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MC Zika map update https://www.google.com/maps/d/u/0/edit?mid=1RcVTrkYW6hax_iITjKUkEcBCVeI

Eurosurveillance, Volume 21, Issue 24, 16 June 2016Rapid communication CONFIRMED CASE OF ZIKA VIRUS CONGENITAL INFECTION, SPAIN, MARCH 2016 S Perez 1 , R Tato 2 , JJ Cabrera 1 , A Lopez 3 , O Robles 4 , E Paz 3 , A Coira 5 , MP Sanchez-Seco 6 , A Vazquez 6 , R Carballo 1 , C Quintas 7 , A Pousa 8+ Author affiliations 1. Microbiology Department, University Hospital of Vigo, Spain 2. Microbiology Department, University Hospital of Pontevedra, Spain 3. Gynecology Department, Lucus Augusti Hospital, Lugo, Spain 4. Pathology Department, Lucus Augusti Hospital, Lugo, Spain 5. Microbiology Department, Lucus Augusti Hospital, Lugo, Spain 6. Arbovirus and Imported Viral Diseases, Virology Area, National Center of Microbiology (CNM), Carlos III Health Institute (ISCIII), Majadahonda, Madrid, Spain 7. Preventive Medicine Department, Lucus Augusti Hospital, Lugo, Spain 8. General Subdirection for Epidemiology and Information Systems, General Direction of Public Health, Consellería de Sanidade, Santiago de Compostela, Spain Correspondence: Sonia Perez ([email protected]) Citation style for this article: Perez S, Tato R, Cabrera JJ, Lopez A, Robles O, Paz E, Coira A, Sanchez-Seco MP, Vazquez A, Carballo R, Quintas C, Pousa A. Confirmed case of Zika virus congenital infection, Spain, March 2016. Euro Surveill. 2016;21(24):pii=30261. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.24.30261 Received:07 June 2016; Accepted:16 June 2016 We describe Zika virus (ZIKV) vertical transmission in an imported case in Spain, in a 17-week pregnant woman. ZIKV IgG, IgM and RNA were detected in serum in week 17. At 19 weeks, ultrasound scan revealed fetal malformations and ZIKV was detected in the amniotic fluid. Pregnancy was terminated at week 21; autopsy of the fetus revealed bilateral hydrocephalus, brain microcalcifications and arthrogryposis multiplex congenita. ZIKV was detected in the umbilical cord and brain tissue. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22506

A woman aborts in Galicia after detecting lesions in the fetus because of the Zika virusThis is the first case of congenital zika in Galicia - Sanidade emphasizes that the virus was infected pregnant in a country of Latin AmericaWriting / Agencies | Corunna / Santiago / Madrid 06/17/2016 | 2:41 The Ministry of health reported yesterday that Galicia has registered the first case of congenital infection Zika virus. Doctors detected abnormalities in the fetus of a pregnant during week 19 of gestation and women decidión terminate pregnancy in week 21. This is, says the department of Jesus Vazquez Almuíña of an imported case since the woman contracted the virus in a Latin American country in which he lived.http://www.laopinioncoruna.es/sociedad/2016/06/17/mujer-aborta-galicia-detectar-lesiones/1080376.html

