20 Nov 2015

Zika Virus: The Americas

International spread of Zika virus with first locally acquired cases in Suriname

On 2 November 2015, the World Health Organization (WHO) was notified of the first locally acquired cases of Zika virus (ZIKV) in Suriname [1]. As of 12 November 2015, five confirmed cases had occurred in the country [2]. Suriname is now the fourth country in the Americas, after Brazil, Chile (Easter Island) and Colombia, to have reported confirmed locally acquired cases of the virus [3].

ZIKV is a dengue-like virus that is transmitted by Aedes mosquitoes. The infection often occurs without symptoms but can also cause an illness similar to dengue. The condition is usually mild and short-lived, but may rarely be associated with neurological complications [3]. No deaths have so far been attributed to the disease [4].

ZIKV was first isolated in Uganda in 1947 and up until 2007 had only been known to cause sporadic human infections in Africa and Asia. In 2007 the first outbreak of ZIKV occurring outside these regions was reported in the Federated States of Micronesia with a further connected outbreak occurring in French Polynesia in 2013. This outbreak subsequently spread to a number of other Pacific Island states including: Cook Islands, Easter Island (Chile) and New Caledonia [5].

The detection of circulating ZIKV in the Americas demonstrates the potential for the virus to spread to countries and continents where the Aedes mosquito vector is found, much like dengue and chikungunya have done in recent years. WHO has issued an alert recommending that member states, vulnerable to the introduction of ZIKV, establish and maintain appropriate measures for surveillance, control and clinical management of ZIKV infection [3].

Current situation in the Americas

Brazil: As of 6 November 2015,locally acquired cases of ZIKV had been detected in 14 states: Alagoas, Bahia, Ceará, Maranhão, Mato Grosso, Pará, Paraná, Paraíba, Pernambuco, Piauí, Rio de Janeiro, Rio Grande do Norte, Roraima, and São Paulo [6].

Chile: In February 2014, the public health authorities of Chile confirmed the first case of locally acquired ZIKV on Easter Island with no further cases reported after June 2014. Chile has not reported any cases of the disease on the mainland [7].

Colombia: The first confirmed, locally acquired cases of ZIKV infection were detected in Bolivar department in October, 2015.   [6]. As of 7 November, a total of 393 positive cases are reported from 22 of 36 local authorities [8].

Suriname: As of 12 November 2015, five confirmed cases have been detected [2].

Advice for travellers

Aedes mosquitoes transmit ZIKV, as well as diseases such as chikungunya, dengue and yellow fever. Aedes mosquitoes bite in the day, particularly around dawn and dusk. You should take insect bite avoidance measures to reduce the risk of infection with ZIKV and other mosquito borne diseases. There is currently no vaccine available to prevent ZIKV.

Advice for health professionals

Health professionals should consider ZIKV among the differential diagnoses of patients with fever returning from the Americas. Health professionals can check for the latest disease outbreaks on our outbreak surveillance database. If a case is suspected, appropriate samples for testing (together with a full travel and clinical history with relevant dates) should be sent as early as possible to the Public Health England, Rare and Imported Pathogens Laboratory.

The Imported Fever Service: Public Health England is available to local infectious disease physicians or microbiologists should specialist advice be needed on 0844 7788990.

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