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American Samoa Says It Has 205 Suspected Cases Of ZikaUpdated February 15, 20163:03 PM ETPublished February 15, 20162:10 PM ETBILL CHAPPELLTwitterAedes aegypti mosquitoes like these are known to carry the Zika virus — four cases of which have now been confirmed in American Samoa, according to officials. Arnulfo Franco/APThere are currently more than 200 suspected cases of Zika virus in American Samoa, local officials say, announcing that the U.S. territory has at least four confirmed cases — including one patient who is pregnant. The territory's acting governor, Lt. Gov. Lemanu Peleti Mauga, "declared a Zika epidemic for American Samoa" after consulting with health officials at the end of last week, Samoa News reports. The news was announced at the end of last week by health and government leaders in American Samoa, which has a population of around 54,000, according to the CIA Factbook. "What we did was that we looked up the four cases that were tested positive and went back to the record book to look at some of the cases that have the same symptom profiles," Samoa News quotes epidemiologist Scott Anesi saying. "So the case definition of Zika is any two of the four symptoms such as pink eye, rash, joint pain and fever. So if you have two of those four, we are going to classify that as Zika, because we know that Zika transmission is ongoing." By declaring an epidemic, the territory is also placing its anti-Zika efforts under the control of a unified command, which will be guided by the federal Centers for Disease Control and Prevention. A CDC medical team is on its way to the island chain to join a CDC doctor who arrived earlier this year, according to local news site Talanei, which says officials are reviewing some 205 possible cases. In November, Samoa, the territory's larger neighbor to the west, reported local transmission of the Zika virus — meaning that mosquitoes in that island nation had been infected with the virus and spread it to people,the CDC says. No vaccine for Zika currently exists, the CDC says. In addition to mosquito bites, the agency says, "Sexual transmission of Zika virus from a male partner is possible." You can follow NPR's coverage of the Zika virus here. Recent stories range from the Brazilian military's fight against the Aedes aegypti mosquito that carries the virus to a timeline of how what had been thought of as a mild virus expanded its reach. http://www.npr.org/sections/thetwo-way/2016/02/15/466834461/american-samoa-says-it-has-205-suspected-cases-of-zika?utm_source=twitter.com&utm_campaign=npr&utm_medium=social&utm_term=nprnews

There are currently more than 200 suspected cases of Zika virus in American Samoa, local officials say, announcing that the U.S. territory has at least four confirmed cases — including one patient who is pregnant. http://www.npr.org/sections/thetwo-way/2016/02/15/466834461/american-samoa-says-it-has-205-suspected-cases-of-zika?utm_source=twitter.com&utm_campaign=npr&utm_medium=social&utm_term=nprnews

Health confirmed the second case of a pregnant ZikaBoth cases have been diagnosed in Catalonia - Health brings to 23 the number of people affected, all imported15/02/2016 | 19:14 EP / MADRID The Ministry of Health, Social Services and Equality has confirmed the second case of virus Zika in Spain in a pregnant woman , both in Catalonia and brings to 23 the number of people affected by this Infecció n, all imported from any of affected countries. This emerges from the latest update of cases published today by the Department of Alfonso Alonso , detailing eight cases in Catalonia (including two pregnant), five in Madrid, three in Castilla and Leon, two in Aragón, two in Asturias, one Andalusia, one in Murcia and one in Navarra. Given the Zika virus epidemic affecting several countries in Latin America, health, communities and the Institute of Health Carlos III established a surveillance of imported cases. Confirmation of infection is carried out at the National Microbiology Center of the Institute of Health Carlos III. In addition, last week the Ministry and the communities agreed in the Committee on Public Health of the National Health System (SNS) the adoption of a protocol Zika epidemiological surveillance and preparedness and response plan for these and other mosquito-borne diseases . Among other issues, it is recommended to anyone who has been to any area where there is a viruspostpone 28 days since his return the unprotected sex with women who are pregnant or intend to be , to avoid possible contagion through the semen. Also, the strategy also recommends that these people from affected areas may also postpone donating blood for 28 days. In both cases, sex and donations, the recommendations would be extended to six months if they had presented symptoms during their stay or return. http://www.laopiniondezamora.es/nacional/2016/02/15/confirmado-segundo-caso-zika-embarazada/904916.html?utm_source=rss&utm_source=twitterfeed&utm_medium=twitter

Second confirmed pregnancy in Spain is the 23rd imported case. http://www.laopiniondezamora.es/nacional/2016/02/15/confirmado-segundo-caso-zika-embarazada/904916.html?utm_source=rss&utm_source=twitterfeed&utm_medium=twitter

First Case of Zika Disease Reported in RussiaThe Moscow TimesFeb. 15 2016 18:58Last edited 18:58Denis Abramov / VedomostiRussia has registered its first case of the Zika fever, the website of Russia's consumer rights watchdog, Rospotrebnadzor, reported Monday. The patient is a woman from Moscow who was on holiday in the Dominican Republic — she is currently undergoing treatment in a Moscow hospital. The disease was not detected in the woman upon arrival at Domodedovo Airport, according to Rospotrebnadzor, but a few days after her return she began feeling unwell and had a temperature and a rash. The woman was hospitalized and laboratory results later confirmed that she had the disease. The woman is still in hospital but her condition is considered stable. Her family members have been under medical observation but have not shown symptoms of the disease.

