Martinique - Zika outbreak 2016

[Gert van der Hoek]

Microcephaly ? France - Martinique

Disease Outbreak News

9 April 2016

On 24 March 2016, the National IHR Focal Point for France notified PAHO/WHO of a foetus with concomitant microcephaly and Zika virus infection in Martinique.

The diagnosis of microcephaly was made during pregnancy on 10 March. On 17 March, the foetus?s samples were collected and tested at the Centre Hospitalier Universitaire of Martinique in Fort-de-France: both amniotic fluid and foetal blood samples resulted positive for Zika virus infection by polymerase chain reaction (PCR). On 22 March, the National Reference Center for arboviruses confirmed the infection with Zika virus.
Between December and March, the serology performed on the mother's serial samples confirmed infection with Zika virus.

WHO risk assessment

This is the first case of Zika virus infection detected in a foetus with microcephaly in Martinique. This report is important because it provides a prospective documentation of Zika virus infection in a mother and her foetus and allows an estimation of the stage of pregnancy at which the mother and the foetus became infected. It also shows that a foetus can be PCR-positive for Zika virus months after the initial infection of the mother. This report provides additional evidence that infection with Zika virus early in pregnancy could be associated with an increased risk of microcephaly. Further investigations, however, will be required to fully comprehend the role of Zika virus infection in the development of congenital abnormalities, such as microcephaly, and to establish any causative links. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

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Translation Google

Source: Point au 28 avril 2016. (pdf- 1,48 Mo)

Emergence of Zika virus in the Caribbean Guyana
epidemiological Situation
epidemiologically 28 April 2016 - No. 16/2016
...
| current epidemiological situation in Martinique |

...
From April 18 to 24
2016 (S2016-16), the estimated number of clinically suggestive cases is increasing compared to four previous weeks
(1600 evocative estimated cases), equivalent to the levels reported before the Easter school holidays. As of 28
April estimate the cumulative number of cases suggestive of Zika who consulted a general practitioner was 20,980.
...
Since viral emergence in Martinique, the infection was confirmed biologically in 184 pregnant women. This number
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some have already
give birth. Furthermore, any complication occurring in the fetus of a mother infected with the virus is identified by the device
monitoring. To date, two fetal microcephaly and one brain malformation have been recorded by the device
surveillance. Note that one of these two microcephaly detected on ultrasound (prenatal care) in a mother
with laboratory confirmation for Zika was overturned at birth.

Fourteen patients with Guillain-Barr? syndrome (GBS) were detected by the monitoring system since
the emergence of Zika including eleven with laboratory confirmation for the Zika virus and three being for biological investigation
Zika virus. Some three other severe neurological forms were biologically confirmed for the Zika virus.
The responsibility of the infection in the occurrence of complications described above has not yet been formally established to
all.
No deaths can be directly attributed to Zika has been reported to date.

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Translation Google

Source: Point au 12 mai 2016. (pdf- 1,34 Mo)

Emergence of Zika virus in the Caribbean Guyana
epidemiological Situation
epidemiologically 12 May 2016 - No. 18/2016
...
| current epidemiological situation in Martinique |

...
May 8, the estimated cumulative number of consultations with a general practitioner Zika was 23,860.
...
Surveillance for complications associated with infection by Zika

Since viral emergence in Martinique, the infection was confirmed biologically in 225 pregnant women. This digit
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some
already given birth.

Furthermore, any complication occurring in the fetus of a mother infected with the virus is identified by device
surveillance. To date, two microcephaly and another fetal brain malformation were detected by ultrasound.

Nineteen patients with Guillain-Barr? syndrome (GBS) were detected by the monitoring system since
the emergence of Zika including fifteen with laboratory confirmation for the Zika virus and four current biological investigation.

Some other severe neurological forms were biologically confirmed for the Zika virus.

The responsibility of the infection in the occurrence of complications described above has not yet been formally established
for all.

No deaths can be directly attributed to Zika has been reported to date.
...

