SITUATION REPORT ZIKA VIRUS MICROCEPHALY GUILLAIN-BARRÉ SYNDROME 20 OCTOBER 2016 DATA AS OF 19 OCTOBER 2016
KEY UPDATES Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week: o None Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week: o Grenada Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week: o None The Ministry of Health of Viet Nam has reported a case of microcephaly, for which testing is underway to determine the cause.
ANALYSIS Overall, the global risk assessment has not changed.
SITUATION 73 countries and territories (Fig. 1, Table 1) have reported evidence of mosquito-borne Zika virus transmission since 2007 (67 with reports from 2015 onwards), of which: o 56 with a reported outbreak from 2015 onwards (Fig. 2, Table 1). o Eight with having possible endemic transmission or evidence of local mosquitoborne Zika infections in 2016. Solomon Islands was previously listed in category 3, however, a Zika virus infection in a returning traveller was reported by Australia. Solomon Islands has therefore been reclassified into category 2. o Nine with evidence of local mosquito-borne Zika infections in or before 2015, but without documentation of cases in 2016, or with the outbreak terminated. Solomon Islands has been removed from this category. Since February 2016, 12 countries have reported evidence of person-to-person 1
transmission of Zika virus (Table 2). 23 countries or territories have reported microcephaly and other CNS malformations potentially associated with Zika virus infection or suggestive of congenital infection (Table 3). Grenada is the latest country to report Zika-associated microcephaly. 19 countries and territories have reported an increased incidence of GBS and/or laboratory confirmation of a Zika virus infection among GBS cases (Table 4). Puerto Rico, which has previously reported GBS cases with confirmed Zika virus infections, has reported an increase in incidence of GBS cases in the last week. On 17 October 2016, the Ministry of Health of Viet Nam reported a 4-month-old child with microcephaly. Blood specimens were collected and testing is being conducted to determine the potential cause of this microcephaly. On 7 October 2016, the Grenada health authorities reported the first confirmed case of congenital syndrome associated with Zika virus infection. The case was laboratoryconfirmed by PCR. In Guinea-Bissau, the investigation of five reported cases of microcephaly is ongoing.
Figure 1. Cumulative number of countries and territories by WHO region1 reporting mosquito-borne Zika virus transmission for the first time in years (2007–2014), and monthly from 1 January 2015 to 19 October 2016
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http://www.who.int/about/regions/en/
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Table 1. Countries and territories reporting mosquito-borne Zika virus transmission Classification WHO Regional Office Country / territory AFRO Cabo Verde; Guinea-Bissau Anguilla; Antigua and Barbuda; Argentina; Aruba; Bahamas; Barbados; Belize; Bolivia (Plurinational State of); Bonaire, Sint Eustatius and Saba – Netherlands; Brazil; British Virgin Islands; Cayman Islands; Colombia; Costa Rica; Cuba; Curaçao; Dominica; Dominican Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico; 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; United States of America; United States Virgin Islands; Venezuela (Bolivarian Republic of) American Samoa; Fiji; Marshall Islands; Micronesia (Federated States of); Samoa; Singapore; Tonga Indonesia; Maldives; Thailand Malaysia; New Caledonia; Philippines; Solomon Islands; Viet Nam Total 2
Category 1: Countries AMRO/PAHO with a reported outbreak # from 2015 onwards
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WPRO Subtotal Category 2: Countries SEARO with possible endemic transmission or evidence of local mosquito-borne WPRO Zika infections in 2016 Subtotal Category 3: Countries AFRO with evidence of local PAHO/AMRO mosquito-borne Zika infections in or before SEARO 2015, but without documentation of cases in WPRO 2016, or outbreak terminated Subtotal Total #
7 56 3 5 8 1 1 1 6 9 73
Gabon** ISLA DE PASCUA – Chile** Bangladesh** Cambodia**; Cook Islands**; French Polynesia**; Lao People’s Democratic Republic; Papua New Guinea; Vanuatu
The wording has been revised in recognition of the fact that a country that has had a first outbreak since 2015 and in which that outbreak has since terminated, may again report a new outbreak or cases which would qualify the country to be re-included in category 1. **These countries and territories have not reported Zika virus cases in 2015 or 2016. Category 1: Countries with a reported outbreak from 2015 onwards# A laboratory confirmed, autochthonous, mosquito-borne case of Zika virus infection in an area where there is no evidence of circulation of the virus in the past (prior 2015), whether it is detected and reported by the country itself or by another state party diagnosing returning travellers OR A laboratory confirmed, autochthonous, mosquito-borne case of Zika virus infection in an area where transmission has been previously interrupted. The assumption is that the size of the susceptible population has built up to a sufficient level to allow transmission again; the size of the outbreak will be a function of the size of the susceptible population OR An increase of the incidence of laboratory confirmed, autochthonous, mosquito-borne Zika virus infection in areas where there is on-going transmission, above two standard deviations of the baseline rate, or doubling the number of cases over a 4-week period. Clusters of febrile illnesses, in particular when epidemiologically-linked to a confirmed case, should be microbiologically investigated. Category 2: Countries with possible endemic transmission or evidence of local mosquito-borne Zika infections in 2016 with the reporting period beginning in 2007 Countries or territories that have reported an outbreak with consistent presence of laboratory confirmed, autochthonous, mosquito-borne cases of Zika virus infection 12 months after the outbreak OR Countries or territories where Zika virus has been circulating for several years with consistent presence of laboratory confirmed, autochthonous, mosquito-borne cases of Zika virus infection or evidence of local mosquito-borne Zika infections in 2016. Reports can be from the country or territory where infection occurred, or from a third party where the case is first recorded according to the International Health Regulations (IHR 2005). Countries with evidence of infection prior to 2007 are listed in http://www.who.int/bulletin/volumes/94/9/16-171082.pdf Category 3: Countries with evidence of local mosquito-borne Zika infections in or before 2015, but without documentation of cases in 2016, or outbreak terminated with the reporting period beginning in 2007 Absence of confirmed cases over a 3-month period in a specific geographical area with climatic conditions suitable for year-round arbovirus transmission, or over a 12-month period in an area with seasonal vector activity.