Zika complications seen in 6 US pregnancies so farFiled Under: ZikaLisa Schnirring | News Editor | CIDRAP News | Jun 16, 2016Share Tweet LinkedIn Email Print & PDFultrasound_on_belly.jpgsplendens / iStockStepping up the level of detail in its reporting on Zika infections in pregnant women, the US Centers for Disease Control and Prevention (CDC) today started announcing poor birth outcomes from US states, noting six instances of birth defects—three involving live births. In a related development, a Spanish team today reported the details of a congenital Zika infection in the fetus of a woman who had been infected with the virus in Venezuela. Three live births among 6 poor outcomesThe CDC has been gradually ramping up the information it shares on Zika infections in pregnant women. On May 20 it announced a change in the way it reports the number of Zika infections in pregnant women to include those with lab-confirmed asymptomatic illnesses, which it said provides a more complete picture of the impact of the disease on pregnant women. At the time, CDC officials said they held off on reporting birth defect numbers because of incomplete details and privacy concerns. The numbers it released today, based on information as of Jun 9, are from one of the CDC's two Zika pregnancy registries: the one that pertains to women in US states and the District of Colombia, which reflects travel-related cases. The CDC added that in the coming weeks it will report poor pregnancy outcomes from the second registry, the one that tracks Zika infections in US territories. So far three US infants have been born live with Zika related birth defects, a group of conditions that include microcephaly, other brain abnormalities, eye problems, and a host of nerve, muscle, and joint issues. Three women infected with Zika virus have had pregnancy losses—miscarriages, stillbirths, and abortions—with birth defects. The cases are from 234 US women who have had any lab evidence of possible Zika virus infection as of Jun 9. During the same timeframe, 189 infections in pregnant women have been reported from the US territories, according to a CDC update yesterday. Officials declined to break down the poor pregnancy outcomes by state due to privacy issues, but some details about some cases are already known, such as severe microcephaly in a baby born to a Hawaiian woman who had spent time in Brazil and a baby born recently to a Honduran woman in a New Jersey hospital. In February, the CDC published a report on a range of outcomes in nine pregnant travelers from the United States who had lab-confirmed Zika infections. Two women had miscarried in their first trimester, two women had abortions, two pregnancies were continuing without any known complications, and, of three live births, only one had microcephaly—presumably the baby born in Hawaii. In today's case update, the CDC included a caveat: Though the poor outcomes occurred alongside lab evidence of Zika infection, it's not known whether the defects were caused by Zika virus or other factors. Congenital Zika case in SpainThe report on the Zika-related congenital malformations detected in Spain was published today in the latest edition of Eurosurveillance. The authors said the problems were found when the woman in her 20s visiting from Venezuela was admitted to a hospital in March for routine follow-up when she was 17 weeks pregnant. The patients said she had experienced a rash in January, and an ultrasound at 12 weeks gestation was normal. Exploring the possibility of Zika virus infection, Spanish clinicians confirmed recent Zika virus infection on serology and molecular tests. Ultrasound done at 19 weeks showed fetal hydrocephalus and extensive muscle and joint problems. Tests on amniotic fluid detected Zika RNA, but ruled out other infections. Due to severe malformations and brain problems in the fetus, the woman had an abortion at 21 weeks gestation. Autopsy confirmed the musculoskeletal defects and hydrocephalus but ruled out microcephaly. Tests confirmed Zika virus in samples from the umbilical cord and brain tissue, but not the placenta. Other developmentsIn its weekly Zika situation report today, the World Health Organization (WHO) said one more country—El Salvador—has reported a Zika-linked microcephaly case, raising the number reporting such birth defects to 12. The WHO said it still doesn't see an overall decline in the outbreak, though cases have dropped in some countries or parts of countries. So far its risk assessment hasn't changed. In an update today. the CDC reported more local Zika infections in US territories and more travel-related cases in US states. Affected territories reported 135 more illnesses last week, raising the total number of local cases to 1,436. One fewer related Guillain-Barre syndrome (GBS) was reported in the territories, dropping that number to 6. In US states, 64 more travel-related Zika cases were reported, along with the recent lab-acquired case in Pennsylvania, putting the overall total at 756. The number of sexually transmitted Zika cases remained the same, at 11, and 1 more GBS cases was reported in US states, lifting that total to 3.See also: Jun 16 CDC media statement CDC Zika pregnancy outcome page CDC Zika pregnancy cases page May 20 CIDRAP News story "Reporting change, rising cases vault US Zika pregnancy cases to 279" Jun 16 Eurosurveill report http://www.cidrap.umn.edu/news-perspective/2016/06/zika-complications-seen-6-us-pregnancies-so-far

