Epidemiological update: Outbreaks of Zika virus and complications potentially linked to the Zika virus infection, 25 February 2016

Epidemiological update

As of 25 February 2016, autochthonous cases of Zika virus infection have been reported from 37 countries and territories worldwide in the past two months, and 42 countries and territories have reported autochthonous cases of Zika virus infection in the past nine months.

New developments since the last epidemiological update published on 19 February 2016

Since last week, Saint Vincent and the Grenadines and Sint Maarten reported the first confirmed cases of Zika virus infection.
 
On 23 February, the US CDC reported that they are investigating 14 new reports of sexual transmission of Zika virus. Some of the women under investigation are pregnant. So far, only two of the women have been confirmed to have been infected, and their only known risk factor was sexual contact with a male partner who had recently travelled to an area with local Zika virus transmission. In all events for which information is available, travellers reported symptom onset within 2 weeks prior to their non-travelling female partner’s symptom onset. 
 
On 26 February, a rapid communication published in Eurosurveillance reported a case of Zika virus infection imported to Italy from Thailand, which lead to a secondary local case through sexual transmission. The two cases occurred in May 2014 and were diagnosed as dengue infections at the time. Retrospective plaque reduction neutralisation tests on stored serum samples performed in 2016 showed that the two cases were infected with Zika virus.

Detailed epidemiological situation

As of 25 February 2016, autochthonous cases of Zika virus infection have been reported from 37 countries and territories worldwide in the past two months (see Table 1 and Figure 1). Forty-two countries and territories have reported autochthonous cases of Zika virus infection in the past nine months (see Table 1 and Figure 2).
 
Several countries in the Americas, Caribbean and the Pacific continue to report an increase in autochthonous cases of Zika virus infection.

Table 1. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past two months, as of 25 February 2016

​Country and territories

​Affected in

the past 2 months

​Affected in the past 9 months

American Samoa

Increasing or widespread transmission

Yes

Aruba

Sporadic transmission following recent introduction

Yes

Barbados

Increasing or widespread transmission

Yes

Bolivia

Sporadic transmission following recent introduction

Yes

Brazil

Increasing or widespread transmission

Yes

Bonaire

Sporadic transmission following recent introduction

Yes

Cape Verde

Increasing or widespread transmission

Yes

Colombia

Increasing or widespread transmission

Yes

Costa Rica

Sporadic transmission following recent introduction

Yes

Curaçao

Increasing or widespread transmission

Yes

Dominican Republic

Increasing or widespread transmission

Yes

Ecuador

Increasing or widespread transmission

Yes

El Salvador

Increasing or widespread transmission

Yes

Fiji

No

Yes

French Guiana

Increasing or widespread transmission

Yes

Guadeloupe

Increasing or widespread transmission

Yes

Guatemala

Increasing or widespread transmission

Yes

Guyana

Sporadic transmission following recent introduction

Yes

Haiti

Increasing or widespread transmission

Yes

Honduras

Increasing or widespread transmission

Yes

Jamaica

Sporadic transmission following recent introduction

Yes

Maldives

No

Yes

Marshall Islands

Sporadic transmission following recent introduction

Yes

Martinique

Increasing or widespread transmission

Yes

Mexico

Increasing or widespread transmission

Yes

New Caledonia

No

Yes

Nicaragua

Increasing or widespread transmission

Yes

Panama

Increasing or widespread transmission

Yes

Paraguay

Increasing or widespread transmission

Yes

Puerto Rico

Increasing or widespread transmission

Yes

Saint Martin

Sporadic transmission following recent introduction

Yes

Saint Vincent and the Grenadines

Sporadic transmission following recent introduction

Yes

Samoa

Increasing or widespread transmission

Yes

Sint Maarten

Sporadic transmission following recent introduction

Yes

Solomon Islands

No

Yes

Suriname

Increasing or widespread transmission

Yes

Thailand

Sporadic transmission following recent introduction

Yes

Tonga

Increasing or widespread transmission

Yes

Trinidad and Tobago

Sporadic transmission following recent introduction

Yes

Vanuatu

No

Yes

Venezuela

Increasing or widespread transmission

Yes

US Virgin Islands

Sporadic transmission following recent introduction

Yes

  

EU/EEA and EU Outermost Regions and Territories

As of 25 February, no autochthonous Zika virus transmission has been reported in continental EU. ECDC is collecting data regarding imported cases through the media and official government communication lines. As of 25 February 2016, ECDC has recorded 176 imported cases in 15 EU/EEA countries: Austria (1), Czech Republic (2), Denmark (1), Finland (2), France (66), Germany (20), Ireland (3), Italy (5), Malta (1), Netherlands (30), Portugal (7), Spain (27), Sweden (2), Slovenia (1) and the UK (8). Ten of the imported cases are pregnant women. This list may not be exhaustive.
 
Thirty EU/EEA countries have issued travel advice for people travelling to Zika-affected areas. Of these, 28 have advised pregnant women to consider postponing travel to countries affected by the Zika epidemic.
 
Several Outermost EU regions continue to report autochthonous transmission.
 Sint Maarten: On 24 February 2016, the Government of Sint Maarten reported two confirmed cases of Zika virus infection.
 Martinique: From December 2015 to 25 February 2016, 7 600 suspected cases have been reported, this is an increase of 1 550 suspected cases since the last update on 18 February 2016.
 French Guiana: From December 2015 to 25 February 2016, 1 030 suspected and 102 laboratory confirmed cases have been reported, an increase of 235 suspected and 3 laboratory confirmed cases since the last update on 18 February 2016.
 Guadeloupe: As of 25 February 2016, 389 suspected and 35 laboratory confirmed cases have been reported, this is an increase of 177 suspected and 10 laboratory confirmed cases since the last update on 18 February 2016.
 Saint Martin: As of 25 February 58 suspected and 11 laboratory confirmed cases have been reported, this is an increase of 14 suspected and 4 laboratory confirmed cases since the last update on 18 February 2016.
 Figure 1. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past two months, as of 25 February 2016
 

Note: the map does not indicate the extent of the autochthonous transmission in the countries.
 
Figure 2. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past nine months, as of 25 February 2016

Note: the map does not indicate the extent of the autochthonous transmission in the countries.
 

Update on the observed increase of congenital malformations and other central nervous system complications

Brazil: According to the Ministry of Health, there have been 5 640 cases of microcephaly notified to date in Brazil compared with 5 280 a week earlier. As of 20 February 2016, 583 of the cases have been confirmed to have microcephaly and/or other central nervous system findings suggestive of congenital infection. Of the confirmed cases, 67 (11%) fulfilled specific laboratory criteria for Zika virus. Across the country, 4 107 suspected cases of microcephaly remain under investigation. The cases have been reported from 1 101 municipalities in 25 Brazilian states. Amapá and Amazonas are the only states with no recorded cases. 

There have been 120 intrauterine or neonatal deaths reported among children notified to have microcephaly and/or central nervous system malformations. Of these, 30 cases were investigated and confirmed to have microcephaly and/or central nervous system malformations. Eighty cases are still under investigation and 10 cases have been discarded.

Colombia: According to local health authorities, there has been a case of microcephaly in a foetus possibly linked to Zika virus infection in Colombia. The mother had a suspected Zika virus infection and had an abortion. However, due to the disposal of the foetal remains, no confirmed diagnosis was possible.
 

Additional information may be found in the latest ECDC Risk Assessment.