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Zika virus outbreak on Yap Island, Federated States of Micronesia.
N Engl J Med 2009; 360(24):2536-43NEJM

Abstract

BACKGROUND

In 2007, physicians on Yap Island reported an outbreak of illness characterized by rash, conjunctivitis, and arthralgia. Although serum from some patients had IgM antibody against dengue virus, the illness seemed clinically distinct from previously detected dengue. Subsequent testing with the use of consensus primers detected Zika virus RNA in the serum of the patients but no dengue virus or other arboviral RNA. No previous outbreaks and only 14 cases of Zika virus disease have been previously documented.

METHODS

We obtained serum samples from patients and interviewed patients for information on clinical signs and symptoms. Zika virus disease was confirmed by a finding of Zika virus RNA or a specific neutralizing antibody response to Zika virus in the serum. Patients with IgM antibody against Zika virus who had a potentially cross-reactive neutralizing-antibody response were classified as having probable Zika virus disease. We conducted a household survey to estimate the proportion of Yap residents with IgM antibody against Zika virus and to identify possible mosquito vectors of Zika virus.

RESULTS

We identified 49 confirmed and 59 probable cases of Zika virus disease. The patients resided in 9 of the 10 municipalities on Yap. Rash, fever, arthralgia, and conjunctivitis were common symptoms. No hospitalizations, hemorrhagic manifestations, or deaths due to Zika virus were reported. We estimated that 73% (95% confidence interval, 68 to 77) of Yap residents 3 years of age or older had been recently infected with Zika virus. Aedes hensilli was the predominant mosquito species identified.

CONCLUSIONS

This outbreak of Zika virus illness in Micronesia represents transmission of Zika virus outside Africa and Asia. Although most patients had mild illness, clinicians and public health officials should be aware of the risk of further expansion of Zika virus transmission.

Authors+Show Affiliations

Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19516034

Citation

Duffy, Mark R., et al. "Zika Virus Outbreak On Yap Island, Federated States of Micronesia." The New England Journal of Medicine, vol. 360, no. 24, 2009, pp. 2536-43.
Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009;360(24):2536-43.
Duffy, M. R., Chen, T. H., Hancock, W. T., Powers, A. M., Kool, J. L., Lanciotti, R. S., ... Hayes, E. B. (2009). Zika virus outbreak on Yap Island, Federated States of Micronesia. The New England Journal of Medicine, 360(24), pp. 2536-43. doi:10.1056/NEJMoa0805715.
Duffy MR, et al. Zika Virus Outbreak On Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Jun 11;360(24):2536-43. PubMed PMID: 19516034.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Zika virus outbreak on Yap Island, Federated States of Micronesia. AU - Duffy,Mark R, AU - Chen,Tai-Ho, AU - Hancock,W Thane, AU - Powers,Ann M, AU - Kool,Jacob L, AU - Lanciotti,Robert S, AU - Pretrick,Moses, AU - Marfel,Maria, AU - Holzbauer,Stacey, AU - Dubray,Christine, AU - Guillaumot,Laurent, AU - Griggs,Anne, AU - Bel,Martin, AU - Lambert,Amy J, AU - Laven,Janeen, AU - Kosoy,Olga, AU - Panella,Amanda, AU - Biggerstaff,Brad J, AU - Fischer,Marc, AU - Hayes,Edward B, PY - 2009/6/12/entrez PY - 2009/6/12/pubmed PY - 2009/6/18/medline SP - 2536 EP - 43 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 360 IS - 24 N2 - BACKGROUND: In 2007, physicians on Yap Island reported an outbreak of illness characterized by rash, conjunctivitis, and arthralgia. Although serum from some patients had IgM antibody against dengue virus, the illness seemed clinically distinct from previously detected dengue. Subsequent testing with the use of consensus primers detected Zika virus RNA in the serum of the patients but no dengue virus or other arboviral RNA. No previous outbreaks and only 14 cases of Zika virus disease have been previously documented. METHODS: We obtained serum samples from patients and interviewed patients for information on clinical signs and symptoms. Zika virus disease was confirmed by a finding of Zika virus RNA or a specific neutralizing antibody response to Zika virus in the serum. Patients with IgM antibody against Zika virus who had a potentially cross-reactive neutralizing-antibody response were classified as having probable Zika virus disease. We conducted a household survey to estimate the proportion of Yap residents with IgM antibody against Zika virus and to identify possible mosquito vectors of Zika virus. RESULTS: We identified 49 confirmed and 59 probable cases of Zika virus disease. The patients resided in 9 of the 10 municipalities on Yap. Rash, fever, arthralgia, and conjunctivitis were common symptoms. No hospitalizations, hemorrhagic manifestations, or deaths due to Zika virus were reported. We estimated that 73% (95% confidence interval, 68 to 77) of Yap residents 3 years of age or older had been recently infected with Zika virus. Aedes hensilli was the predominant mosquito species identified. CONCLUSIONS: This outbreak of Zika virus illness in Micronesia represents transmission of Zika virus outside Africa and Asia. Although most patients had mild illness, clinicians and public health officials should be aware of the risk of further expansion of Zika virus transmission. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/19516034/Zika_virus_outbreak_on_Yap_Island_Federated_States_of_Micronesia_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa0805715?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -