Two cases of Zika fever imported from French Polynesia to Japan, December 2013 to January 2014

Abstract

We present two cases of imported Zika fever to Japan, in travellers returning from French Polynesia, where an outbreak due to Zika virus (ZIKV) is ongoing since week 41 of 2013. This report serves to raise awareness among healthcare professionals, that the differential diagnosis of febrile and subfebrile patients with rash should include ZIKV infection, especially in patients returning from areas affected by this virus.

Zika virus disease: a current review of the literature

“…At present, more than 30 countries in Asia, Africa, Oceania, Micronesia and South America have reported indigenous human ZIKV cases [29]. The travel-related cases from epidemic and endemic regions were also reported in North America, Australia, Europe and Japan [30][31][32][33][34][35][36][37]. As of 27th July 2016, a total of 50 territories and countries in the Americas have reported ZIKV infections.…”

“…The other suspected routes of ZIKV transmission include monkey bite, mucocutaneous exposure, organ transplantation or hemodialysis [56,57]. The risk of ZIKV infection among kidney recipients should also be considered if the donors are either residing in or returning from endemic regions, because the virus may be shed in the urine of the infected person for more than 30 days [31,32,58]. Due to occasional detection of viral RNA in saliva samples and nasopharyngeal swab, it is still unknown that ZIKV could be spread through respiratory droplets [52,59].…”

“…The biochemical and hematological laboratory parameters are generally normal, though some patients may have transient and mild leucopenia, lymphopenia or activated lymphocytes, neutropenia, thrombocytopenia, monocytosis, increased erythrocyte sedimentation rate and raised serum levels of gamma-glutamyl transpeptidase, lactate dehydrogenase, aspartate aminotransferase, ferritin, fibrinogen and C-reactive protein during the course of the viremic phase [20,32,34].…”

“…In non-endemic regions, a questionnaire should be answered by the blood donors to obtain their recent travel history to identify the potential carriers. Likewise, the donated organs, particularly kidneys, from persons with a recent travel history to affected areas should be examined for ZIKV, because the virus may exist in the genitourinary tract for an uncertain time duration [31,32]. Safe sexual practices are also recommended to prevent the sexual transmission of ZIKV.…”

Zika virus infection: Clinical overview with a summary of Japanese cases

“…[13][14][15] The outbreak in French Polynesia and Brazil was caused by Asian strains. 13,15 The Asian lineage can be divided into three clades (Southeast Asian, Pacific and American), and the Southeast Asian clade might have a lower cytotoxicity and replicative ability than the American clade and African lineage.…”