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Source: Point au 19 mai 2016. (pdf- 1,34 Mo)

Translation Google

Emergence of Zika virus in the Caribbean Guyana
epidemiological Situation
epidemiologically 19 May 2016 - No. 19/2016

| current epidemiological situation in Martinique |

...
As of May 15, the estimated cumulative number of consultations with a general practitioner Zika was 25,610.
...
Surveillance for complications associated with infection by Zika

Since viral emergence in Martinique, the infection was confirmed biologically in 255 pregnant women. This number
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some
already given birth.

Furthermore, any complication occurring in the fetus of a mother infected with the virus is identified by device
surveillance. To date, two microcephaly and another fetal brain malformation were detected by ultrasound.

Twenty patients with Guillain-Barr? syndrome (GBS) were detected by the monitoring system since
the emergence of Zika including nineteen with laboratory confirmation for the Zika virus and one current biological investigation.

Three others severe neurological forms were biologically confirmed for the Zika virus.

The responsibility of the infection in the occurrence of complications described above has not yet been formally established
for all.

One death of a patient with Guillain-Barr? syndrome was evaluated as directly attributable to Zika.
...

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Source: Point au 2 juin 2016. (pdf- 1,24 Mo)

Translation Google

Emergence
Zika the Caribbean Guyana
Epidemiological Situation
epidemiologically 2 June 2016 - No. 21/2016

| current epidemiological situation in Martinique |

...
To May 29, the estimated cumulative number of consultations with a general practitioner Zika
was 27,800.
...
Surveillance for complications associated with infection by Zika

Since viral emergence in Martinique, the infection was confirmed biologically in 302 pregnant women. This number
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some
already given birth. Furthermore, any complication occurring in the fetus of a mother infected with the virus is identified by
the monitoring device. To date, two microcephaly and two other fetal brain malformations were detected
ultrasonography in pregnant women infected with the virus Zika

Twenty-one patients with Guillain-Barr? syndrome (GBS) were detected by the monitoring system since
the emergence of Zika including nineteen with biological confirmation Zika and two current biological investigation.
Three other severe neurological forms were biologically confirmed for the Zika virus.
The responsibility of the infection in the occurrence of complications described above has not yet been formally established
for all.

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Source: Point au 16 juin 2016. (pdf- 265,58 Ko)

Translation Google

Emergence
Zika the Caribbean Guyana
epidemiological Situation
epidemiological point of 16 June 2016 - No. 23/2016
...
| current epidemiological situation in Martinique |
...
June 12, the estimated cumulative number of consultations
Zika for a general practitioner was 30,000.
...
Since viral emergence in Martinique, the infection was confirmed biologically in 342 pregnant women. This digit
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some
already given birth.

Twenty-three patients with Guillain-Barr? syndrome (GBS) were detected by the monitoring system since
the emergence of Zika including nineteen with laboratory confirmation for the Zika virus and four current biological investigation.

Three other severe neurological forms were biologically confirmed for the Zika virus.

The responsibility of the infection in the occurrence of complications described above has not yet been formally established
for all.

A death of a patient with Guillain-Barr? syndrome was evaluated as directly attributable to Zika.

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Source: Point au 7 juillet 2016. (pdf- 638,69 Ko)

Translation Google

Emergence
Zika the Caribbean Guyana
epidemiological Situation
epidemiological point of the July 7, 2016 - No. 26/2016

...
| current epidemiological situation in Martinique |
...
Since the beginning of the epidemic, the cumulative number of
Zika consultations with a general practitioner is
estimated at 32,400.
...
Since viral emergence in Martinique, the infection was confirmed biologically in 384 pregnant women. This number
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some
already given birth.

Twenty-five patients with Guillain-Barr? syndrome (GBS) were detected by the monitoring system since
the emergence of Zika including twenty-one with laboratory confirmation for the Zika virus and four under investigation
biological. Finally, three others severe neurological forms were biologically confirmed for the Zika virus.

