Epidemiological update: Outbreaks of Zika virus and complications potentially linked to the Zika virus infection, 11 February 2016

​New developments

Slovenia: A case of congenital central nervous system malformation and microcephaly caused by transplacental Zika virus infections was reported in by The New England Journal of Medicine on 10 February 2016 by scientists in Slovenia. The woman developed Zika-like infection during her first trimester of pregnancy while residing in Brazil. The pregnancy was terminated after ultrasonography revealed central nervous system malformations. Tissue samples from the aborted foetus showed unequivocal evidence of Zika virus infection in the central nervous system.

This is the first documented case of congenital malformation in the EU that is associated with Zika virus infection acquired in a Zika-affected area. Several similar cases have been reported from Brazil and one from Hawaii. Cases such as this are not unexpected as the epidemic of Zika virus continues to spread in the Americas and the Caribbean.

Brazil: Scientists from the Oswaldo Cruz Foundation (Fiocruz) in Brazil have detected live Zika virus in urine and saliva samples. The ability of the virus to infect other people through these bodily fluids requires further investigation.
 

Update of the epidemiological situation

Since last week, no new additional countries or territories have reported laboratory-confirmed autochthonous transmission.
 
As of 12 February 2016, autochthonous cases of Zika virus infection have been reported from 31 countries or territories worldwide in the past two months (see Table 1 and Figure 1), and 36 countries or territories have reported autochthonous cases of Zika virus infection in the past nine months (see Table 1 and Figure 2):
 

Table 1. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past two months, as of 12 February 2016

EU/EEA and EU Outermost Regions

As of 12 February, no autochthonous Zika virus transmission has been reported in the EU. ECDC is collecting data regarding imported cases through the media and official government communication lines. As of 12 February 2016, ECDC has recorded imported cases in 14 EU/EEA countries:  Austria (1), Denmark (1), Finland (2), France (18), Germany (7), Ireland (2), Italy (5), Malta (1), Netherlands (2), Portugal (6), Spain (9), Sweden (1), Slovenia (1) and the UK (7).
 
Thirty EU/EEA countries have issued travel advice for people travelling to Zika-affected areas. Of these, 25 have advised pregnant women to consider postponing travel to countries affected by the Zika epidemic.
 
Several Outermost EU regions continue to report autochthonous transmission.

• Martinique: From December 2015 to 4 February 2016, 3 940 clinically confirmed cases have been reported.
• French Guiana: From December 2015 to 4 February 2016, 430 laboratory and clinically confirmed cases have been reported.
• Guadeloupe: As of 4 February 2016, there have been 17 laboratory confirmed cases, this is an increase of seven cases since the last update on 29 January 2016.

Figure 1. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past two months, as of 12 February 2016

Note: the map does not indicate the extent of the autochthonous transmission in the countries.
 

Figure 2. Countries and territories with reported confirmed autochthonous cases of Zika virus infection in the past nine months, as of 12 February 2016

Note: the map does not indicate the extent of the autochthonous transmission in the countries.

Update on the observed increase of congenital microcephaly and other central nervous system symptoms

• Slovenia: A case of congenital malformation (microcephaly) was detected in a pregnant woman in Slovenia, who developed Zika-like infection during pregnancy while residing in Brazil.
• French Polynesia: According to the WHO situation report published on 5 February 2016, during the 2013 outbreak, 8 750 suspect cases of Zika virus were reported, of which 383 were laboratory-confirmed. Seventy-four patients presented with neurological syndromes or auto-immune syndromes after an illness consistent with Zika virus infection. Of these, 42 were classified as Guillain–Barré syndrome (GBS). Of these 42 patients, 88% reported an illness compatible with Zika infection. Retrospective analysis demonstrated that all 42 cases were positive for dengue and Zika virus infection.
• Guadeloupe: Among the 17 laboratory-confirmed cases of Zika virus infection, one case of myelitis was reported on 3 February 2016.   
• French Guiana: During January 2016, three suspected cases of GBS were reported with a possible link to Zika virus infection.
• Suriname: According to WHO, on 29 January 2016, the Suriname health authorities reported that during 2015 the surveillance system detected an increased incidence of GBS. On average Suriname registers 4 cases of GBS per year, however, in 2015 there were 10 GBS cases registered and 3 GBS cases reported in the first three weeks of 2016.
• Venezuela: On 2 February 2016, Venezuela reported that since the second week of January 2016, an increase in the number of GBS cases has been detected. In January 2016 there were 252 GBS cases. A clinical history consistent with Zika virus infection was observed in the days prior to onset of neurological symptoms in 76% of the GBS cases.  Associated comorbidity was present in 65% of the cases. Additionally, among the laboratory-confirmed cases there are two cases of GBS and three with other neurological disorders. 
• Colombia: According to WHO, in February 2016, Colombia reported an increase in cases of GBS. Colombia reports an average of 242 cases of GBS per year. However, in the five weeks up to 30 January 2016, 86 cases of GBS had already been reported.
• Honduras: According to media quoting national health authorities, 35 cases of GBS linked to Zika have been registered in the country.

Additional information may be found in the latest ECDC Risk Assessment (link).