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  • LCMCD News

    Arbovirus update

    June 15, 2017


    For earlier Arbovirus reports click here:  https://www.lcmcd.com/what-we-do/disease-surveillance



    A ProMED-mail post


    ProMED-mail is a program of the

    International Society for Infectious Diseases <http://www.isid.org>


    Date: Tue 18 Apr 2017

    Source: The News [edited]



    An outbreak of the mosquito-borne viral disease chikungunya was confirmed in city’s [Karachi] coastal areas after around 840 people were reported by health authorities to have contracted the virus in the first 15 days of April [2017] only. Of these, 198 patients were confirmed to have contracted the virus by the National Institute of Health in Islamabad.

    The areas from where the highest numbers of cases were reported include Ibrahim Hyderi, Keamari, Malir and Lyari among others. “The NIH, Islamabad tested 198 people positive for the mosquito-borne virus,” Karachi Director Health Karachi Dr Muhammad Taufiq informed The News.

    The disease is non-lethal and is [transmitted] by the _Aedes aegypti_ mosquito, which also carries the dengue and Zika viruses. Its symptoms include high fever, severe pain in joints and muscles, headache, nausea, fatigue, and body rashes.

    “In the 1st 15 days of April [2017] alone, 840 persons were brought to various public and private hospitals on suspicion of having chikungunya infection,” Dr Taufiq said. Most of the cases were reported from areas known for having poor sanitary conditions, he added.

    “Controlling the outbreak of the virus only lies in extensive fumigation of the areas by the municipal authorities. It is the Karachi Metropolitan Corporation’s (KMC) job to improve sanitary conditions and keep the city clean to prevent an outbreak of such vector-borne diseases,” the director health maintained.

    Another official in the Sindh Health Department informed that a total of 1740 people have been brought to hospitals with chikungunya symptoms since [19 Dec 2016] — an outbreak of the disease was reported in Malir after hundreds of people were confirmed to have contracted the infection.

    “I have a list of around 1740 people who were brought to the hospitals, blood samples of around 260 of them were sent to the NIH, Islamabad,” the official claimed. The highest number of cases, 664, were reported from Malir followed by 320 cases in Ibrahim Hyderi, 286 in Keamari, 260 from Bin Qasim Town, whereas 136 and 70 cases were reported from Orangi Town and Lyari respectively.

    “Of the 1740, both the genders were found to have been affected in equal ratio. Most of the patients were aged between 30-39 years even though it is the children and elderly who are usually affected by the mosquito-borne infection,” the health department official claimed.

    Provincial officials of the World Health Organization (WHO) also confirmed the virus’s outbreak in Karachi. According to their data maintained till [14 Apr 2017], around 1419 cases of chikungunya had been reported; 215 blood samples were sent to the NIH Islamabad and out of them 169 were confirmed to have the mosquito-borne disease.

    “WHO is in close coordination with the Regional Disease Surveillance and Response Unit (RDSRU-Sindh) and is providing them with necessary support including setting up an advisory council, providing them with pamphlets and posters written in local languages,” Dr Sara Salman, head of WHO Sindh, said in response to queries regarding the infection’s outbreak.

    Citing WHO and [US] Centre for Disease Control (CDC) Atlanta’s guidelines, renowned physician Dr Zeeshan Ansari said there was no specific antiviral drug treatment for chikungunya yet. “Treatment is directed primarily at relieving the symptoms, such as administering paracetamol to patients for joint pains, anti-pyretics, optimal analgesics and fluids for other symptoms.” Those infected with the disease were advised by Dr Ansari to have plenty of rest, fluids, and use non-steroidal anti-inflammatory drugs (NSAIDs) to relieve acute pain and fever.

    [Byline: M Waqar Bhatti]

    Communicated by:



    [Based on the recent report from the Regional Disease Surveillance and Response Unit (RDSRU), from 19 Dec 2016 to 14 Apr 2017, 1419 suspected cases of chikungunya were identified and registered, using the following WHO recommended case definition in the different towns of

    Karachi: “A person with acute onset of fever (102 deg F/39 deg C) and severe arthralgia or arthritis not explained by other medical conditions, and who resides or has visited epidemic or endemic areas within 2 weeks before the onset of symptoms.”


    According to the available data (up to 16 Apr 2017), cases continue to be reported. A total of 245 samples have been sent to the National Institute of Health (NIH), Islamabad from Sindh, for diagnostic Laboratory confirmation. Out of these, 179 samples were found positive for chikungunya virus on RT-PCR.


    The numbers mentioned in the news report above are lower than the figures shared by RDSRU Sindh.


    ProMED-mail thanks Dr Muhammad Asif Syed, Provincial Technical Officer the Regional Disease Surveillance and Response Unit, Karachi, Sindh, for the information above on the chikungunya outbreak. – Mod.UBA


    For information from the State Health Department go to:  http://www.floridahealth.gov/diseases-and-conditions/zika-virus/index.html

    You will need to cut and paste this page into your browser.

