Epidemiological update: Outbreaks of Zika virus and complications potentially linked to the Zika virus infection, 4 August 2016

Epidemiological update

Since 1 February 2016, Zika virus infection and the related clusters of microcephaly cases and other neurological disorders constitute a public health emergency of international concern (PHEIC). Since 2015, and as of 4 August 2016, WHO has reported 65 countries and territories with mosquito-borne transmission. There is now a scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome. As of 3 August 2016, 14 countries or territories have reported microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection.

 Page last updated: 5 August 2016

Since 1 February 2016, Zika virus infection and the related clusters of microcephaly cases and other neurological disorders constitute a public health emergency of international concern (PHEIC). Since 2015, and as of 4 August 2016, WHO has reported 65 countries and territories with mosquito-borne transmission. There is now a scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome. As of 3 August 2016, 14 countries or territories have reported microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection.

On 1 August, the Florida Department of Health in US confirmed four autochthonous Zika virus cases through local mosquitoes in Miami-Dade and Broward counties. As of 4 August, the Florida Department of Health (DOH) has identified 15 locally-acquired Zika cases in Florida who likely acquired the infection through a mosquito bite. The DOH believes that active transmission of the Zika virus is still only occurring in one small area of Miami-Dade County. Among the 15 cases, six are asymptomatic and were identified as a result of the door-to-door community survey that the DOH is conducting. ​
 

New developments since the last epidemiological update

 
The US CDC has issued travel advice for people who live in or travelled to Wynwood in Miami any time after 15 June. Pregnant women have been advised not to travel to this neighbourhood. 

In addition, the US CDC has published an official health advisory on guidance for 'Travel and Testing of Pregnant Women and Women of Reproductive Age for Zika Virus Infection Related to the Investigation for Local Mosquito-borne Zika Virus Transmission in Miami-Dade and Broward Counties, Florida'. The CDC is also recommending Zika testing for all pregnant women in the continental United States at prenatal visits in their first and second trimesters. 

On 3 August, the Ministry of Health in Cuba reported two cases of locally-acquired Zika in the city of Hoguin. 

In Vietnam, the Ministry of Health reported one case of locally-acquired Zika virus in Phu Yen Province. 

EU/EEA imported cases

 
Since week 45/2015, 18 countries (Austria, Belgium, the Czech Republic, Denmark, Finland, France, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovenia, Spain, Sweden and the UK) have reported 1 136 travel-associated Zika virus infections through  The European Surveillance System (TESSy). 

EU’s Outermost Regions and Territories

 
As of 4 August 2016: 
Guadeloupe: 26 520 suspected cases have been detected, an increase of 1 060 suspected cases since last week. The weekly number of cases has decreased compared to the previous week.
 
French Guiana: 9 330 suspected cases have been detected, an increase of 110 since last week. The weekly number of cases is decreasing compared to the previous week. 
 
Martinique: 34 310 suspected cases have been reported, an increase of 415 since last week. The weekly number of cases is declining. 
 
St Barthélemy: 370 suspected cases have been detected, an increase of 60 suspected cases since last week. The virus is still actively circulating.
 
St Martin: 1 835 suspected cases have been detected, an increase of 105 suspected cases since last week. The weekly number of cases has decreased slightly compared to the previous week. 
 

Update on microcephaly and/or central nervous system (CNS) malformations potentially associated with Zika virus infection

 As of 3 August 2016, microcephaly and other central nervous system (CNS) malformations associated with Zika virus infection or suggestive of congenital infection have been reported by 14 countries or territories. Brazil has reported the highest number of cases. 
Fifteen countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. 
Since February 2016, 11 countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route. 
In the EU, Spain (2) and Slovenia (1) have reported congenital malformations associated with Zika virus infection after travel in the affected areas. Cases have also been detected in the EU’s Outermost Regions and Territories in Martinique, French Guiana and French Polynesia. 
 

ECDC assessment

The spread of the Zika virus epidemic in the Americas is likely to continue as the vectors (Aedes aegypti and Aedes albopictus mosquitoes) are widely distributed there. The likelihood of travel-related cases in the EU is increasing. A detailed risk assessment is available here. As neither treatment nor vaccines are available, prevention is based on personal protection measures. Pregnant women should consider postponing non-essential travel to Zika-affected areas.
 

Table 1. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past three months, as of 5 August 2016  

Countries affected in past 3 months Areas (non-tropical countries only) Type of transmission
American Samoa   Widespread transmission
Argentina Tucumán Province Widespread transmission
Aruba   Widespread transmission
Barbados   Widespread transmission
Belize   Widespread transmission
Bolivia   Widespread transmission
Bonaire   Widespread transmission
Brazil   Widespread transmission
Cape Verde   Widespread transmission
Colombia   Widespread transmission
Costa Rica   Widespread transmission
Curaçao   Widespread transmission
Dominica   Widespread transmission
Dominican Republic   Widespread transmission
Ecuador   Widespread transmission
El Salvador   Widespread transmission
Fiji   Widespread transmission
French Guiana   Widespread transmission
Guadeloupe   Widespread transmission
Guatemala   Widespread transmission
Haiti   Widespread transmission
Honduras   Widespread transmission
Jamaica   Widespread transmission
Martinique   Widespread transmission
Mexico   Widespread transmission
Micronesia, Federated States of   Widespread transmission
Nicaragua   Widespread transmission
Panama   Widespread transmission
Paraguay   Widespread transmission
Peru   Widespread transmission
Puerto Rico   Widespread transmission
Saint Lucia   Widespread transmission
Saint Martin   Widespread transmission
Saint Vincent and the Grenadines   Widespread transmission
Saint-Barthélemy   Widespread transmission
Samoa   Widespread transmission
Sint Maarten   Widespread transmission
Suriname   Widespread transmission
Thailand   Widespread transmission
Tonga   Widespread transmission
Trinidad and Tobago   Widespread transmission
US Virgin Islands   Widespread transmission
Venezuela   Widespread transmission
​​United States of America ​Florida (Miami-Dade and Broward counties) Widespread transmission
Antigua and Barbuda   Sporadic transmission
Anguilla   Sporadic transmission
​Cuba ​Sporadic transmission
Grenada   Sporadic transmission
Guinea-Bissau   Sporadic transmission
Indonesia   Sporadic transmission
Philippines   Sporadic transmission
Saba   Sporadic transmission
Sint Eustatius   Sporadic transmission
Turks and Caicos Islands   Sporadic transmission
​Vietnam ​Sporadic transmission

 
The classification of countries above is based on: 1) number of reported autochthonous confirmed cases; 2) number of countries who report a zika virus transmission or a country’s transmission status changes; 3) duration of the circulation.

Figure 1. Countries or territories with reported confirmed autochthonous cases of Zika virus infection in the past three months, as of 5 August 2016

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