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DiscussionLocal mosquito transmission of ZIKV infection was reported in Venezuela in November 2015 [4]. In January 2016, a total of 252 cases of Guillain-Barré syndrome with a spatiotemporal association to Zika virus were reported. Zika virus infection was confirmed in three of them [5]. Phylogenetic analysis based on the conserved region NS5 has revealed the existence of two major lineages: the African lineage that includes the African strains and the Asian lineage which has recently emerged in the Pacific and the Americas including the Asian and American strains [6]. In this case, phylogenetic analysis showed that ZIKV strain isolated from this patient belonged to the Asian lineage. The illness caused by ZIKV, commonly named Zika virus disease (ZVD), usually has a benign cause and presents with signs and symptoms similar to other arbovirus infections such as dengue virus (DENV) and chikungunya virus (CHKV): mild fever, exanthema, arthralgia and/or non-purulent conjunctivitis. Recently, ZIKV infection has been associated with neurological complications, such as Guillain–Barré syndrome, but encephalitis or meningitis have also been reported [7]. The patient reported generalised skin rash compatible with ZIKV infection during her stay in Venezuela. ZIKV is transmitted through mosquito bites of the genus Aedes, mainly Aedes aegypti, which is the most important vector in Asia and the Americas and in some regions in the Pacific. Other possible modes for human infection include sexual transmission and blood transfusion, and vertical transmission from mother to fetus can have serious consequences. If a pregnant woman acquires a ZIKV infection, the virus might cross placental barrier causing congenital infection. In this case, ZIKV RNA was detected in amniotic fluid, confirming that ZIKV crossed the placental barrier. When this happens, the fetus might develop brain damage including microcephaly and, less frequently, calcifications, ventriculomegaly or hydrocephalus, and other congenital malformations such as arthrogryposis [8]. Viraemia of ZIKV infection is relatively short, and viral RNA is usually detected in serum samples only around seven days after onset of symptoms. It is remarkable that in this case, ZIKV RNA was detected in the serum of the pregnant woman up to two months after the acute phase of the disease. Persistent viraemia was previously described in another case of congenital Zika transmission and it might be a consequence of high viral replication in the fetus [9]. The recent outbreaks in Brazil and French Polynesia indicate that the greatest risk of brain damage for the fetus is in the first trimester, often between seven and 13 weeks of gestation [10,11]. A preliminary report from Brazil indicated that fetal abnormalities were present in almost 30% of women with ZIKV infection during pregnancy [12]. In the case presented here, microcephaly was not present in the ultrasound scan at 19 weeks of gestation, probably due to the short gestational age, and this is in agreement with other reported cases in which microcephaly was not diagnosed until 27 to 35 weeks [12]. However, other malformations, such as hydrocephalus and arthrogryposis, were detected in this case. Presence of ZIKV RNA was detected in the umbilical cord and brain tissue but not in placenta as recently reported in another congenital case [13]. Another study showed that ZIKV is unlikely to access the fetal compartment by its direct replication in placental tissue. This might be explained due to the potent antiviral properties of type III interferons (IFNs), specifically IFNλ1, which protects the human placental trophoblasts from viral infections, suggesting that ZIKV may invade the intrauterine cavity by unknown mechanisms that are independent of direct placental infection [14]. In this case, comparison of the Ct values between umbilical cord and brain tissue indicates a higher viral load (ca 10,000 times higher) in the central nervous system (CNS), showing a strong neurotropism of the virus, although the mechanism is not clear. A possible persistence of ZIKV in the fetal brain because of the immunologically secure milieu for the virus was suggested [15]. Additionally, recent studies found that neural progenitor cells are more susceptible to ZIKV infection than mature cortical neurons, explaining microcephaly and other abnormalities in the developing brain [16-18]. In the Zika situation report of the World Health Organization (WHO) on 6 June 2016 [19], only eleven countries or territories have reported microcephaly and/or CNS malformation cases potentially associated with ZIKV infection. The total number of cases reached 1,520, and most of them are related to the recent outbreak in Brazil. In Spain, the Ministry of Health reported 141 cases of confirmed ZIKV infection on 6 June 2016, all of them imported from areas with active transmission [20]. Nineteen cases were pregnant women, but no evidence of intrauterine transmission was detected, except in this case. The first case of imported ZIKV infection and two cases of ZIKV infection in pregnant women in Spain, have been published recently [21,22]. Aside from this case, there has been only one other confirmed ZIKV congenital infection in Europe [15]. This case highlights the new challenge gynaecologists face when performing ultrasound in pregnant women originating from or having stayed in countries with risk of transmission of Zika. Nowadays, there is a considerable number of pregnant women who travel from South America; moreover, other pregnant women or their sexual partners may travel to affected areas. This may have an impact on prenatal care in Europe. Positive and negative predictive values of screening for Zika virus in amniotic fluid or maternal serum have not yet been established. Accurate and quick detection of the presence of Zika virus in maternal samples in collaboration with expert gynaecologists follow-up might help the early diagnosis of congenital Zika infections. It is important to carefully communicate risks associated with ZVD to those possibly concerned, and to improve the evidence base to perform well-informed risk assessments. AcknowledgementsAuthors are very grateful to the patient for providing informed consent for publication. Authors also thank Alonso P from the Microbiology Department of Lucus Augusti Hospital of Lugo, Spain, Ory F and all the staff from the ‘Arbovirus and Imported Viral Diseases’ laboratory of the National Center of Microbiology - Carlos III Health Institute, Majadahonda, Madrid, Spain. Authors specially thank the staff from the Microbiology Department of University Hospital of Vigo, Spain.