    Pro med summary of Zika cases in the Americas:

    [1] Cases in various countries:


    [Maps showing the location of the affected islands and countries in the Americas mentioned below can be accessed at <http://www.cdc.gov/chikungunya/images/maps/CHIK_Caribbean_Map-060214.jpg>

    and <http://healthmap.org/promed/p/35574>;

    North America at <http://healthmap.org/promed/p/106>;

    Central America and the Caribbean at

    <http://healthmap.org/promed/p/39455>; and South America at <http://healthmap.org/promed/p/6186>. – Mod.TY]

    Mexico and Central America

    Mexico (national). 21 Mar 2016. (registered) 160 cases, of whom 30 are pregnant women. States most affected: Chiapas 82 cases, Oaxaca 59 cases, Guerrero 7 cases, Nuevo León 4 cases, Jalisco 2 cases, Michoacán, Nayarit, Sinaloa, Tabasco, Veracruz, Yucatán 1 case each.


    [in Spanish]

    Panama (national). 21 Mar 2016. (confirmed (conf)) 149 cases.

    Localities affected: provinces of Panamá, Colón, Panamá Oeste, comarca de Guna Yala.



    US Virgin Islands

    – St Croix. 19 Mar 2016. (conf) 11 cases.


    – St Thomas. 21 Mar 2016. (conf) 1st case on the island. Samples taken

    1 month ago.


    Trinidad (national). 22 Mar 2016. (conf) 6 cases, at least 3 locally acquired.


    Martinique (national). 2 Mar 2016. (reported) 1st case of microcephaly (suspected (susp)) linked to Zika virus infection of mother.


    South America

    Argentina (Corrientes province). 22 Mar 2016. (conf) 2 cases imported [locality where the infections were acquired not stated].


    [in Spanish]


    – Microcephaly cases. 22 Mar 2016. (susp) as of 19 Mar 2016, 4293 cases, (conf) 907 cases. [The relationship of these cases to Zika virus infection of the mother not stated.] <http://kdal610.com/news/articles/2016/mar/22/brazil-says-confirmed-and-suspected-microcephaly-cases-rise-to-5200/>

    – Virus arrival. 24 Mar 2016. (reported) Zika likely arrive in Brazil between May – December 2013, probably from French Polynesia or SE Asia. The full genome of virus samples taken from 7 Brazilian patients who were infected with Zika between March and November 2015 were determined. Genomes of the Brazilian samples were compared to those from patients in 9 other countries, 6 from the current outbreak in the Americas and one each from French Polynesia, the Cook Islands, and Thailand. The sequences from the Americas were the most closely related; the sequence from a patient in Thailand in 2013 was the most distant. That’s consistent with the leading theory that the virus entered Brazil only once, from someone infected in the 2013 Zika epidemic in French Polynesia, and spread to the rest of the Americas from there.


    Chile (national). 24 Mar 2016. (conf.) the 1st autochthonous case of Zika virus infection in Continental Chilean territory has been documented by the Virology Laboratory of the School of Medicine, Pontificia Universidad Católica de Chile.

    The male partner traveled to Haiti from [5-17 Jan 2016]. He presented with Zika symptoms on [22 Jan 2016]. The infection was confirmed retrospectively by serology Zika IgM positive and IgG seroconversion in convalescent sample. Dengue IgM was negative. While he was symptomatic he had sexual intercourse with his female partner during

    23 and 29 Jan [2016]. She presented with rash, retroauricular adenopathies, conjunctivitis, and arthritis on [4 Feb 2016] and was diagnosed of Zika infection by Zika IgM positive, and Zika IgG seroconversion in a convalescent blood sample. She also traveled to Haiti from [14-17 Jan 2016] and Miami and Managua (few hours in the airport only) on [21 Jan 2016]. Her disease started 18 and 14 days respectively after eventual exposure in countries with Zika [virus] transmission (Haiti and Nicaragua). Considering a Zika [virus infection] incubation period of up to 12 days, vector transmission is very unlikely.

    This is the 1st documented case of Zika infection by sexual transmission in Chile being also the 1st case acquired in continental Chilean territory where there is no presence of aedes [vector] mosquitoes.

    [ProMED-mail thanks Ceclia Perret MD <cperret@med.puc.cl>, Marcela Ferrés MD of the School of Medicine, Virology Laboratory, Pontificia Universidad Católica de Chile, for sending in this case report. – Mod.TY]


    Cape Verde (national). 21 Mar 2016. (susp) 7490 cases of whom 165 are pregnant women; 1 case of microcephaly with mother susp of Zika virus infection; localities affected: 2 of 9 islands — Santiago island and São Filipe municipality (Fogo island); WHO sending a team of experts.


    [Maps showing the location of the Cape Verde Islands off the east coast of Africa can be accessed at <http://i.infopls.com/images/mcapverd.gif> and <http://healthmap.org/promed/p/15>. – Mod.TY]

    Countries with cases but no ongoing transmission

    Bangladesh (national). 23 Mar 2016. (conf) 1st case detected serologically in blood sample taken in 2014 [not indicated if imported or locally acquired].