Media reporting first Russia Zika import, Moscow ex-Dominican Republic. http://www.themoscowtimes.com/article/559613.html

China confirms second imported Zika case Source: Xinhua | 2016-02-15 22:35:33 | Editor: huaxia A doctor examines a larva of the Aedes aegypti mosquito, the carrier of Zika virus, in a laboratory of the Ministry of Health, in San Jose, Costa Rica, on Jan. 29, 2016.(Xinhua/Kent Gilbert) BEIJING, Feb. 15 (Xinhua) -- China confirmed a second imported Zika case Monday, six days after the first was detected, the General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) said. The AQSIQ's Guangdong provincial branch found a passenger with fever at Guangzhou Baiyun International Airport on Friday before the patient was confirmed with Zika virus by the Chinese Center for Disease Control and Prevention on Monday. The patient was exposed to an infected person in Venezuela days before returning to Guangzhou on Feb. 9 via the Netherlands and Russia, the AQSIQ said in a statement. China's first patient with the virus was discharged from hospital on Sunday after a full recovery. Symptoms of the Zika virus, which spreads to people through mosquito bites, include fever, joint pain, a rash, conjunctivitis, headache and muscle pain.

Media citing a second Zika export in China. http://news.xinhuanet.com/english/2016-02/15/c_135100900.htm

Map update https://www.google.com/maps/d/u/0/edit?mid=zv94AJqgUct4.kT4qLMXp3SLU&hl=en

First case of Zika virus confirmed in Erie CountyBy Sara Johnson, News 4 ProducerPublished: February 14, 2016, 4:40 pmClick to share on Twitter (Opens in new window) Click to share on Google+ (Opens in new window) 6Share on Facebook (Opens in new window)6 Click to share on Pinterest (Opens in new window)FILE - This 2006 file photo provided by the Centers for Disease Control and Prevention shows a female Aedes aegypti mosquito in the process of acquiring a blood meal from a human host. The The Centers for Disease Control and Prevention on Tuesday, Jan. 19, 2016, announced new guidance for doctors whose pregnant patients may have traveled to regions with a tropical illness linked to birth defects. Officials say doctors should ask pregnant women about their travel and certain symptoms, and, if warranted, test them for an infection with the Zika virus. The virus is spread through mosquito bites. (James Gathany/Centers for Disease Control and Prevention via AP, File)BUFFALO, N.Y. (WIVB) – Health officials confirm they are treating the first case of the Zika virus in Erie County. Dr. Gale Burstein, the Erie County Health Commissioner, tells News 4 the patient visited El Salvador sometime within the past few weeks. The patient was diagnosed with the Zika virus on Wednesday. Dr. Burstein could not disclose personal information about the patient. The patient is receiving treatment and will recover. Dr. Burstein says 80 percent of people with the Zika virus do not develop symptoms. State health officials say Zika virus testing is being offered to pregnant women, who traveled to an area with confirmed cases of the Zika virus at any point during or immediately before pregnancy.

Health officials confirm they are treating the first case of the Zika virus in Erie County. Dr. Gale Burstein, the Erie County Health Commissioner, tells News 4 the patient visited El Salvador sometime within the past few weeks. The patient was diagnosed with the Zika virus on Wednesday. Dr. Burstein could not disclose personal information about the patient. The patient is receiving treatment and will recover. http://wivb.com/2016/02/14/first-case-of-zika-virus-confirmed-in-erie-county/

WHO adviceThe proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection. During outbreaks, space spraying of insecticides may be carried out following the technical orientation provided by WHO to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers, when this is technically indicated. Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering. Based on the current available information, WHO does not recommend any travel or trade restrictions to Zika virus affected countries.

WHO risk assessmentZika virus infection has been laboratory confirmed in only three of the reported GBS cases from Venezuela, while the infection has not been detected in any of the GBS cases from Colombia. Although the cause of the rise in GBS cases has not yet been established, similar increases have been observed in other countries, notably El Salvador and Brazil (see DONs published on 21 January and 8 February 2016, respectively). Further investigations are needed to identify the potential role of previous infections known to be associated, or potentially associated, with GBS. WHO recommends Member States affected or susceptible to Zika virus outbreaks to: monitor the incidence and trends of neurological disorders, especially GBS, to identify variations against their expected baseline values;develop and implement sufficient patient management protocols to manage the additional burden on health care facilities generated by a sudden increase in patients with Guillain-Barre Syndrome;raise awareness among health care workers and establish and/or strengthen links between public health services and clinicians in the public and private sectors.