BackgroundZIKV is an arbovirus (arthropod-borne virus) of the genus Flavivirus. It was isolated for the first time in 1947 from the blood of a Rhesus monkey in the Zika forest (Uganda), but the infection was relatively unknown until the recent outbreak in South America. Prior to 2015, minor ZIKV outbreaks were reported in areas of Africa, south-east Asia and the Pacific Islands [2]. In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed ZIKV infections in Brazil [3], which quickly spread all over the South America continent.

Case descriptionA pregnant woman in her mid-twenties (week 17 of pregnancy), from Venezuela, was admitted to the Gynaecology Department of a hospital in Spain, for routine follow up, in March 2016, while she was visiting Spain. Her medical history was uneventful apart from a generalised skin rash in January 2016, at eight weeks of gestational age. This led us to investigate a ZIKV infection, given the epidemiological situation in Venezuela. The rash had lasted for 48 hours but there was no microbiological diagnosis. At 12 weeks of gestational age, the ultrasound scan was normal, and the results of laboratory tests for HIV, Treponema pallidum and Toxoplasma gondii were negative. Serum samples were collected upon hospital admission in March and recent ZIKV infection was diagnosed by serology and molecular biology. ZIKV IgG and IgM antibodies were detected by indirect immune fluorescence test (Euroimmun Arboviral Fever Mosaic 2, Luebeck, Germany). ZIKV IgG antibodies were confirmed by plaque reduction neutralization test (PRNT). NS2A protein gen of ZIKV was detected (2.4 x104 copies/mL) by real-time quantitative RT-PCR using Light Mix Modular ZikaVirus (Tib Molbiol, Berlin, Germany) and Light Cycler Multiplex RNA Virus Master (Roche Diagnostics, Mannheim, Germany) in a Cobas Z 480 analyser (Roche Diagnostics, Indianapolis, United States). Extraction of nucleic acids was performed with the MagNA Pure Compact Nucleic Acid Isolation Kit I (Roche Diagnostics, Indianapolis, United States). Ultrasound scan at 19 weeks of gestational age showed fetal hydrocephalus with dilation of both lateral ventricles (Figure 1), and stiffness and severe contractures of the four extremities compatible with arthrogryposis multiplex congenita (AMC) (Figure 2). Figure 1Ultrasound scan on fetal skull showing bilateral hydrocephalus, case of vertical transmission of Zika virus infection, gestation week 19, imported to Spain, March 2016 Ventricular measurements 14.3 mm (yellow) and 10.7 mm (blue) (norm: ≤10 mm) Figure 2Ultrasound scan on fetal extremities, case of vertical transmission of Zika virus infection, gestation week 19, imported to Spain, March 2016 The arrow indicates severe contracture and deformation with extreme bending and twisting of the wrist. Amniotic fluid was obtained by amniocentesis. Chromosomal abnormalities were discarded by array comparative genomic hybridisation and karyotype analysis. ZIKV RNA was detected in amniotic fluid (9.1 x104 copies/mL) by real-time quantitative RT-PCR. Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus, erythrovirus B19 and measles virus infections were discarded by PCR in amniotic fluid. Due to severe malformations and brain disease, the neonatal health prognosis was poor. The patient asked for voluntary termination of the pregnancy, and the procedure was approved by national and hospital ethics committees. Medical termination of the pregnancy was performed at 21 weeks of gestation. Autopsy of the female fetus (295 g) showed no microcephaly (cranial, thoracic and abdominal circumference were 17 cm, 16 cm and 14 cm respectively, normal for sex and gestational age) but confirmed AMC with flexion contracture and deformity of joints of all four limbs, extreme flexion of hips and crossed femurs. Under-developed muscles with replacement of muscle by adipose tissue and fibrous proliferation in interarticularis spaces were also found. In addition, fetal hydrocephalus with dilation of both lateral ventricles, cerebral cortex 2.5 mm thick and multiple calcifications at cortical level and brainstem were diagnosed (Figure 3). Figure 3Microphotography of the entire cerebral cortex thickness with abundant microcalcifications, case of vertical transmission of Zika virus infection, gestation week 21, imported to Spain, April 2016 Arrows indicate microcalcifications. ZIKV real-time quantitative RT-PCR was performed in placenta, umbilical cord and brain tissue samples, as previously described. Before nucleic acid extraction, ca 10 mg of tissue were treated with 50 µL of proteinase K at 56 °C until sample digestion, and then heated at 95 °C for 10 min to inactivate proteinase K. ZIKV RNA was detected in umbilical cord (threshold cycle, Ct: 36.7) and brain tissue (Ct: 22.1), but it was not detected in the placenta sample. For phylogenetic analysis, amplification of NS5 gene (192 bp) was performed from amniotic fluid sample as previously described [1] with Mega 7 Software and it was deposited in GenBank (accession number: KX358623). The sequence clustered within the Asian lineage.

