Differences in Prevalence of Symptomatic Zika Virus Infection, by Age and Sex—Puerto Rico, 2016

Lozier, Matthew; Burke, Rachel M; López, Juan Guillermo; Acevedo, Verónica; Amador, Manuel; Read, Jennifer S.; Jara, Amanda; Waterman, Stephen H.; Barrera, Roberto; Muñoz‐Jordán, Jorge L.; Rivera-García, Brenda; Sharp, Tyler M.

doi:10.1093/infdis/jix630

Cited by 34 publications

(48 citation statements)

References 38 publications

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“…Should additional sub-national data on the timing of the peak become available, the model fitting and projections can easily be updated. Case reporting rates indicate a lower rate within countries that report only confirmed cases, and the rates within Brazil, El Salvador, Martinique, Puerto Rico, and Suriname align well with other estimates measured using alternative methods [ 21 , 46 , 47 ]. Whilst the fit to the data was good in many countries, there were a number of cases where the timing of the peak in the epidemic did not fit the data, as shown by the Bayesian posterior checks.…”

Section: Discussionsupporting

confidence: 77%

Projecting the end of the Zika virus epidemic in Latin America: a modelling analysis

O’Reilly

Lowe

Edmunds

et al. 2018

BMC Med

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BackgroundZika virus (ZIKV) emerged in Latin America and the Caribbean (LAC) region in 2013, with serious implications for population health in the region. In 2016, the World Health Organization declared the ZIKV outbreak a Public Health Emergency of International Concern following a cluster of associated neurological disorders and neonatal malformations. In 2017, Zika cases declined, but future incidence in LAC remains uncertain due to gaps in our understanding, considerable variation in surveillance and the lack of a comprehensive collation of data from affected countries.MethodsOur analysis combines information on confirmed and suspected Zika cases across LAC countries and a spatio-temporal dynamic transmission model for ZIKV infection to determine key transmission parameters and projected incidence in 90 major cities within 35 countries. Seasonality was determined by spatio-temporal estimates of Aedes aegypti vectorial capacity. We used country and state-level data from 2015 to mid-2017 to infer key model parameters, country-specific disease reporting rates, and the 2018 projected incidence. A 10-fold cross-validation approach was used to validate parameter estimates to out-of-sample epidemic trajectories.ResultsThere was limited transmission in 2015, but in 2016 and 2017 there was sufficient opportunity for wide-spread ZIKV transmission in most cities, resulting in the depletion of susceptible individuals. We predict that the highest number of cases in 2018 would present within some Brazilian States (Sao Paulo and Rio de Janeiro), Colombia and French Guiana, but the estimated number of cases were no more than a few hundred. Model estimates of the timing of the peak in incidence were correlated (p < 0.05) with the reported peak in incidence. The reporting rate varied across countries, with lower reporting rates for those with only confirmed cases compared to those who reported both confirmed and suspected cases.ConclusionsThe findings suggest that the ZIKV epidemic is by and large over within LAC, with incidence projected to be low in most cities in 2018. Local low levels of transmission are probable, but the estimated rate of infection suggests that most cities have a population with high levels of herd immunity.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1158-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 77%

Projecting the end of the Zika virus epidemic in Latin America: a modelling analysis

O’Reilly

Lowe

Edmunds

et al. 2018

BMC Med

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“…As ZIKV infections typically produce milder clinical manifestations, it is possible that ZIKV-infected children were more likely to be brought by their parents or guardians for medical care than adults. It is also possible that Zika clinical manifestations in older adults are less prominent than in children and younger adults, as previously observed in a Puerto Rico study that showed that, among individuals with laboratory-confirmed ZIKV infections, those who were symptomatic were younger than those who were asymptomatic [21].…”

Section: Temporal Distribution Of Arboviral Infectionsmentioning

confidence: 94%

Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings From Surveillance for Acute Febrile Illness

