
Zika virus (49): Americas, Asia, Europe, Middle East, research, notes
http://promedmail.org/post/20160915.4491053
Zika virus (48): Americas, PAHO/WHO
http://promedmail.org/post/20160909.4477370
Zika virus (47): Americas, Asia, research, observations
http://promedmail.org/post/20160908.4475100
Zika virus (46): Americas, Asia, Europe, research, observations
http://promedmail.org/post/20160905.4467034
Zika virus (45): worldwide, WHO, research, comment
http://promedmail.org/post/20160904.4464015
Zika virus (43): Americas, Europe: Tampa Florida area, research
http://promedmail.org/post/20160823.4436991.
Zika virus (45): worldwide, WHO, research, comment
http://promedmail.org/post/20160904.4464015
Zika virus (42): Americas, Europe
http://promedmail.org/post/20160821.4430310
Zika virus (41): Americas, Asia, Europe
http://promedmail.org/post/20160812.4412646
Zika virus (40) - Americas
http://promedmail.org/post/20160810.4407318
Zika virus (39): Americas, Europe
http://promedmail.org/post/20160729.4378060
Zika virus (38) - Americas, Africa, Europe
http://promedmail.org/post/20160725.4368191
Zika virus (37): Americas http://promedmail.org/post/20160722.4361791
Zika virus (36) - Americas: USA (FL, UT) RFI
http://promedmail.org/post/20160720.4356276
Zika virus (34): Americas, Asia, Africa, Europe
http://promedmail.org/post/20160707.4331999
Zika virus (33): Americas, Asia, Europe
http://promedmail.org/post/20160701.4321150
Zika virus (32): Americas, Asia, Pacific, Europe
http://promedmail.org/post/20160622.4303191
Zika virus (31): worldwide, WHO
http://promedmail.org/post/20160617.4290853
Zika virus (30): Americas, Asia, Atlantic, Europe
http://promedmail.org/post/20160616.4292221
Zika virus (29): Americas, Asia, Europe
http://promedmail.org/post/20160529.4253278
Zika virus (28): Americas, Asia, Pacific, Atlantic, Europe
http://promedmail.org/post/20160524.4240474
Zika virus (27): Americas, Asia, Europe
http://promedmail.org/post/20160511.4214303
Zika virus (26): Americas, Asia, Europe, Indian Ocean
http://promedmail.org/post/20160504.4202525
Zika virus (25): Americas http://promedmail.org/post/20160501.4195452
Zika virus (24): Americas http://promedmail.org/post/20160422.4177323
Zika virus (23): Americas http://promedmail.org/post/20160419.4168370
Zika virus (22): sexual transmission
http://promedmail.org/post/20160416.4162854
Zika virus (21): Americas (Brazil) diagnostic imaging
http://promedmail.org/post/20160415.4160993
Zika virus (20): Americas, Pacific, Asia, Europe
http://promedmail.org/post/20160414.4160595
Zika virus (19): Americas http://promedmail.org/post/20160411.4152933
Zika virus (18): Americas http://promedmail.org/post/20160402.4134955
Zika virus (17): Americas, Pacific
http://promedmail.org/post/20160401.4129524
Zika virus (16): Americas, Asia, Pacific, Atlantic
http://promedmail.org/post/20160325.4118019
Zika virus (15): Americas http://promedmail.org/post/20160321.4109160
Zika virus (14): Americas, Europe, Atlantic Ocean
http://promedmail.org/post/20160317.4102468
Zika virus (13): Americas, Asia, Europe, Pacific
http://promedmail.org/post/20160311.4086075
Zika virus (12): Brazil, microcephaly
http://promedmail.org/post/20160305.4070601
Zika virus (11): Americas, Europe, Asia
http://promedmail.org/post/20160301.4059896
Zika virus (10): Americas, Asia, Europe, Pacific
http://promedmail.org/post/20160229.4058161
Zika virus (09): Americas, Africa, Europe, Pacific
http://promedmail.org/post/20160223.4042828
Zika virus (08): Americas, Asia, Europe, Pacific
http://promedmail.org/post/20160217.4026836
Zika virus (07): update http://promedmail.org/post/20160216.4023810
ProMED-mail endorses sharing of Zika virus data
http://promedmail.org/post/20160211.4012212
Zika virus (06): overview http://promedmail.org/post/20160209.4007411
Zika virus (05): Americas, Asia, Pacific
http://promedmail.org/post/20160203.3990632
Zika virus (04): WHO declares worldwide PHEIC
http://promedmail.org/post/20160201.3985366
Zika virus (03): Americas, Asia
http://promedmail.org/post/20160128.3974426
Zika virus - Americas (02)
http://promedmail.org/post/20160111.3925377
Zika virus - Americas (01)
http://promedmail.org/post/20160108.3921447]
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