We describe Zika virus (ZIKV) vertical transmission in an imported case in Spain, in a 17-week pregnant woman. ZIKV IgG, IgM and RNA were detected in serum in week 17. At 19 weeks, ultrasound scan revealed fetal malformations and ZIKV was detected in the amniotic fluid. Pregnancy was terminated at week 21; autopsy of the fetus revealed bilateral hydrocephalus, brain microcalcifications and arthrogryposis multiplex congenita. ZIKV was detected in the umbilical cord and brain tissue.

S Perez 1 , R Tato 2 , JJ Cabrera 1 , A Lopez 3 , O Robles 4 , E Paz 3 , A Coira 5 , MP Sanchez-Seco 6 , A Vazquez 6 , R Carballo 1 , C Quintas 7 , A Pousa 8+ Author affiliations 1. Microbiology Department, University Hospital of Vigo, Spain 2. Microbiology Department, University Hospital of Pontevedra, Spain 3. Gynecology Department, Lucus Augusti Hospital, Lugo, Spain 4. Pathology Department, Lucus Augusti Hospital, Lugo, Spain 5. Microbiology Department, Lucus Augusti Hospital, Lugo, Spain 6. Arbovirus and Imported Viral Diseases, Virology Area, National Center of Microbiology (CNM), Carlos III Health Institute (ISCIII), Majadahonda, Madrid, Spain 7. Preventive Medicine Department, Lucus Augusti Hospital, Lugo, Spain 8. General Subdirection for Epidemiology and Information Systems, General Direction of Public Health, Consellería de Sanidade, Santiago de Compostela, Spain Correspondence: Sonia Perez ([email protected]) Authors’ contributionsWrote the manuscript: SP, RT, AL, OR; performed laboratory investigations: SP, RT, JJC, OR, AC, MPSS, AV, RC; revised the manuscript: JJC, EP, AC, MPSS, AP, AV, RC, CQ; managed the patient: AL, OR, EP, AP, CQ. Citation style for this article: Perez S, Tato R, Cabrera JJ, Lopez A, Robles O, Paz E, Coira A, Sanchez-Seco MP, Vazquez A, Carballo R, Quintas C, Pousa A. Confirmed case of Zika virus congenital infection, Spain, March 2016. Euro Surveill. 2016;21(24):pii=30261. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.24.30261 Received:07 June 2016; Accepted:16 June 2016