    [Bangladesh has vector mosquitoes that can transmit Zika virus and does transmit dengue viruses there. The risk of ongoing transmission is real, even though this single case did not initiate an outbreak.

    Maps of Bangladesh can be seen at


    and <http://healthmap.org/promed/p/153>. – Mod.TY]


    South Korea (national). 22 Mar 2016. (conf.) 1st case in country ex Brazil.


    [Maps of South Korea can be accessed at <http://tinyurl.com/jvukf5u> and <http://healthmap.org/promed/p/195>. – Mod.TY]


    – Case numbers mainland. Zika virus disease in the United States,

    2015-2016 as of 23 Mar 2016


    State / no. imported cases

    Alabama / 2

    Arkansas / 1

    California / 17

    Colorado / 2

    Connecticut / 1

    Delaware / 3

    District of Columbia / 3

    Florida / 70

    Georgia / 7

    Hawaii / 5

    Illinois / 9

    Indiana / 4

    Iowa / 4

    Kansas / 1

    Kentucky / 2

    Louisiana / 2

    Maryland / 5

    Massachusetts / 3

    Michigan / 2

    Minnesota / 9

    Missouri / 1

    Montana / 1

    Nebraska / 2

    New Hampshire / 2

    New Jersey / 2

    New York / 43

    North Carolina / 7

    Ohio / 8

    Oklahoma / 3

    Oregon / 6

    Pennsylvania / 8

    Tennessee / 1

    Texas / 23

    Virginia / 7

    Washington / 2

    West Virginia / 5

    Total / 273


    [Maps of the USA showing the states mentioned above can be accessed at <http://www.mapsofworld.com/usa> and <http://healthmap.org/promed/p/106>. – Mod.TY]

    – Territories and Commonwealth

    American Samoa: 14 locally acquired

    Puerto Rico: 1 imported, 3 imported 317 locally acquired US Virgin Islands: 1 imported, 10 locally acquired Total locally acquired: 341

    – Guillain-Barré syndrome (GBS). 21 Mar 2016 (reported) as of 10 Mar 2016, 2 cases of GBS with evidence of Zika virus infections.


    – Vector mosquitoes. 16 Mar 2016. A report published in PLoS Current Outbreaks indicates where _Aedes aegypti_ and _Ae. albopictus_ are present or could become present in the USA with accompanying risk of Zika virus transmission.



    [However, the vector capacity of local _Ae. albopictus_ for local strains of Zika virus has not yet been established. – Mod.TY]

    communicated by:

    ProMED-mail <promed@promedmail.org>


    Roland Hubner

    Superior Health Council

    Brussels, Belgium



    [2] Guillain-Barré syndrome

    Date: Thu 24 Mar 2016

    Source: New England Journal of Medicine, Journal Watch [edited] <http://www.jwatch.org/fw111351/2016/03/24/who-zika-circulating-38-countries-linked-guillain-barr-12>

    The Zika virus is currently circulating in 38 countries and territories, WHO director-general Margaret Chan said in a media briefing on [Tue 22 Mar 2016]. Of these, 12 have reported an increase in Guillain-Barré syndrome [GBS] or laboratory evidence of Zika among GBS patients.

    In addition, the virus has now been linked to microcephaly in Panama, and Colombia is examining a potential link to microcephaly cases there. To date, Brazil has confirmed over 900 cases of Zika-linked microcephaly, according to news reports. In other areas, the virus hasn’t been circulating long enough to see potential effects in term pregnancies.

    Dr Chan said, “There is now scientific consensus that Zika virus is implicated in these neurological disorders,” although the link “is not yet scientifically proven.” 14 teams in 5 countries are working on vaccines, she said.

    [byline: Amy Orciari Herman, edited by Susan Sadoughi, Richard Saitz]

    communicated by:



    [This situation is rapidly changing as the outbreak expands and surveillance increases. Expect increases in the numbers of GBS cases in the near future. – Mod.TY]


    EXPERT REACTION: Is a pesticide, not Zika virus, causing microcephaly?



    Get answers to your questions about #Zika from CDC’s Disease Detectives Friday, 2/12 at 11AM ET. Use #CDCchat. pic.twitter.com/JknJrLeqfe

    Información sobre el virus Zika: Información sobre el virus Zika


    Governor declares a Public Health Emergency.

    On February 3, 2016 the Governor signs a Declaration of Emergency for four counties.


    State Health Department Press Release: State Press Release 02022016

    State Department of Health Video on Protecting Yourself from mosquitoes:

    Miami-Dade and Hillsborough Counties have reported their first imported Zika fever cases.

    Miami-Dade: The first case is a 23 year old, Hispanic female with a travel history to Colombia in December. She had onset of fever, fatigue, myalgia, and rash on 12/22/15. The second case is a 60 year old female with a with a travel history to Colombia in December/January. She had onset of fever, arthralgia, and conjunctival erythema on 1/3/16.

    Hillsborough: The case is a 10 year old male with a travel history to Venezuela in December/January. He had onset of fever, cough, runny nose, and rash on 1/4/16.