The responsibility of the infection in the occurrence of complications described above has not yet been formally established
for all.

A death of a patient with Guillain-Barr? syndrome was evaluated as directly attributable to Zika.

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Translation Google

The epidemic of Zika declining

C. Everard Monday, July 18, 2016
...

The trend is confirmed for a month in Martinique. Researchers also believe that the epidemic will turn off within three years in Latin America.

The good news is rare at the moment but here is one. Zika epidemic is in decline in Martinique and this is clearly visible on the curve below. On the last week of June, only 640 cases of patients with the signs of the disease went check, against 1,140 a month earlier.

This brings the number of estimated cases, having consulted, to 32,960 since the beginning of virus circulation. The peak of the epidemic seems well beyond, spreading the same time the fear of the past management system. For now, only one death was directly attributable to zika, in a 84 years old patient who contracted Guillain-Barre syndrome. In Guyana, some regions are also decreasing. In Guadeloupe, where the epidemic began later, the number of weekly cases is stable.

UNTIL 10 YEARS

In addition, researchers focused on Latin America as a whole. Their work have just been published in the American publication Science.

"Our analyzes suggest that the spread of infection zika can not be contained and that the epidemic will shut itself within two to three years," says Professor Neil Ferguson, of the faculty of public health at Imperial College and lead author of this work.

Since the virus can not infect the same person twice, the epidemic reached a stage where there are too few people who have not yet been infected so that the transmission will continue, explain the researchers. This is why a new large epidemic can not be restarted until at least ten years, when a new generation has not yet been exposed to zika.

The end of the epidemic zika would of course be a good thing, but also pose problems for the ongoing development of vaccines, noted Professor Ferguson.

"If our projections are correct, the number of cases of zika have fallen significantly by the end of 2017 or before and that means we will have vaccines ready to be tested and not enough cases of infection in the population to clinical trials, "Neil Ferguson fears.

The researchers also point out the large number of gray areas that remain about this virus - responsible for cases of congenital malformations in infants - and others of the same family, such as dengue.

http://www.martinique.franceantilles.fr/actualite/sante/l-epidemie-de-zika-en-decroissance-369094.php

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Translation Google

Emergence
Zika the Caribbean Guyana
epidemiological Situation
epidemiologically August 18, 2016 - No. 32/2016

...
| current epidemiological situation in Martinique |
...
Since the beginning of the epidemic, the cumulative number of consultations with a general practitioner Zika is estimated at 34,960.
...
Twenty-seven patients with Guillain-Barr? syndrome
(GBS) were detected by the monitoring system since
the emergence of Zika including 26 with laboratory confirmation
for the Zika virus and current biological investigation.

Finally, three other severe neurological forms were
biologically confirmed to Zika virus (Figure 6).

Since viral emergence in Martinique, the infection was
biologically confirmed in 490 pregnant women. This
figure is the cumulative number, since the emergence of
viruses, pregnant women who were infected and which
some have already given birth. After a decline that began in
2016-20 week and continues until week 2016-
25, the weekly number of pregnant women with
laboratory confirmation for Zika is stable (Figure 7). Due to a delay in the reporting of results, data
S2016-32 the week are being consolidated.

Furthermore, any complication occurring in the fetus of a
mother infected with the virus is identified by device
surveillance. To date, three microcephalies and seven
other fetal brain malformations were detected by
ultrasound among pregnant women confirmed
biologically.

The responsibility of the infection in the occurrence of
complications described above is not yet
formally established for all.

