Update: Ongoing Zika Virus Transmission — Puerto Rico, November 1, 2015–July 7, 2016

Published on Aug 5, 2016in Morbidity and Mortality Weekly Report13.606
· DOI :10.15585/MMWR.MM6530E1
Laura Adams9
Estimated H-index: 9
(CDC: Centers for Disease Control and Prevention),
Melissa Bello-Pagan5
Estimated H-index: 5
+ 30 AuthorsBrenda Rivera-Garcia17
Estimated H-index: 17
Zika virus is a flavivirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes, and infection can be asymptomatic or result in an acute febrile illness with rash (1). Zika virus infection during pregnancy is a cause of microcephaly and other severe birth defects (2). Infection has also been associated with Guillain-Barre syndrome (GBS) (3) and severe thrombocytopenia (4,5). In December 2015, the Puerto Rico Department of Health (PRDH) reported the first locally acquired case of Zika virus infection. This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico (6,7). A confirmed case of Zika virus infection is defined as a positive result for Zika virus testing by reverse transcription-polymerase chain reaction (RT-PCR) for Zika virus in a blood or urine specimen. A presumptive case is defined as a positive result by Zika virus immunoglobulin M (IgM) enzyme-linked immunosorbent assay (MAC-ELISA)* and a negative result by dengue virus IgM ELISA, or a positive test result by Zika IgM MAC-ELISA in a pregnant woman. An unspecified flavivirus case is defined as positive or equivocal results for both Zika and dengue virus by IgM ELISA. During November 1, 2015-July 7, 2016, a total of 23,487 persons were evaluated by PRDH and CDC Dengue Branch for Zika virus infection, including asymptomatic pregnant women and persons with signs or symptoms consistent with Zika virus disease or suspected GBS; 5,582 (24%) confirmed and presumptive Zika virus cases were identified. Persons with Zika virus infection were residents of 77 (99%) of Puerto Rico's 78 municipalities. During 2016, the percentage of positive Zika virus infection cases among symptomatic males and nonpregnant females who were tested increased from 14% in February to 64% in June. Among 9,343 pregnant women tested, 672 had confirmed or presumptive Zika virus infection, including 441 (66%) symptomatic women and 231 (34%) asymptomatic women. One patient died after developing severe thrombocytopenia (4). Evidence of Zika virus infection or recent unspecified flavivirus infection was detected in 21 patients with confirmed GBS. The widespread outbreak and accelerating increase in the number of cases in Puerto Rico warrants intensified vector control and personal protective behaviors to prevent new infections, particularly among pregnant women.
Figures & Tables
📖 Papers frequently viewed together
2,141 Citations
1,547 Citations
1,916 Citations
#1Tyler M. SharpH-Index: 23
Last. Brenda Rivera-Garcia (Puerto Rico Department of Health)H-Index: 17
view all 12 authors...
: We report two patients that developed severe thrombocytopenia after Zika virus (ZIKV) infection. The first patient had 1000 platelets/μL and died after multiple hemorrhages. The second patient had 2000 platelets/μL, had melena and ecchymoses, and recovered after receiving intravenous immunoglobulin. ZIKV may be associated with immune-mediated severe thrombocytopenia.
58 CitationsSource
Zika virus has been identified as a cause of congenital microcephaly and other serious brain defects (1). CDC issued interim guidance for the prevention of sexual transmission of Zika virus on February 5, 2016, with an initial update on April 1, 2016 (2). The following recommendations apply to all men and women who have traveled to or reside in areas with active Zika virus transmission* and their sex partners. The recommendations in this report replace those previously issued and are now updated...
80 CitationsSource
Transfusion-transmitted infections have been documented for several arboviruses, including West Nile and dengue viruses (1). Zika virus, a flavivirus transmitted primarily by Aedes aegypti mosquitoes that has been identified as a cause of congenital microcephaly and other serious brain defects (2), became recognized as a potential threat to blood safety after reports from a 2013-2014 outbreak in French Polynesia. Blood safety concerns were based on very high infection incidence in the population...
63 CitationsSource
BackgroundColombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. MethodsUsing the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of ...
193 CitationsSource
#1Thomas FréourH-Index: 23
#2Sophie MiralliéH-Index: 12
Last. Isabelle Leparc-GoffartH-Index: 33
view all 7 authors...
The current Zika virus outbreak and its potential severe health consequences, especially congenital fetal syndrome, have led to increased concern about sexual transmission, especially in pregnant women and women of reproductive age. Here we report a case of Zika virus sexual transmission, likely male-to-female, in a totally asymptomatic couple.
120 CitationsSource
Regina M. Simeone, MPH1; Carrie K. Shapiro-Mendoza, PhD2; Dana Meaney-Delman, MD3; Emily E. Petersen, MD2; Romeo R. Galang, MD4,5; Titilope Oduyebo, MD2,4; Brenda Rivera-Garcia, DVM6; Miguel Valencia-Prado, MD7; Kimberly B. Newsome, MPH1; Janice Perez-Padilla, MPH8; Tonya R. Williams, PhD9; Matthew Biggerstaff, MPH10; Denise J. Jamieson, MD2; Margaret A. Honein, PhD1; Zika and Pregnancy Working Group
33 CitationsSource
Aedes species mosquitoes transmit chikungunya virus, as well as dengue and Zika viruses, and bite most often during the day.* Infectious mosquito bites frequently occur in and around homes (1,2). Caribbean countries first reported local transmission of chikungunya virus in December 2013, and soon after, chikungunya virus spread throughout the Americas (3). Puerto Rico reported its first laboratory-positive chikungunya case in May 2014 (4), and subsequently identified approximately 29,000 suspect...
