Epidemiological update: Outbreaks of Zika virus and complications potentially linked to the Zika virus infection, 8 September 2016

Epidemiological update

​Since week 45/2015, 19 countries (Austria, Belgium, the Czech Republic, Denmark, Finland, France, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK) have reported 1 557 travel-associated Zika virus infections through The European Surveillance System (TESSy). Over the same time period, seven EU countries reported 79 Zika cases among pregnant women.

Since 1 February 2016, Zika virus infection and the related clusters of microcephaly cases and other neurological disorders constitute a public health emergency of international concern (PHEIC).

Since 2015, and as of 2 September 2016, there have been 63 countries and territories reporting mosquito-borne transmission. According to WHO and as of 8 September 2016, 20 countries or territories have reported microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection or suggestive of congenital infection.

New developments since the last epidemiological update

The USA

Nine new autochthonous cases have been reported in Florida since the last CDTR, bringing the number of locally transmitted cases to 56. As of 7 September, the number of autochthonous cases reported in Florida state is as follows: 49 cases in Miami-Dade, one in Broward, three in Palm Beach and one in Pinellas. The department is conducting an investigation into the other two cases to determine where exposure occurred. The Florida Department of Agriculture and Consumer Services has detected Zika in three mosquito samples from a small area in Miami Beach.

Malaysia

On 2 September, the Ministry of Health in Malaysia reported the first local transmission of Zika virus infection in a 61-year-old male.

Singapore

Following the detection of a case of Zika virus infection on 27 August 2016, the Ministry of Health reports 267 locally-acquired cases including two cases diagnosed in pregnant women.

Philippines

On 6 September, the Department of Health reported a case of locally-acquired Zika virus infection in a woman from Iloilo City. This is the first locally-acquired case reported in 2016 and the sixth case reported in the country since 2012.

WHO

On 6 September, WHO published updated interim guidance on the prevention of sexual transmission of Zika virus. WHO recommends that both women and men who are returning from Zika-affected areas abstain or practice safe sex for six months, even if they are not trying to conceive and regardless of symptoms.

Publications

Cell published 'Zika Virus Infection in Mice Causes Panuveitis with Shedding of Virus in Tears'. In addition, Clinical Infectious Diseasespublished 'Fetal infection by Zika virus in the third trimester'.
 

EU/EEA imported cases

Since week 45/2015, 19 countries (Austria, Belgium, the Czech Republic, Denmark, Finland, France, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK) have reported 1 557 travel-associated Zika virus infections through The European Surveillance System (TESSy). Over the same time period, seven EU countries reported 79 Zika cases among pregnant women.

Zika virus infections through The European Surveillance System (TESSy). Over the same time period, seven EU countries reported 79 Zika cases among pregnant women.

EU’s Outermost Regions and Territories

As of 8 September 2016:
Martinique: 35 795 suspected cases have been reported, an increase of 225 since last week. The weekly number of cases is stable. 
French Guiana: 9 630 suspected cases have been detected, an increase of 77 cases since last week. The weekly number has been slightly increasing during the past week.
Guadeloupe: 29 460 suspected cases have been detected, an increase of 385 suspected cases since last week. The weekly number of cases continues to decrease.
St Barthélemy: 630 suspected cases have been detected, an increase of 36 suspected cases since last week. The weekly number of cases has been decreasing during the past two weeks.
St Martin: 2 165 suspected cases have been detected, an increase of 80 suspected cases since last week. The weekly number of cases is stable.

Update on microcephaly and/or central nervous system (CNS) malformations potentially associated with Zika virus infection

As of 8 September 2016, microcephaly and other central nervous system (CNS) malformations associated with Zika virus infection or suggestive of congenital infection have been reported by 20 countries or territories. Brazil reports the highest number of cases. Eighteen countries and territories worldwide have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases.

Since February 2016, 11 countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual
route.

In the EU, Spain (2) and Slovenia (1) have reported congenital malformations associated with Zika virus infection after travel in the affected areas. Cases have also been detected in the EU’s Outermost Regions and Territories in Martinique, French Guiana and French Polynesia.
 

ECDC assessment

The spread of the Zika virus epidemic in the Americas is likely to continue as the vectors (Aedes aegypti and Aedes albopictus mosquitoes) are widely distributed there. The likelihood of travel-related cases in the EU is increasing. A detailed risk assessment is available here. As neither treatment nor vaccines are available, prevention is based on personal protection measures. Pregnant women should consider postponing non-essential travel to Zika-affected areas. 

Table 1. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past three months, as of 9 September 2016  

Countries affected in past 3 months Areas (non-tropical countries only) Type of transmission
American Samoa   Widespread transmission
Argentina Tucumán Province Widespread transmission
Barbados   Widespread transmission
Belize   Widespread transmission
Bolivia   Widespread transmission
Bonaire   Widespread transmission
Brazil   Widespread transmission
Cape Verde   Widespread transmission
Colombia   Widespread transmission
Costa Rica   Widespread transmission
Curaçao   Widespread transmission
Dominica   Widespread transmission
Ecuador   Widespread transmission
El Salvador   Widespread transmission
Fiji   Widespread transmission
French Guiana   Widespread transmission
Guadeloupe   Widespread transmission
Guatemala   Widespread transmission
Haiti   Widespread transmission
Honduras   Widespread transmission
Jamaica   Widespread transmission
Martinique   Widespread transmission
Mexico   Widespread transmission
Micronesia, Federated States of   Widespread transmission
Nicaragua   Widespread transmission
Panama   Widespread transmission
Paraguay   Widespread transmission
Peru   Widespread transmission
Puerto Rico   Widespread transmission
Saint Lucia   Widespread transmission
Saint Martin   Widespread transmission
Saint Vincent and the Grenadines   Widespread transmission
Saint-Barthélemy   Widespread transmission
Samoa   Widespread transmission
​Singapore ​Widespread transmission
Sint Maarten   Widespread transmission
Suriname   Widespread transmission
Thailand   Widespread transmission
Trinidad and Tobago   Widespread transmission
US Virgin Islands   Widespread transmission
Venezuela   Widespread transmission
​​United States of America ​Florida (Miami-Dade county) Widespread transmission
​​​United States of America ​Florida (Broward, Palm Beach and Pinellas  counties) ​Sporadic transmission
Antigua and Barbuda   Sporadic transmission
Anguilla   Sporadic transmission
​Bahamas ​Sporadic transmission
​British Virgin Island (UK) ​Sporadic transmission
​Cayman Islands ​Sporadic transmission
​Cuba ​Sporadic transmission
Grenada   Sporadic transmission
Guinea-Bissau   Sporadic transmission
​Malaysia Sporadic transmission​
​Philippines ​Sporadic transmission
Saba   Sporadic transmission
Sint Eustatius   Sporadic transmission
Turks and Caicos Islands   Sporadic transmission
​Vietnam ​Sporadic transmission

The classification of countries above is based on: 1) number of reported autochthonous confirmed cases; 2) number of countries who report a zika virus transmission or a country’s transmission status changes; 3) duration of the circulation.

Figure 1. Countries or territories with reported confirmed autochthonous cases of Zika virus infection in the past three months, as of 9 September 2016