Silva

Tauro

Kikuti

et al. 2018

Clinical Infectious Diseases

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Abstract Background Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil. Methods Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil, between September 2014 and July 2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or nonspecific flavivirus (FLAV) diagnosis. Results Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV, 32 [3.4%]; CHIKV, 159 [16.7%]; ZIKV, 13 [1.4%]; and FLAV, 20 [2.1%]) and 23 (2.4%) coinfections (DENV/CHIKV, 13 [1.4%]; CHIKV/FLAV, 9 [0.9%]; and DENV/ZIKV, 1 [0.1%]). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with ZIKV presented with rash and pruritus (69.2% each) more frequently than those with DENV (37.5% and 31.2%, respectively) and CHIKV (22.9% and 14.7%, respectively) (P < .001 for both comparisons). Conversely, arthralgia was more common in CHIKV (94.9%) and FLAV/CHIKV (100.0%) than in DENV (59.4%) and ZIKV (53.8%) (P < .001). A correct presumptive clinical diagnosis was made for 9%–23% of the confirmed patients. Conclusions Arboviral infections are frequent causes of febrile illness. Coinfections are not rare events during periods of intense, concomitant arboviral transmission. Given the challenge to clinically distinguish these infections, there is an urgent need for rapid, point-of-care, multiplex diagnostics.

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“…Unexpectedly, patients with GBS and evidence of ZIKV infection were more frequently female, mirroring the higher incidence of ZIKV disease among this sex in Puerto Rico and elsewhere. [28][29][30][31] Timing of specimen collection was important in detecting ZIKV nucleic acid by rRT-PCR among 39.4% (28 of 71) of patients with GBS and evidence of ZIKV infection. Most specimens with confirmatory results were collected within 9 days of neurologic illness onset.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016

et al. 2018

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The pathophysiologic mechanisms of Guillain-Barré syndrome (GBS) associated with Zika virus (ZIKV) infection may be indicated by differences in clinical features. OBJECTIVE To identify specific clinical features of GBS associated with ZIKV infection. DESIGN, SETTING, AND PARTICIPANTS During the ZIKV epidemic in Puerto Rico, prospective and retrospective strategies were used to identify patients with GBS who had neurologic illness onset in 2016 and were hospitalized at all 57 nonspecialized hospitals and 2 rehabilitation centers in Puerto Rico. Guillain-Barré syndrome diagnosis was confirmed via medical record review using the Brighton Collaboration criteria. Specimens (serum, urine, cerebrospinal fluid, and saliva) from patients with GBS were tested for evidence of ZIKV infection by real-time reverse transcriptase-polymerase chain reaction; serum and cerebrospinal fluid were also tested by IgM enzyme-linked immunosorbent assay. In this analysis of public health surveillance data, a total of 123 confirmed GBS cases were identified, of which 107 had specimens submitted for testing; there were 71 patients with and 36 patients without evidence of ZIKV infection. Follow-up telephone interviews with patients were conducted 6 months after neurologic illness onset; 60 patients with and 27 patients without evidence of ZIKV infection participated. MAIN OUTCOMES AND MEASURES Acute and long-term clinical characteristics of GBS associated with ZIKV infection. RESULTS Of 123 patients with confirmed GBS, the median age was 54 years (age range, 4-88 years), and 68 patients (55.3%) were male. The following clinical features were more frequent among patients with GBS and evidence of ZIKV infection compared with patients with GBS without evidence of ZIKV infection: facial weakness (44 [62.0%] vs 10 [27.8%]; P < .001), dysphagia (38 [53.5%] vs 9 [25.0%]; P = .005), shortness of breath (33 [46.5%] vs 9 [25.0%]; P = .03), facial paresthesia (13 [18.3%] vs 1 [2.8%]; P = .03), elevated levels of protein in cerebrospinal fluid (49 [94.2%] vs 23 [71.9%]; P = .008), admission to the intensive care unit (47 [66.2%] vs 16 [44.4%]; P = .03), and required mechanical ventilation (22 [31.0%] vs 4 [11.1%]; P = .02). Six months after neurologic illness onset, patients with GBS and evidence of ZIKV infection more frequently reported having excessive or inadequate tearing (30 [53.6%] vs 6 [26.1%]; P = .03), difficulty drinking from a cup (10 [17.9%] vs 0; P = .03), and self-reported substantial pain (15 [27.3%] vs 1 [4.3%]; P = .03). CONCLUSIONS AND RELEVANCE In this study, GBS associated with ZIKV infection was found to have higher morbidity during the acute phase and more frequent cranial neuropathy during acute neuropathy and 6 months afterward. Results indicate GBS pathophysiologic mechanisms that may be more common after ZIKV infection.

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Differences in Prevalence of Symptomatic Zika Virus Infection, by Age and Sex—Puerto Rico, 2016

Cited by 34 publications

References 38 publications

Projecting the end of the Zika virus epidemic in Latin America: a modelling analysis

Projecting the end of the Zika virus epidemic in Latin America: a modelling analysis

Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings From Surveillance for Acute Febrile Illness

Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016

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