    Cases were confirmed at the state laboratory by RT-PCR and Mosquito Control was advised when the County Health Department was notified.

    There is a Level 2 (Alert) Travel Health Notice from the CDC for multiple countries in the Caribbean, Central and South America, and Mexico related to Zika virus transmission and possible association with poor pregnancy outcomes.

    Until more is known about the link between Zika virus, microcephaly, and other poor pregnancy outcomes, CDC recommends special precautions for pregnant women and women trying to become pregnant:

    • Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
    • Women trying to become pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.


    Please view the below link for additional details.



    December 15, 2015, Duval County has reported their first human case of West Nile virus illness in 2015. The case spends a lot of time outdoors and did not recall being bitten by mosquitoes. The case only used some preventive measures against mosquitoes. The case was confirmed at the state laboratory and had no travel outside the county during the two weeks prior to onset. Mosquito Control was advised when the County Health Department was notified.

    Manatee County has reported their first WNV-positive, asymptomatic blood donor in 2015. The case never developed any symptoms. This person does not recall being bitten by mosquitoes and does not use any preventive measures against mosquitoes. Lab results were confirmed at the state laboratory. The case had travel back and forth between Manatee and Sarasota Counties during the two weeks prior to onset. Mosquito Control at both counties were advised when the County Health Departments were notified.

    This brings the state of Florida total to 10 cases of WNV illness and 2 asymptomatic blood donors.

    Dengue fever Hawaii 2015: outbreak can last for months as new cases are discovered

    Latinos Health

    By Staff Reporter media@latinoshealth.com

    Dec 04, 2015 05:30 AM EST

    The Hawaii Department of Health confirmed that there have already been 130 dengue fever cases on Hawaii’s Big Island since September, CNN reported This figure is eight more than the figure that was reported on Wednesday. These new cases of dengue fever made Dr. Lyle Peterson, Centers for Disease Control and Prevention’s director of vector-borne diseases, conclude that the outbreak will continue for months.

    It has been confirmed that 114 of the patients are locals of Hawaii while the other 16 patients are tourists. Also, Big Island is the only part of Hawaii experiencing this outbreak. No dengue-related illness or hospitalization from other parts have been reported.

    The Big Island Video News said that it is the biggest dengue outbreak since Hawaii was announced as a state. It is also reported that the total number of dengue fever in Hawaii surpasses the Maui’s 2001 outbreak, which infected over 1,600 people and lasted for 10 months.

    Peterson is concerned about the fact that the number of affected people on Maui in two months was reached by the current Hawaii outbreak in only two months. However, the doctor made the distinction that in this outbreak, there is a higher number of people in the area.

    He also emphasized that if the outbreak will really continue for months, it won’t be due to system failure. Instead, it would be due to the fact that they do not have the necessary tools in order to put an end or minimize the outbreak as soon as possible. It is difficult to control mosquitoes, especially that both the two types of virus-carrying mosquitoes are found in the state and that they breed very fast.

    According to the Huffington Post, the state and county officials are working together to prevent the infection from spreading further. They decided to temporarily close the beach resorts in the infected areas. This includes Hookena Beach, which is identified as a high-risk area.

    Also, they sprayed insecticides in nearby schools to get rid of mosquitoes that transmit the dengue virus.

    The officials also launched the “Fight the Bite” campaign. It educates people about the outbreak. It also encourages them to protect themselves against the virus on their own by getting rid of the stagnant water in their homes and using insect repellant. The CDC is also offering their help to the state through technical and laboratory assistance.


    Painful Chikungunya Virus Can be Worse Than Feared, Study Shows:  Nov 27 2015, 7:29 pm ET  by Maggie Fox

    Chikungunya, a painful, mosquito-borne virus that’s spreading fast across the Americas, can be more serious than feared, researchers report.

    They found it can cause a serious brain inflammation called encephalitis far more frequently than reported before. That’s bad news for Latin America and the Caribbean, where the rate of infection is about a million people a year.

    “Since there is no vaccine to prevent chikungunya and no medicine to treat it, people who are traveling to these areas should be aware of this infection and take steps to avoid mosquito bites, such as wearing repellent and long sleeves and pants if possible,” said Dr. Patrick Gérardin of Central University Hospital in Saint Pierre, Reunion Island, who led the study.

    Chikungunya is not usually deadly, but it can cause a very bad headache, joint pain, rash and fever. Its name in the Makonde language, spoken in Tanzania and Mozambique in Africa, means “it bends up,” because patients are often contorted with pain. They can spend weeks in bed, racked with pain.

    The virus only arrived in the Western Hemisphere in December 2013, on St. Martin. But it spread fast and has been found as far north as Florida and across Central and South America.

    More than 600,000 cases have been reported so far this year, with 76 deaths, according to the Pan American Health Organization. In 2013 and 2014 more than 1.1 million cases were reported and it killed 194 people.

    Gérardin and colleagues studied an outbreak on Reunion Island in 2005 and 2006. They went back through medical records and found encephalitis had been diagnosed in 8.6 per 100,000 people. That’s a much higher rate than previously believed, they reported in the journal Neurology.

