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Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016.

Abstract

Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes, and symptoms of infection can include rash, fever, arthralgia, and conjunctivitis (1).* Zika virus infection during pregnancy is a cause of microcephaly and other severe brain defects (2). Infection has also been associated with Guillain-Barré syndrome (3). In December 2015, Puerto Rico became the first U.S. jurisdiction to report local transmission of Zika virus, with the index patient reporting symptom onset on November 23, 2015 (4). This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico. During November 1, 2015-April 14, 2016, a total of 6,157 specimens from suspected Zika virus-infected patients were evaluated by the Puerto Rico Department of Health (PRDH) and CDC Dengue Branch (which is located in San Juan, Puerto Rico), and 683 (11%) had laboratory evidence of current or recent Zika virus infection by one or more tests: reverse transcription-polymerase chain reaction (RT-PCR) or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). Zika virus-infected patients resided in 50 (64%) of 78 municipalities in Puerto Rico. Median age was 34 years (range = 35 days-89 years). The most frequently reported signs and symptoms were rash (74%), myalgia (68%), headache (63%), fever (63%), and arthralgia (63%). There were 65 (10%) symptomatic pregnant women who tested positive by RT-PCR or IgM ELISA. A total of 17 (2%) patients required hospitalization, including 5 (1%) patients with suspected Guillain-Barré syndrome. One (<1%) patient died after developing severe thrombocytopenia. The public health response to the outbreak has included increased laboratory capacity to test for Zika virus infection (including blood donor screening), implementation of enhanced surveillance systems, and prevention activities focused on pregnant women. Vector control activities include indoor and outdoor residual spraying and reduction of mosquito breeding environments focused around pregnant women's homes. Residents of and travelers to Puerto Rico should continue to employ mosquito bite avoidance behaviors, take precautions to reduce the risk for sexual transmission (5), and seek medical care for any acute illness with rash or fever.

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    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Child
    Child, Preschool
    Disease Outbreaks
    Female
    Humans
    Infant
    Male
    Middle Aged
    Population Surveillance
    Pregnancy
    Public Health Practice
    Puerto Rico
    Young Adult
    Zika Virus
    Zika Virus Infection

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    27149205

    Citation

    Dirlikov, Emilio, et al. "Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016." MMWR. Morbidity and Mortality Weekly Report, vol. 65, no. 17, 2016, pp. 451-5.
    Dirlikov E, Ryff KR, Torres-Aponte J, et al. Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(17):451-5.
    Dirlikov, E., Ryff, K. R., Torres-Aponte, J., Thomas, D. L., Perez-Padilla, J., Munoz-Jordan, J., ... Rivera-Garcia, B. (2016). Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016. MMWR. Morbidity and Mortality Weekly Report, 65(17), pp. 451-5. doi:10.15585/mmwr.mm6517e2.
    Dirlikov E, et al. Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016. MMWR Morb Mortal Wkly Rep. 2016 May 6;65(17):451-5. PubMed PMID: 27149205.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016. AU - Dirlikov,Emilio, AU - Ryff,Kyle R, AU - Torres-Aponte,Jomil, AU - Thomas,Dana L, AU - Perez-Padilla,Janice, AU - Munoz-Jordan,Jorge, AU - Caraballo,Elba V, AU - Garcia,Myriam, AU - Segarra,Marangely Olivero, AU - Malave,Graciela, AU - Simeone,Regina M, AU - Shapiro-Mendoza,Carrie K, AU - Reyes,Lourdes Romero, AU - Alvarado-Ramy,Francisco, AU - Harris,Angela F, AU - Rivera,Aidsa, AU - Major,Chelsea G, AU - Mayshack,Marrielle, AU - Alvarado,Luisa I, AU - Lenhart,Audrey, AU - Valencia-Prado,Miguel, AU - Waterman,Steve, AU - Sharp,Tyler M, AU - Rivera-Garcia,Brenda, Y1 - 2016/05/06/ PY - 2016/5/6/entrez PY - 2016/5/7/pubmed PY - 2017/1/4/medline SP - 451 EP - 5 JF - MMWR. Morbidity and mortality weekly report JO - MMWR Morb. Mortal. Wkly. Rep. VL - 65 IS - 17 N2 - Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes, and symptoms of infection can include rash, fever, arthralgia, and conjunctivitis (1).* Zika virus infection during pregnancy is a cause of microcephaly and other severe brain defects (2). Infection has also been associated with Guillain-Barré syndrome (3). In December 2015, Puerto Rico became the first U.S. jurisdiction to report local transmission of Zika virus, with the index patient reporting symptom onset on November 23, 2015 (4). This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico. During November 1, 2015-April 14, 2016, a total of 6,157 specimens from suspected Zika virus-infected patients were evaluated by the Puerto Rico Department of Health (PRDH) and CDC Dengue Branch (which is located in San Juan, Puerto Rico), and 683 (11%) had laboratory evidence of current or recent Zika virus infection by one or more tests: reverse transcription-polymerase chain reaction (RT-PCR) or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). Zika virus-infected patients resided in 50 (64%) of 78 municipalities in Puerto Rico. Median age was 34 years (range = 35 days-89 years). The most frequently reported signs and symptoms were rash (74%), myalgia (68%), headache (63%), fever (63%), and arthralgia (63%). There were 65 (10%) symptomatic pregnant women who tested positive by RT-PCR or IgM ELISA. A total of 17 (2%) patients required hospitalization, including 5 (1%) patients with suspected Guillain-Barré syndrome. One (<1%) patient died after developing severe thrombocytopenia. The public health response to the outbreak has included increased laboratory capacity to test for Zika virus infection (including blood donor screening), implementation of enhanced surveillance systems, and prevention activities focused on pregnant women. Vector control activities include indoor and outdoor residual spraying and reduction of mosquito breeding environments focused around pregnant women's homes. Residents of and travelers to Puerto Rico should continue to employ mosquito bite avoidance behaviors, take precautions to reduce the risk for sexual transmission (5), and seek medical care for any acute illness with rash or fever. SN - 1545-861X UR - https://www.unboundmedicine.com/medline/citation/27149205/Update:_Ongoing_Zika_Virus_Transmission___Puerto_Rico_November_1_2015_April_14_2016_ L2 - https://dx.doi.org/10.15585/mmwr.mm6517e2 DB - PRIME DP - Unbound Medicine ER -