A death of a patient with Guillain-Barr? syndrome
was assessed as directly attributable to Zika.

http://www.invs.sante.fr/fr/Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Antilles-Guyane/2016/Situation-epidemiologique-du-virus-Zika-aux-Antilles-Guyane.-Point-au-18-aout-2016

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Translation Google

Emergence of Zika virus in the Caribbean Guyana
epidemiological Situation
epidemiologically 15 September 2016 - No. 36/2016
epidemiological synthesis territory at September 15, 2016
...
| current epidemiological situation in Martinique |
...
Since the beginning of the epidemic, the cumulative number of consultations with a general practitioner Zika is estimated at 36 100.
...
Surveillance for complications associated with infection by Zika

Twenty-seven patients with Guillain-Barr? syndrome
(GBS) were detected by the monitoring system since
the emergence of Zika including 26 with laboratory confirmation
for the Zika virus and current biological investigation.
Finally, five other severe neurological forms were
biologically confirmed to Zika virus (Figure 6).
Since viral emergence in Martinique, the infection was
biologically confirmed in 516 pregnant women. This
figure is the cumulative number, since the emergence of
viruses, pregnant women who were infected and which
some have already given birth. Since the 2016-32 week,
weekly number of pregnant women with
laboratory confirmation for Zika decreases (Figure 7). In
Due to a delay in the reporting of results, data
S2016-36 the week are being consolidated.

Furthermore, any complication occurring in the fetus of a
mother infected with the virus is identified by device
surveillance. To date, three microcephaly and eight other
fetal brain malformations were detected
ultrasound confirmed among pregnant women
biologically. An abnormality detected after birth
in the baby of a mother biologically confirmed was
reported to the monitoring device during the four
recent weeks.

The responsibility of the infection in the occurrence of
complications described above is not yet
formally established for all.

A death of a patient with Guillain-Barr? syndrome
was assessed as directly attributable to Zika.
...

http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Antilles-Guyane/2016/Situation-epidemiologique-du-virus-Zika-aux-Antilles-Guyane.-Point-au-15-septembre-2016

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Translation Google

Zika virus surveillance in the Caribbean Guyana
epidemiological Situation
epidemiologically of 20 October 2016 - No. 39/2016
...
| current epidemiological situation in Martinique |
...
At the beginning of June (S2016-23), the outbreak of Zika
began its decline, the estimated number of cases
suggestive Zika descending steadily, 1140 in
S2016-22 S2016-30 to 415.

During the month of August until the first week of
September the decline stalled and the trend is
steady with an average of 270 weekly event
estimated. S2016-37 from the week, the phase
decline resumed with a continued decline in the
estimated number of cases suggestive of less than 200.

From 10 to 16 October (S2016-41), the estimated number of cases
clinically suggestive of Zika seen in general practice is
65. The decline of this indicator confirms this
week.

Since the beginning of the epidemic, the cumulative number of
Zika consultations with a general practitioner is
estimated at 36,590.
...
Since viral emergence in Martinique, the infection was confirmed biologically in 537 pregnant women. This digit
corresponds to the cumulative number since the emergence of the virus, pregnant women with the infection and some
already given birth.

Thirty patients with Guillain-Barr? Syndrome (GBS) were detected by the monitoring system since
the emergence of Zika, including 28 with laboratory confirmation for Zika and two current biological investigation. Finally,
five other severe neurological forms were biologically confirmed for the Zika virus.

The responsibility of the infection in the occurrence of complications described above has not yet been formally established
for all.

A death of a patient with Guillain-Barr? syndrome was evaluated as directly attributable to Zika.
...
In Martinique, for five consecutive weeks, the estimated number of cases is clinically suggestive
less than 200. In the light of the epidemiological situation, the members of glycemia meeting October 10, 2016
proposed transition phase 4 of Psage * "End of epidemic with ongoing viral traffic".
This proposal was cohosh at the Management Unit held October 13, 2016.
Monitoring of complications associated with infection by Zika virus is maintained.
* Monitoring Program, alerting and management of emergencies (emerging arboviruses)
...

http://invs.santepubliquefrance.fr/fr/Publications-et-outils/Points-epidemiologiques/Tous-les-numeros/Antilles-Guyane/2016/Situation-epidemiologique-du-virus-Zika-aux-Antilles-Guyane.-Point-au-20-octobre-2016