    Encephalitis was more likely in infants and people over 65. The incidence rate in infants was 187 per 100,000 people; it was 37 per 100,000 people in people over age 65, they found.

    “These numbers are both much higher than the rates of encephalitis in the United States in these age categories, even when you add together all the causes of encephalitis,” Gérardin said.

    They said it’s higher than the rate of encephalitis the United States from West Nile virus and similar infections between 1999 and 2007.

    West Nile was only introduced into the United States in 1999, but it quickly spread to all 50 states as well as Canada and Mexico. Since then, it’s infected hundreds of thousands of people, causing severe illness in about 40,000 and killing more than 1,600.

    Fewer than 1 percent of people who are infected will develop a serious neurologic illness such as encephalitis or meningitis (inflammation of the brain or surrounding tissues).

    Symptoms of encephalitis or meningitis include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures, or paralysis.

    There’s no vaccine against either chikungunya or West Nile and the only treatment is rest and pain relief.

    Summary report of laboratory confirmed imported cases of Chikungunya as of 17 Nov 2015:

    Alaska 1 case

    Arizona 17 cases

    Arkansas 4 cases

    California 117 cases

    Colorado 4 cases

    Connecticut 13 cases

    Florida 65 cases

    Georgia 8 cases

    Hawaii 6 cases

    Idaho 3 cases

    Illinois 15 cases

    Indiana 7 cases

    Iowa 2 cases

    Kansas 11 cases

    Kentucky 8 cases

    Maine 2 cases

    Maryland 18 cases

    Massachusetts 22 cases

    Michigan 5 cases

    Minnesota 4 cases

    Mississippi 1 case

    Missouri 4 cases

    Montana 1 case

    Nebraska 3 cases

    Nevada 1 case

    New Hampshire 1 case

    New Jersey 27 cases

    New York 63 cases

    North Carolina 13 cases

    North Dakota 1 case

    Ohio 9 cases

    Oklahoma 2 cases

    Pennsylvania 7 cases

    Rhode Island 5 cases

    South Carolina 3 cases

    Tennessee 7 cases

    Texas 37 cases

    Utah 3 cases

    Vermont 1 case

    Virginia 22 cases

    Washington 22 cases

    Wisconsin 6 cases


    Puerto Rico (imported) 0 cases, (locally acquired) 192 cases US Virgin Islands (imported) 0 cases, (locally acquired) 4 cases <http://www.cdc.gov/chikungunya/pdfs/2015table2-092915.pdf>.

    Maps showing the location of the states mentioned above can be accessed at <http://healthmap.org/promed/p/106>. – Mod.TY]

    Zika Virus in Brazil and Columbia more a concern than first thought:

    In a report of  associated with Zika virus infections in Bahia state, Mod RNA commented that Guillain-Barre syndrome (GBS) has been related to infections by Zika virus in French Polynesia as well as elsewhere to dengue and chikungunya virus infections (citing references) (see ProMED-mail archive no. http://promedmail.org/post/20150716.3513770). GBS is a severe inflammatory neurological disorder that attacks the peripheral nerves and causes paralysis. This syndrome often occurs a few weeks after a viral infection, even a benign one. Usually, when the body is attacked by viruses or bacteria, lymphocytes are responsible for attacking the aggressors. But sometimes, in very rare cases, the action of these lymphocytes is misdirected after a viral infection or the immune system can over-react. The body’s immune system begins to attack itself. The patient develops symptoms of muscle weakness, and difficulty swallowing and breathing. Muscle weakness can turn into quadriplegia.

    Guillain-Barre syndrome is characterized by tingling, prickling and muscle weakness, and ascending paralysis. It starts from the feet, then rises gradually; in most serious cases, it can cause respiratory paralysis with the need for respiratory support in patients. ProMED would be interested in learning about any post-Zika virus infection associated GBS cases in Colombia, where a Zika virus outbreak is occurring. – Mod.TY]

    Another concern is for pregnant women that contract Zika virus:

    A ProMED-mail post


    ProMED-mail is a program of the

    International Society for Infectious Diseases <http://www.isid.org>

    Date: Tue 24 Nov 2015

    Source: Secretariat of Health Surveillance, Ministry of Health of Brazil [in Portuguese, trans. Mod.TY, summ. & edited] <http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/secretarias/svs/noticias-svs/20929-ministerio-divulga-boletim-epidemiologico-sobre-microcefalia>

    Up to 21 Nov 2015, 739 suspected cases of microcephaly were reported, identified in 160 municipalities in 9 states of Brazil, according to the 2nd edition of the epidemiological report on microcephaly, released on [Tue 24 Nov 2015]. The government continues to make every effort to monitor and investigate the increasing number of cases of microcephaly in the country as a priority.

    Pernambuco state remains with the highest number of cases (487); it was the first to identify an increase of microcephaly in its area and has had the collaboration of a Ministry of Health team since [22 Oct 2015]. Next are the states of Paraiba (96), Sergipe (54), Rio Grande do Norte (47), Piaui (27), Alagoas (10), Ceara (9), Bahia (8) and Goias (1). Among the total cases, a suspicious death was reported in the state of Rio Grande do North. This case is under investigation to determine the cause of death.