39 CitationsSource
61 CitationsSource
Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus. Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic, the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pat...
26 CitationsSource
Summary The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we concl...
1,339 CitationsSource
Cited By75
#1Sheliza Halani (U of T: University of Toronto)H-Index: 2
#2Panashe Tombindo (U of T: University of Toronto)
Last. Justin Boyle (U of T: University of Toronto)
view all 15 authors...
#1Velasco Cimica (ATCC)H-Index: 1
#2Jose M. GalarzaH-Index: 2
Last. Timothy T. Stedman (ATCC)H-Index: 2
view all 4 authors...
Introduction null Zika virus disease received little attention until its recent explosive emergence around the globe. The devastating consequences of this pandemic include congenital Zika syndrome (CZS) and the neurological autoimmune disorder Guillain-Barre syndrome. These potential outcomes prompted massive efforts to understand the course of Zika infection and to develop therapeutic and prophylactic strategies for treatment and prevention of disease. null Area covered null Preclinical and cli...
#1Sascha R. Ellington (UGA: University of Georgia)H-Index: 30
#2Regina M. Simeone (CDC: Centers for Disease Control and Prevention)H-Index: 14
Last. Carrie K. Shapiro-Mendoza (CDC: Centers for Disease Control and Prevention)H-Index: 34
view all 11 authors...
Introduction Zika virus is primarily transmitted through mosquito bites. Because Zika virus infection during pregnancy can cause serious birth defects, reproductive-aged women need protection from Zika virus infection. This report describes Zika virus prevention behaviors among women aged 18–49 years and assesses whether pregnancy status and healthcare provider counseling increases Zika virus prevention behaviors. Methods A population-based cell phone survey of women aged 18–49 years living in P...
#1Talia M. Quandelacy (CDC: Centers for Disease Control and Prevention)H-Index: 6
#2Jessica M Healy (CDC: Centers for Disease Control and Prevention)H-Index: 6
Last. Michael A. Johansson (Harvard University)H-Index: 39
view all 12 authors...
Emerging epidemics are challenging to track. Only a subset of cases is recognized and reported, as seen with the Zika virus (ZIKV) epidemic where large proportions of infection were asymptomatic. However, multiple imperfect indicators of infection provide an opportunity to estimate the underlying incidence of infection. We developed a modeling approach that integrates a generic Time-series Susceptible-Infected-Recovered epidemic model with assumptions about reporting biases in a Bayesian framewo...
#1Marlos Melo Martins (UFRJ: Federal University of Rio de Janeiro)H-Index: 5
#2Antonio José Ledo Alves da Cunha (UFRJ: Federal University of Rio de Janeiro)H-Index: 24
Last. Roberto de Andrade Medronho (UFRJ: Federal University of Rio de Janeiro)H-Index: 18
view all 6 authors...
The occurrence of fetal and neonatal disorders in pregnant women with Zika virus infection in the literature is not consistent. This study aims to estimate the prevalence rate of these disorders in fetuses/neonates of pregnant women with confirmed or probable infection by Zika virus. A systematic review with meta-analysis was conducted in November 2020. Cohort studies that contained primary data on the prevalence of unfavorable outcomes in fetuses or neonates of women with confirmed or probable ...
2 CitationsSource
#1Susannah Hopkins Leisher (Columbia University)H-Index: 2
#2Arin A. Balalian (Columbia University)H-Index: 4
Last. Stephen Morse (Columbia University)H-Index: 62
view all 7 authors...
OBJECTIVES Zika virus is linked to several adverse pregnancy outcomes. We assessed whether Zika infection during pregnancy is associated with increased risk of foetal death (miscarriage, stillbirth, abortion) and whether there is incomplete reporting of such deaths. METHODS We searched PubMed, Embase, CINAHL, Web of Science and LILACS for studies reporting Zika-affected completed pregnancies (ending in foetal death or live birth), excluding studies whose aim required live birth. Studies 'allowed...
3 CitationsSource
The recent emergence of a new strand of the Zika virus evinces the global entwinement of viral, human, and animal ecologies on a dynamic planet. Capable of shaping physiological development in uter...
4 CitationsSource
#1Sascha R. Ellington (UGA: University of Georgia)H-Index: 30
#2Ruby Serrano Rodriguez (Puerto Rico Department of Health)H-Index: 1
Last. Carrie K. Shapiro-Mendoza (CDC: Centers for Disease Control and Prevention)H-Index: 34
view all 13 authors...
Abstract Objectives The objectives of this analysis were to 1) estimate prevalence of contraceptive use among women at risk for unintended pregnancy and 2) identify correlates of contraceptive use among women with ongoing or potential need for contraceptive services in Puerto Rico during the 2016 Zika virus (ZIKV) outbreak. Study Design We conducted a cell-phone survey July–November, 2016. Women aged 18–49 years living in Puerto Rico were eligible. We completed 3,059 interviews; the overall resp...
2 CitationsSource
#1Evan M. Bloch (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 21
#1Wilma González–Barreto (University of Puerto Rico, Medical Sciences Campus)
view all 4 authors...
Zika is a virus transmitted primarily by the Aedes genus mosquito bites. Most people are asymptomatic or present with mild symptoms; however, after the Zika virus outbreak reported in several countries, an increase in the number of cases with neurological complications including Guillain-Barre syndrome were identified. Guillain-Barre syndrome is a rare immune-mediated neurological disorder characterized by rapid progression of symptoms including weakness, paralysis and in some cases death. Due t...