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Peru finds local Zika cases; report supports complication links
Filed Under:
Dengue; Zika
Lisa Schnirring | News Editor | CIDRAP News
| May 03, 2016 Among key developments in the Zika virus outbreak, Peru's health ministry yesterday reported its first local cases, and a new analysis today from a Brazilian research team revealed a strong temporal correlation between the outbreak and later spikes in Guillain-Barre syndrome (GBS) and suspected microcephaly.
In other developments today, two top health officials briefed the media on outbreak and vaccine developments at the Pan American Health Organization's (PAHO's) Washington, DC, headquarters, where a conference on Zika risk communication is under way.
Peru finds cases in 2 regions
At the PAHO briefing today, Sylvain Aldighieri, MD, PAHO's Zika incident manager, said Peru had reported its first local cases, and the country's Ministry of Health (MOH) described the findings yesterday in a press release in Spanish on its Web site. In mid-April Peru had reported a sexual transmission case in a woman who was infected by her husband, who had contracted the virus during travel to Venezuela.
In yesterday's announcement the MOH said three other locally acquired cases have been reported, two from Yurimaguas in Loreto region and one from Jaen in Cajamarca region. Both are in northern Peru. It said three other cases are under investigation.
Health Minister Anibal Velasquez said the patients are being treated and tests on people who live nearby have been negative. The ministry said mosquito control efforts, including fumigation, are underway to prevent further spread of the virus and that microcephaly monitoring has been stepped up in affected areas.
Overall, the country has reported nine imported cases, four locally acquired infections (including the sexual transmission case from Lima), and three that are under investigation.
Brazilian data show GBS, microcephaly lag
The Brazilian report showed a clear-cut relationship between a rise in acute exanthematous (rashlike) illness (AEI) in Brazil and rises in Guillain-Barre syndrome 5 to 9 weeks later, followed by a spike in microcephaly 30 to 33 weeks later. The findings, published today in Emerging Infectious Diseases, are based on sentinel surveillance established in April 2015 in Brazil's Salvador state to track patients with unexplained acute rashlike illness.
Investigators reached back to Feb 15, 2015, to look for such cases, including ones reported through Dec 31. When Salvador had its first reports of neurologic syndrome cases in adults in late May, officials modified their surveillance to look for hospitalized patients with complications that might be linked to Zika virus.
After the increase in microcephaly cases was first reported in Pernambuco state in September, the surveillance system requested all reports of newborns with suspected neurologic problems. The first was reported Jul 11, 2015, and the researchers included all cases reported up to Mar 10, 2016. They said they included all suspected microcephaly cases, since only 27.7% of them had been investigated.
The surveillance system recorded 17,503 illness cases, 51 GBS hospitalizations, and 367 newborns with suspected microcephaly. Researchers found that raw and smoothed data showed a clear start, peak, and decline in cases, followed by classic epidemic time-series incidences for acute rashlike illness, GBS, and suspected microcephaly. Acute illnesses peaked in early May, with GBS cases peaking in early to mid-June and suspected microcephaly peaking from mid-November through mid-December.
They said the lag time they saw with GBS fit with the results from a recent case-control study from French Polynesia's Zika virus outbreak and that the suspected microcephaly findings show a strong association with acute illness during the first pregnancy trimester, which they said is also consistent with other findings.
"Although such temporal associations do not prove causation, their strength and pattern makes a major contribution to the growing body of data supporting the association of GBS and congenital malformations with previous exposure to Zika virus (or , at least an AEI)," the group wrote.
Briefing covers disease risks, vaccine trial
During today's PAHO briefing, Aldighieri and Tony Fauci, MD, director of the US National Institute for Allergy and Infectious Diseases (NIAID), addressed the communication challenges regarding a disease that is typically mild but has serious complications against a backdrop of many unanswered questions.
Fauci said it's still not known what percentage of mothers infected with Zika virus will deliver a baby with microcephaly or another congenital abnormality, noting that early studies have put the number at anywhere between 1% and 29%. He said global health groups haven't recommended that women in affected areas delay pregnancy, because the issue is extremely personal and is colored by religious and cultural practices, with little access to birth control in some countries.
Fauci said local transmission on the US mainland is likely and will hopefully be confined to areas in Florida and Texas that have reported two other diseases carried by Aedes aegypti mosquitoes: chikungunya and dengue. Though Aedes albopictus mosquitoes can spread the disease and occur in more states, he said, they aren't as focused on humans. "Just because it is capable of spreading the disease doesn't mean it will be a major player," he added
Regarding vaccine development, Fauci said a small phase 1 trial involving about 80 people is slated to begin in September to assess if the vaccine is safe and hits immune response targets. The next step would be to test the vaccine in a country with local transmission, and if high levels of transmission are still under way, researchers might be able to enroll enough people for the trial to qualify as phase 2b, which might produce enough information to assess if the vaccine is effective.
It's always possible that the population could develop herd immunity, which would make testing the vaccine difficult, Fauci said. "But if you look at the history of dengue, dengue did not come and disappear."
Aldighieri said the long-term outlook in the Americas region is uncertain, but in the short- and mid-term, millions of infections are expected.
See also:
May 2 Peru MOH report (in Spanish)
May 3 Emerg Infect Dis report
Peru finds local Zika cases; report supports complication links
Filed Under:
Dengue; Zika
Lisa Schnirring | News Editor | CIDRAP News
| May 03, 2016 Among key developments in the Zika virus outbreak, Peru's health ministry yesterday reported its first local cases, and a new analysis today from a Brazilian research team revealed a strong temporal correlation between the outbreak and later spikes in Guillain-Barre syndrome (GBS) and suspected microcephaly.
In other developments today, two top health officials briefed the media on outbreak and vaccine developments at the Pan American Health Organization's (PAHO's) Washington, DC, headquarters, where a conference on Zika risk communication is under way.
Peru finds cases in 2 regions
At the PAHO briefing today, Sylvain Aldighieri, MD, PAHO's Zika incident manager, said Peru had reported its first local cases, and the country's Ministry of Health (MOH) described the findings yesterday in a press release in Spanish on its Web site. In mid-April Peru had reported a sexual transmission case in a woman who was infected by her husband, who had contracted the virus during travel to Venezuela.
In yesterday's announcement the MOH said three other locally acquired cases have been reported, two from Yurimaguas in Loreto region and one from Jaen in Cajamarca region. Both are in northern Peru. It said three other cases are under investigation.
Health Minister Anibal Velasquez said the patients are being treated and tests on people who live nearby have been negative. The ministry said mosquito control efforts, including fumigation, are underway to prevent further spread of the virus and that microcephaly monitoring has been stepped up in affected areas.
Overall, the country has reported nine imported cases, four locally acquired infections (including the sexual transmission case from Lima), and three that are under investigation.
Brazilian data show GBS, microcephaly lag
The Brazilian report showed a clear-cut relationship between a rise in acute exanthematous (rashlike) illness (AEI) in Brazil and rises in Guillain-Barre syndrome 5 to 9 weeks later, followed by a spike in microcephaly 30 to 33 weeks later. The findings, published today in Emerging Infectious Diseases, are based on sentinel surveillance established in April 2015 in Brazil's Salvador state to track patients with unexplained acute rashlike illness.
Investigators reached back to Feb 15, 2015, to look for such cases, including ones reported through Dec 31. When Salvador had its first reports of neurologic syndrome cases in adults in late May, officials modified their surveillance to look for hospitalized patients with complications that might be linked to Zika virus.
After the increase in microcephaly cases was first reported in Pernambuco state in September, the surveillance system requested all reports of newborns with suspected neurologic problems. The first was reported Jul 11, 2015, and the researchers included all cases reported up to Mar 10, 2016. They said they included all suspected microcephaly cases, since only 27.7% of them had been investigated.
The surveillance system recorded 17,503 illness cases, 51 GBS hospitalizations, and 367 newborns with suspected microcephaly. Researchers found that raw and smoothed data showed a clear start, peak, and decline in cases, followed by classic epidemic time-series incidences for acute rashlike illness, GBS, and suspected microcephaly. Acute illnesses peaked in early May, with GBS cases peaking in early to mid-June and suspected microcephaly peaking from mid-November through mid-December.
They said the lag time they saw with GBS fit with the results from a recent case-control study from French Polynesia's Zika virus outbreak and that the suspected microcephaly findings show a strong association with acute illness during the first pregnancy trimester, which they said is also consistent with other findings.
"Although such temporal associations do not prove causation, their strength and pattern makes a major contribution to the growing body of data supporting the association of GBS and congenital malformations with previous exposure to Zika virus (or , at least an AEI)," the group wrote.
Briefing covers disease risks, vaccine trial
During today's PAHO briefing, Aldighieri and Tony Fauci, MD, director of the US National Institute for Allergy and Infectious Diseases (NIAID), addressed the communication challenges regarding a disease that is typically mild but has serious complications against a backdrop of many unanswered questions.
Fauci said it's still not known what percentage of mothers infected with Zika virus will deliver a baby with microcephaly or another congenital abnormality, noting that early studies have put the number at anywhere between 1% and 29%. He said global health groups haven't recommended that women in affected areas delay pregnancy, because the issue is extremely personal and is colored by religious and cultural practices, with little access to birth control in some countries.
Fauci said local transmission on the US mainland is likely and will hopefully be confined to areas in Florida and Texas that have reported two other diseases carried by Aedes aegypti mosquitoes: chikungunya and dengue. Though Aedes albopictus mosquitoes can spread the disease and occur in more states, he said, they aren't as focused on humans. "Just because it is capable of spreading the disease doesn't mean it will be a major player," he added
Regarding vaccine development, Fauci said a small phase 1 trial involving about 80 people is slated to begin in September to assess if the vaccine is safe and hits immune response targets. The next step would be to test the vaccine in a country with local transmission, and if high levels of transmission are still under way, researchers might be able to enroll enough people for the trial to qualify as phase 2b, which might produce enough information to assess if the vaccine is effective.
It's always possible that the population could develop herd immunity, which would make testing the vaccine difficult, Fauci said. "But if you look at the history of dengue, dengue did not come and disappear."
Aldighieri said the long-term outlook in the Americas region is uncertain, but in the short- and mid-term, millions of infections are expected.
See also:
May 2 Peru MOH report (in Spanish)
May 3 Emerg Infect Dis report