Eurosurveillance, Volume 21, Issue 24, 16 June 2016Rapid communication CONFIRMED CASE OF ZIKA VIRUS CONGENITAL INFECTION, SPAIN, MARCH 2016 http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22506

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22506 Eurosurveillance, Volume 21, Issue 24, 16 June 2016Rapid communication CONFIRMED CASE OF ZIKA VIRUS CONGENITAL INFECTION, SPAIN, MARCH 2016 S Perez 1 , R Tato 2 , JJ Cabrera 1 , A Lopez 3 , O Robles 4 , E Paz 3 , A Coira 5 , MP Sanchez-Seco 6 , A Vazquez 6 , R Carballo 1 , C Quintas 7 , A Pousa 8+ Author affiliations 1. Microbiology Department, University Hospital of Vigo, Spain 2. Microbiology Department, University Hospital of Pontevedra, Spain 3. Gynecology Department, Lucus Augusti Hospital, Lugo, Spain 4. Pathology Department, Lucus Augusti Hospital, Lugo, Spain 5. Microbiology Department, Lucus Augusti Hospital, Lugo, Spain 6. Arbovirus and Imported Viral Diseases, Virology Area, National Center of Microbiology (CNM), Carlos III Health Institute (ISCIII), Majadahonda, Madrid, Spain 7. Preventive Medicine Department, Lucus Augusti Hospital, Lugo, Spain 8. General Subdirection for Epidemiology and Information Systems, General Direction of Public Health, Consellería de Sanidade, Santiago de Compostela, Spain Correspondence: Sonia Perez ([email protected]) Citation style for this article: Perez S, Tato R, Cabrera JJ, Lopez A, Robles O, Paz E, Coira A, Sanchez-Seco MP, Vazquez A, Carballo R, Quintas C, Pousa A. Confirmed case of Zika virus congenital infection, Spain, March 2016. Euro Surveill. 2016;21(24):pii=30261. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.24.30261 Received:07 June 2016; Accepted:16 June 2016 We describe Zika virus (ZIKV) vertical transmission in an imported case in Spain, in a 17-week pregnant woman. ZIKV IgG, IgM and RNA were detected in serum in week 17. At 19 weeks, ultrasound scan revealed fetal malformations and ZIKV was detected in the amniotic fluid. Pregnancy was terminated at week 21; autopsy of the fetus revealed bilateral hydrocephalus, brain microcalcifications and arthrogryposis multiplex congenita. ZIKV was detected in the umbilical cord and brain tissue.

Eurosurveillance, Volume 21, Issue 24, 16 June 2016Rapid communication CONFIRMED CASE OF ZIKA VIRUS CONGENITAL INFECTION, SPAIN, MARCH 2016 S Perez 1 , R Tato 2 , JJ Cabrera 1 , A Lopez 3 , O Robles 4 , E Paz 3 , A Coira 5 , MP Sanchez-Seco 6 , A Vazquez 6 , R Carballo 1 , C Quintas 7 , A Pousa 8+ Author affiliations 1. Microbiology Department, University Hospital of Vigo, Spain 2. Microbiology Department, University Hospital of Pontevedra, Spain 3. Gynecology Department, Lucus Augusti Hospital, Lugo, Spain 4. Pathology Department, Lucus Augusti Hospital, Lugo, Spain 5. Microbiology Department, Lucus Augusti Hospital, Lugo, Spain 6. Arbovirus and Imported Viral Diseases, Virology Area, National Center of Microbiology (CNM), Carlos III Health Institute (ISCIII), Majadahonda, Madrid, Spain 7. Preventive Medicine Department, Lucus Augusti Hospital, Lugo, Spain 8. General Subdirection for Epidemiology and Information Systems, General Direction of Public Health, Consellería de Sanidade, Santiago de Compostela, Spain Correspondence: Sonia Perez ([email protected]) http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22506 Citation style for this article: Perez S, Tato R, Cabrera JJ, Lopez A, Robles O, Paz E, Coira A, Sanchez-Seco MP, Vazquez A, Carballo R, Quintas C, Pousa A. Confirmed case of Zika virus congenital infection, Spain, March 2016. Euro Surveill. 2016;21(24):pii=30261. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.24.30261 Received:07 June 2016; Accepted:16 June 2016 We describe Zika virus (ZIKV) vertical transmission in an imported case in Spain, in a 17-week pregnant woman. ZIKV IgG, IgM and RNA were detected in serum in week 17. At 19 weeks, ultrasound scan revealed fetal malformations and ZIKV was detected in the amniotic fluid. Pregnancy was terminated at week 21; autopsy of the fetus revealed bilateral hydrocephalus, brain microcalcifications and arthrogryposis multiplex congenita. ZIKV was detected in the umbilical cord and brain tissue.