    Case investigations are being done by the Ministry of Health, integrated with the state and municipal secretariats, and with the help of national and international institutions. Committees of specialists are supported by the Ministry of Health in epidemiological and laboratory analysis, as well as case monitoring.

    Since the cases appeared, the Ministry of Health sent to the state secretariats orientation for the process of notification, surveillance, and assistance for pregnant women and their babies affected with microcephaly. This information is constantly updated.

    It is not yet possible to ascertain the cause of the increase in cases of microcephaly that has been recorded in 9 states. All hypotheses are being thoroughly analyzed by the Ministry of Health and any conclusion at this point is premature. Analyses were not completed and, therefore, are still ongoing.

    The Flavivirus Laboratory of the Instituto Oswaldo Cruz (Fiocruz) in Rio de Janeiro participates in the investigations and concluded on [17 Nov 2015] a diagnostic test established the presence of the Zika virus genome in samples from 2 pregnant women from Paraiba, whose fetuses had microcephaly confirmed by ultrasound examination. The genetic material (RNA) of the virus was detected in samples from amniotic fluid, using real-time RT-PCR.

    Despite being an important scientific finding for understanding of Zika virus infection in humans, the current data do not allow one to correlate unequivocally, infection by Zika virus as a causal factor of microcephaly. Such an explanation will be made by studies coordinated by the Ministry and other institutions involved in research into the causes of microcephaly in the country.

    For managers and health professionals, the Ministry of Health directs that all cases of microcephaly be communicated immediately, electronically. Also, that prevention efforts be strengthened and that vector control in urban and peri-urban areas, conform to the Guidelines of the National Dengue Control Program.

    It is important that pregnant women maintain monitoring and prenatal medical consultations, with the completion of all tests recommended by their doctors. The Ministry of Health reinforces the guidance to not consume alcohol or any other type of drugs, not use drugs without medical prescription, and avoid contact with people with fever or infections.

    It is important, also, that pregnant women adopt measures to reduce the presence of mosquitoes that transmit pathogens, by the elimination of breeding sites and to protect themselves from exposure to mosquitoes, such as keeping doors and windows closed or screened, wear long pants and long-sleeved shirts, and use [mosquito] repellants that are approved for use by pregnant women.

    Microcephaly is not a new problem. It is a congenital malformation in which the brain does not develop properly. In the current situation, the investigation of the cause has the health authorities worried. In this case, babies are born with head circumference (PC) lower than normal, which is usually greater than 33 cm [13 in]. This defect can be a congenital effect of a number of factors from different sources, such as chemicals, biological (infectious) agents such as bacteria, viruses, and radiation.

    Cases of microcephaly under investigation [state / number of cases]:

    Pernambuco / 487

    Paraiba / 96

    Sergipe / 54

    Rio Grande do Norte / 47

    Piaui / 27

    Alagoas / 10

    Ceara / 9

    Bahia / 8

    Goias / 1Communicated by:




    [Concerning the data, now updated, of microcephaly in Brazil: indeed, there was a significant increase in the number of cases — 399 cases up to 17 Nov 2015 to 739 on 24 Nov 2015. There is still little information available or reported on the results of clinical, epidemiological, and laboratory investigations conducted to date.

    Reportedly, albeit in general terms, the most common causes of congenital infections are toxoplasmosis, cytomegalovirus, as well as environmental causes, etc., that apparently already have been (or are being) investigated. Early on, there are no findings or conclusive results.

    The identification of the Zika virus genome in the amniotic fluid of 2 pregnant women who showed clinical signs compatible with those expected/described for symptomatic infection with Zika virus, and whose fetuses showed signs of microcephaly in prenatal exams, points to the ability of the virus to cross the placental barrier. That is, one of the conditions for fetal infection to occur has been demonstrated. However, although it is a quite significant finding, it is subject to corroboration for the possible elucidation of the (or a few) cases of microcephaly in the northeast region; the results are still not definitive, that is, a causal relationship has not yet been (and cannot) be definitively proven.

    What now? There is a temporal association between increased incidence of microcephaly and the length and geographic distribution of transmission (and the exposure of pregnant women) to Zika [virus] in the northeast states. A large proportion of mothers whose newborns now have microcephaly at birth, mentioned a clinical presentation during pregnancy that would be compatible with infection (symptomatic) caused by Zika [virus]. Identification of the genome of Zika [virus in] amniotic fluid indicates that the virus is capable of crossing the placental barrier. In short, evidence adds up to, but does not establish for now, a causal relationship.

    The surveillance system is on alert. Clinical and epidemiological investigations must (or should) be conducted. The research protocol proposed by the Ministry of Health (see <http://portalsaude.saude.gov.br/images/pdf/2015/novembro/18/microcefalia-nota-informativa-17nov2015-c.pdf>;

    in Portuguese) contribute to standardization and uniformity of definition of criteria and prospective investigation of upcoming cases. But until final and conclusive results are obtained, all caution should be taken in order to prevent alarmism, panic, or extreme measures.