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Table 2. Countries reporting non mosquito-borne Zika virus transmission since February 2016 Classification WHO Regional Office Country / territory Argentina, Canada, Chile, Peru, United States of America France, Germany, Italy, Netherlands, Portugal, Spain New Zealand Total 5 6 1 12
AMRO/PAHO Countries with evidence of person-to-person transmission of Zika virus, other than mosquito- EURO borne transmission WPRO Total
Table 3. Countries and territories reporting microcephaly and/or CNS malformation cases potentially associated with Zika virus infection Reporting country or territory Brazil Cabo Verde Canada Costa Rica Colombia Dominican Republic El Salvador French Guiana French Polynesia Grenada Guatemala Haiti Honduras Marshall Islands Martinique Panama Paraguay Puerto Rico Slovenia Spain Suriname Thailand United States of America Number of microcephaly and/or CNS malformation cases suggestive of congenital Zika infections or potentially associated with a Zika virus infection 2 2033 9 1 1 3 46 4 10 4 5 10 8 1 6 17 1 1 1 6 12 5 7 2 8 2 9 1 2 1 2 10 28 Probable location of infection Brazil Cabo Verde Undetermined Costa Rica Colombia Dominican Republic El Salvador French Guiana French Polynesia Grenada Guatemala Haiti Honduras Marshall Islands Martinique Panama Paraguay Puerto Rico Brazil Colombia, Venezuela (Bolivarian Republic of) Suriname Thailand Undetermined*
*The probable locations of three of the infections were Brazil (1 case), Haiti (1 case) and Mexico, Belize or Guatemala (1 case).
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http://portalsaude.saude.gov.br/images/pdf/2016/outubro/14/Informe-Epidemiologico-n%2047_SE40_2016-13out2016_13h45.pdf http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2016%20Boletin%20epidemiologico%20semana%2040.pdf 4 http://digepisalud.gob.do/documentos/?drawer=Boletines%20epidemiol%C3%B3gicos*Boletines%20semanales*2016 5 http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Antilles-Guyane/2016/Situationepidemiologique-du-virus-Zika-aux-Antilles-Guyane.-Point-au-6-octobre-2016 6 http://www.mspas.gob.gt/index.php/en/mspas/noticias/1239-comunicado-ante-la-epidemia-del-viruszika.html?tmpl=component&print=1&layout=default&page= 7 http://www.mspbs.gov.py/v3/paraguay-reporta-sus-dos-primeros-casos-de-microcefalia-asociados-al-zika/ 8 http://www.salud.gov.pr/Estadisticas-Registros-y-Publicaciones/Informes%20Arbovirales/Reporte%20ArboV%20semana%2038-2016.pdf 9 http://www.nejm.org/doi/pdf/10.1056/NEJMoa1600651 10 http://www.cdc.gov/zika/geo/pregnancy-outcomes.html
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Figure 2. New detection of mosquito-borne Zika virus infections, 2013-2016
A report is considered an official notification from the government or a peer-reviewed publication. This map shows cases officially reported by the country/territory where infection occurred and cases of returned travellers reported by countries other than the location of infection. Date of onset is used where known, otherwise date of report is used. Circulation of Zika virus in Indonesia, Malaysia, Philippines, Thailand and Viet Nam was reported before 2013 and Zika is considered to be possibly endemic in these countries. Countries where person-to-person transmission occurred are not represented in this map. Available information does not permit measurement of the risk of infection in any country; the variation in transmission intensity among countries is therefore NOT represented on this map. Zika virus is not necessarily present throughout the countries/territories shaded in this map.
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Table 4. Countries and territories reporting Guillain-Barré syndrome (GBS) potentially associated with Zika virus infection Classification Reported increase in incidence of GBS cases, with at least one GBS case with confirmed Zika virus infection No increase in GBS incidence reported, but at least one GBS case with confirmed Zika virus infection Country / territory Brazil, Colombia, Dominican Republic, El Salvador*, 11 French Guiana, French Polynesia, Guadeloupe , 12 Honduras, Jamaica, Martinique, Puerto Rico , Suriname**, Venezuela (Bolivarian Republic of) 13 Costa Rica, Grenada , Guatemala, Haiti, Mexico, Panama
*GBS cases with previous history of Zika virus infection were reported by the International Health Regulations (2005) National Focal Point in the United States of America. **One case living in continental Netherlands was diagnosed in mid-January 2016 and reported by the Netherlands.
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http://invs.santepubliquefrance.fr//Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Antilles-Guyane/2016/Situationepidemiologique-du-virus-Zika-aux-Antilles-Guyane.-Point-au-15-septembre-2016 12 http://www.salud.gov.pr/Estadisticas-Registros-yPublicaciones/Informe%20Sndrome%20GillainBarr/Informe%20de%20Casos%20del%20S%C3%ADndrome%20de%20GuillainBarr%C3%A9_7Oct2016.pdf 13 http://health.gov.gd/index.php?option=com_content&view=article&id=434:nine-confirmed-zika-cases-in-grenada&catid=83:latestnews&Itemid=932&lang=en
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