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Two more cases of Zika virus in Washington. That brings the total eight in the state. Marla Evans of SeaTac tested positive. She visited Haiti with her 17-year-old daughter Olivia, who also caught Zika. “My hands would swell up, I couldn’t close them all the way. My ankles hurt, it hurt to walk.” The other case is a woman in her 30s who traveled to Honduras. The cases do not pose a risk to the public and the mosquitoes that transmit Zika aren’t found in the Pacific Northwest. KGMI Newsroom Email: [email protected] Twitter: @kgmiradio http://kpug1170.com/news/007700-two-more-cases-of-zika-virus-show-up-in-washington/

Zika Confirmed Cases County Cases* Chelan1Clallam1Cowlitz 1King4Mason1Washington State Total 8* Confirmed travel-associated cases in WA as of 6/16/16http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/ZikaVirus\

Zika Confirmed Cases County Cases* Chelan1Clallam1Cowlitz 1King4Mason1Washington State Total 8* Confirmed travel-associated cases in WA as of 6/16/16

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June 16, 2016 Tests confirms seventh traveler infected with Zika virusThe Missouri Department of Health and Senior Services confirmed an additional case of Zika virus in a female, non-pregnant Missouri resident who travelled to the Dominican Republic. International health officials have found a connection between pregnant women contracting the virus and a birth defect called microcephaly in their newborn infants. According to the CDC, babies with microcephaly often have smaller head sizes and brains that might not have developed properly. According to the CDC, Zika virus has the potential to be spread through a mosquito bite, through unprotected sexual contact, through blood transfusion and an infected pregnant woman can pass Zika virus to her fetus during pregnancy. There is not currently a vaccine for Zika virus. The best prevention measure is to avoid mosquito bites in areas with ongoing transmission. There have been no reported cases of Zika virus contracted from a mosquito bite in Missouri. Ways to avoid mosquito bites while outdoors include wearing EPA-registered insect repellent with DEET, wearing pants and long sleeves, or remaining indoors in an air conditioned environment. The CDC is recommending pregnant women avoid traveling to Zika-affected areas which include countries ranging from Mexico into the Caribbean, Central American and South America. Since the beginning of the year, DHSS has regularly updated health care providers and the public about Zika virus in addition to coordinating the approval of Missourians for testing. Please consult our additional resources for more information about Zika virus:http://health.mo.gov/living/healthcondiseases/communicable/zika/

The Missouri Department of Health and Senior Services confirmed an additional case of Zika virus in a female, non-pregnant Missouri resident who travelled to the Dominican Republic. http://health.mo.gov/information/news/2016/zika61616

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State totals do not include recent Pregnancy Registry cases StatesStatesStatesCDCStates 13-Jun14-Jun15-Jun16-Jun16-JunAL66626AR55555AZ44424CA5757574857CO44455CT202323123DE55545DC66666FL176183185141188GA2021212021HI1010101010IL1818181919IN7771010IA77777KS22222KY66666LA44466MD2121212525MA2020202727ME66666MI77777MN1717171919MO66646MS33333MT11111NC1212121515ND11101NE22222NH44444NJ2828281728NM33333NV66677NY221229236174243OH1414141414OK55566OR121212712PA2424242324RI44488SC11111TN44444TX5757574257UT22222VA2525252626VT11111WA101010510WI55525WV66666 885904913755953

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