    ProMED-PORT takes the opportunity to thank Dr Ricardo Albernaz <ricmanga@gmail.com> for his submitted comments that are in line with comments previously stated in the current and previous post, and that point to “the self-evident severity of the event,” to the fact that the data available [still] do not prove a causal relationship between microcephaly and Zika [virus infections], to the lack of “detailed information on the cases, and to the need for appropriate strategies for research and health risk communication from the public agencies. – Mod.RNA

    Establishing a causal relationship between Zika virus infections during gestation and microcephaly will not be easy. If there is retrospective study to determine what proportion of the mothers of microcephalic infants have antibodies to Zika virus, ProMED-mail would be interested in the results.

    Prospective studies, as mentioned above, have a greater possibility of establishing the Zika virus-microcephaly link. If Zika virus continues to spread in in Brazil, there may be a sufficiently large pool of cases for a significant study. Now that there is a Zika virus outbreak going on in Colombia, it would be prudent for physicians there to watch for an increase in microcephaly cases in infected pregnant women. Ideally, there should be close communication and collaboration between the public health authorities in both countries to employ standardized approaches to obtain comparable results.


    Hillsborough County has reported their first human case of West Nile virus illness in 2015.  The case onset 9/17/15.

    The case was confirmed at the state laboratory and had no travel outside the county during the two weeks prior to onset. Mosquito Control was advised when the County Health Department was notified. Hillsborough County is already under a mosquito-borne illness advisory due to WNV activity in their sentinel chicken flocks.



    Escambia County has reported their third human case of West Nile virus illness in 2015. (9/30/2015)

    The case was confirmed at the state laboratory and Mosquito Control was advised when the County Health Department was notified. Escambia County is already under a mosquito-borne illness alert due to the two previous WNV illness cases.



    Mosquito Borne Illness Alert Continues After West Nile Cases Confirmed

    August 30, 2015

    A mosquito-borne illness alert for Escambia County continues after at least two West Nile virus cases were conformed in the county.

    The second case of West Nile was recently confirmed in an adult male. This makes the sixth human case in Florida in 2015.


    Pinellas Issues West Nile Virus Advisory

    So far this year 19 sentinel chickens have tested positive for the potentially fatal disease.

    By Sherri Lonon (Patch Staff)

     August 21, 2015

    With 19 sentinel chickens testing positive for West Nile virus in recent weeks, Pinellas County health officials are asking residents to take precautions to avoid bites. The health department issued an advisory Friday warning residents about the dangers of this mosquito-borne illness.

    “This advisory is being issued due to 19 positive tests for West Nile Virus in sentinel chickens from Pinellas County Mosquito Control coops,” the department explained in an email. “As a result, the risk of transmission to humans in the county has increased.”

    With that in mind, the health department is asking residents to take precautions to avoid bites.

    Mara Burger, press secretary for the Florida Department of Health, told Patch there have been five confirmed cases of West Nile in Florida this year. Two were reported in Walton County, two in Escambia and one in Volusia. There have been no reported human cases in Pinellas or the Bay area so far.

    “It is important for people to remember to drain standing water, cover their skin and wear insect repellent, as well as cover doors and windows with screens to prevent being bitten by mosquitoes,” Burger said.

    West Nile virus produces no symptoms in about 70 to 80 percent of people infected, according to the U.S. Centers for Disease Control and Prevention. Some people, however, can develop such symptoms fever, rash, headache, body aches, joint pains, vomiting and diarrhea. In less than 1 percent of those infected severe symptoms may develop. The infection may lead to encephalitis or meningitis, which is an inflammation of the brain or surrounding tissue, the CDC says. Of those who develop severe complications about 10 percent die.

    Residents can do their part to control the mosquito population by eliminating ideal breeding locations from their yards. Mosquitoes can breed in as little as a quarter inch of standing water, the county noted. It is asking residents to heed these precautions:

    • Empty water from old tires, flower pots, garbage can lids, recycling containers, boat tarps and buckets
    • Eliminate standing water near plumbing drains, air conditioner drips, septic tanks or rain gutters
    • Flush birdbaths and wading pools weekly
    • Flush bromeliads twice weekly or treat with a biological larvicide
    • Change the water in outdoor pet dishes daily
    • Keep pools adequately chlorinated
    • Stock ornamental ponds with mosquito-eating gambusia fish
    • Cover rain barrels with fine mesh screening
    • Repair rips or tears in door and window screens


    Officials: 41 cases of West Nile Virus in Valley

    By:  abc15.com staff

    Posted: 12:21 PM, Aug 20, 2015

    Updated: 4:38 AM, Aug 21, 2015

    PHOENIX – Officials are investigating after there have been two mosquito-borne outbreaks in Maricopa County.

    The Maricopa County Department of Public Health and Arizona Department of Health Services are reminding the community to do its part in preventing the spread of mosquitoes after the West Nile Virus and St. Louis Encephalitis arrived in the county.

