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Zika virus outbreak on Yap Island, Federated States of Micronesia.

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.

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  • 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.

    , , , , , , , , , , , , , , , , , ,

    Source

    The New England journal of medicine 360:24 2009 Jun 11 pg 2536-43

    MeSH

    Adolescent
    Adult
    Aedes
    Age Distribution
    Animals
    Antibodies, Viral
    Arthralgia
    Child
    Child, Preschool
    Conjunctivitis, Viral
    Dengue Virus
    Disease Outbreaks
    Exanthema
    Fever
    Humans
    Immunoglobulin M
    Infant
    Insect Vectors
    Micronesia
    Middle Aged
    Population Surveillance
    RNA, Viral
    Sex Distribution
    Young Adult
    Zika Virus
    Zika Virus Infection

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    19516034

    Citation

    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/full_citation L2 - http://www.nejm.org/doi/abs/10.1056/NEJMoa0805715?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov ER -