    According to officials, there have been 41 cases of West Nile and 10 cases of St. Louis Encephalitis in Maricopa County in 2015.

    Officials said two people have died from West Nile Virus in Maricopa County in 2015. One death in Maricopa County from St. Louis Encephalitis is awaiting CDC confirmation.

    Maricopa County said there are usually about 20 cases of St. Louis Encephalitis nationwide.

    West Nile and St. Louis Encephalitis have similar symptoms. Those that develop symptoms usually report fever, headache, body aches and muscle weakness.



    4 deaths in Arizona prompt mosquito concerns  – August 21, 2015

    Public health officials say three people in Arizona have died from West Nile virus and a fourth death is suspected from a similar disease called St. Louis encephalitis, prompting public health officials to coordinate a probe of the dual outbreaks of mosquito-borne diseases.

    Public health officials have never reported outbreaks of both mosquito-borne diseases in the same community at the same time, said  Dr. Rebecca Sunenshine, medical director of the disease control division at Maricopa County Department of Public Health.

    That is why state and local health officials have invited investigators from the United States Centers for Disease Control and Prevention to Arizona to probe the dual outbreaks.

    There are usually 20 cases of St. Louis encephalitis each year in the U.S., but public health officials this year have confirmed 10 cases in Maricopa County and two cases in other Arizona counties. There are 46 cases of West Nile virus statewide, and all but five of those cases were in Maricopa County.

    One person who died in Maricopa County tested positive for St. Louis encephalitis, but officials are awaiting for the Arizona state laboratory’s preliminary test to be confirmed by the CDC. There have been three confirmed deaths from West Nile virus — two in Maricopa County and one in Pima County.

    West Nile virus and St. Louis encephalitis are both transmitted through the bite of infected mosquitoes. About 80 percent of people who are bit by an infected mosquito show no symptoms.

    Those who do develop symptoms usually report fever, headache, body aches and muscle weakness. In less than 1 percent of infections, both diseases can cause severe illness involving the brain and nervous system. These people, typically over 50 years old, experience severe headache, neck stiffness and/or encephalitis or inflammation of brain, which can lead to paralysis or death.

    Sunenshine said outbreaks of St. Louis encephalitis are rare. There were only four cases in Arizona from 2004 through 2013, according to the CDC.

    “We do know the disease is carried by the same mosquito that carries West Nile virus,” Sunenshine said. “Every decade or longer, there is an outbreak, usually in an urban area. It appear that outbreak is here.”

    Maricopa County and Arizona public health officials urge everyone to take precautions to avoid mosquitoes. People who encounter mosquitoes outdoors should wear clothes that cover arms and legs and use an insect repellent.

    Sunenshine said it’s also important for people to eliminate mosquito-breeding sites around the home by removing water in potted plants, tires, birdbaths and other containers where water may collect.

    Public health officials are urging doctors and other health-care providers to be aware of both mosquito-borne diseases, particularly for hospital patients with a high fever,  according to Dr. Cara Christ, director of the Arizona Department of Health Services.

    Christ said health professionals who suspect St. Louis encephalitis should contact a local health department for testing procedures.

    There are no commercial tests for St. Louis encephalitis, and tests by public health laboratories aren’t always clear or accurate. The CDC is assisting the Arizona state laboratory to process samples for both St. Louis encephalitis and West Nile virus.



    State of Florida Department of Health, Weekly Arbovirus Report





    To view earlier reports go to Disease Surveillance.


    Chikungunya cases rise by more than 8,000

     As of July 31, 2015:

    The Pan American Health Organization (PAHO) on Jul 31 reported 8,636 new cases of chikungunya in the Caribbean and Americas, bringing the outbreak total to 1,622,954.

    The new total includes 470,546 suspected and 14,706 confirmed locally acquired cases and 755 imported cases reported in 2015.

    Colombia, which has reported thousands of cases per week for the past several months, reported the largest increase with 6,452 new cases, bringing its outbreak total this year to 308,522.

    Brazil reported 1,299 new cases for a 2015 outbreak total of 8,378. Ecuador, which reported a substantial 5-week increase last week, experienced a case increase of 503, bringing its outbreak total to 30,548.

    No new fatalities were reported, and the 2015 outbreak death total stands at 61.

    The epidemic began in December 2013 with the first locally acquired chikungunya case ever reported in the Americas, on St. Martin in the Caribbean.

    July 31 PAHO update


    As of July 21, a total of 237 chikungunya virus disease cases have been reported to ArboNET from 34 U.S. states.  All reported cases occurred in travelers returning from affected areas. No locally-transmitted cases have been reported from U.S. states. For the full report: 2015-07-21 Chikungunya update.

    As of July 21st, 205 counties from 33 states have reported West Nile Virus (WNV) activity to ArboNET for 2015, including 16 states with reported WNV human infections (i.e., disease cases or viremic blood donors) and 17 additional states with reported WNV activity in non-human species only (i.e., veterinary cases, mosquito pools, dead birds, or sentinel animals). For the full report: 2015_07_21 Arboviral activity update .


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