VenezuelaFrom 1 January to 31 January 2016, 252 GBS cases with a spatiotemporal association to Zika virus were reported. While cases were recorded in the majority of the federal territories of the country, 66 were detected in the state of Zulia, mainly in the Maracaibo municipality. Preliminary analysis of the GBS cases in the state of Zulia indicates that the 66 cases originated from six municipalities. Of the 66 cases, 30% were 45 to 54 years old and 29% were 65 years or older; 61% were male and 39% were female. A clinical history consistent with Zika virus infection was observed in the days prior to onset of neurological symptoms in 76% of the GBS cases in the state of Zulia. Associated comorbidities were present in 65% of the cases. Patients were treated with plasmapheresis and/or immunoglobulin. In some cases, according to medical indication, both treatments were used following the treatment protocol established by the Ministry of Popular Power for Health. Zika virus infection was confirmed by polymerase chain reaction in three GBS cases, including a fatal case with no comorbidities. A total of three cases presenting with other neurological disorders were also biologically confirmed. Between late November to 28 January 2016, 192 cases of Zika virus infection were laboratory confirmed through reverse transcription polymerase chain reaction. Of the 192 cases, 110 (57%) are from the state of Zulia.

ColombiaFrom epidemiological week (EW) 51 of 2015 to EW 3 of 2016, 86 GBS cases were reported. On average, Colombia registers 242 GBS cases per year or approximately 19 cases per month or 5 cases per week. The 86 GBS cases reported in those 5 weeks is three times higher than the averaged expected cases of the 6 previous years. Initial reports indicated that all the 86 reported GBS cases presented with symptoms compatible with a Zika virus infection. Of the 58 cases for which information is available, 57% were male and 94.8% were 18 years old or older.

Guillain-Barré syndrome – Colombia and VenezuelaDisease Outbreak News 12 February 2016 Between 30 January and 2 February 2016, the National IHR Focal Points of Colombia and Venezuela informed PAHO/WHO of increases in the number of Guillain-Barre Syndrome (GBS) cases recorded at the national level. http://www.who.int/csr/don/12-february-2016-gbs-colombia-venezuela/en/

WHO adviceThe proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection. During outbreaks, space spraying of insecticides may be carried out following the technical orientation provided by WHO to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers, when this is technically indicated. Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering. WHO does not recommend any travel or trade restriction to Zika-affected countries based on the current information available.

WHO risk assessmentThis is not the first Zika virus case acquired through sexual transmission. Sporadic cases of infection acquired via this route have already been reported in the literature. The risk of disease spread through sexual activity is very limited. This potential case of sexual transmission does not change the overall risk assessment since the virus is primarily transmitted to people through mosquito bites. The risk of a global spread of Zika virus to areas where the competent vectors, the Aedes mosquitoes, are present is significant, given the wide geographical distribution of these mosquitoes in various regions of the world. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

On 5 February 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of a probable case of sexual transmission of Zika virus. Person A, a resident of Dallas, Texas, travelled to Venezuela for one week between late December and the beginning of January. Several days after returning to the United States, Person A developed symptoms consistent with Zika virus infection, including fever, rash, conjunctivitis, and malaise. One day prior to symptom onset and once during the symptomatic period, Person A had sex with Person B (non-traveller). Approximately one week after the onset of illness in Person A, Person B developed symptoms consistent with Zika virus disease, including fever, pruritic rash, conjunctivitis, small joint arthralgia and malaise. Laboratory tests confirmed Zika virus infection in both Person A and Person B. Samples collected from Person A at 14 days after symptom onset and from Person B at 4 and 7 days after illness onset had evidence of Zika virus IgM and neutralizing antibodies. Additional tests are being carried out. Local meteorological conditions at the time would not have supported mosquito activity; furthermore, entomological sampling that was conducted in the concerned area yielded no mosquitoes.

WHO details Zika sexual transmission in Dallas, Texas. http://www.who.int/csr/don/12-february-2016-zika-usa/en/

WHO adviceThe proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection. During outbreaks, space spraying of insecticides may be carried out following the technical orientation provided by WHO to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers, when this is technically indicated. Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering. WHO does not recommend any travel or trade restriction to Zika-affected countries based on the current information available.

WHO risk assessmentThis case report adds to the growing literature on Zika virus and microcephaly. Although evidence concerning a potential association between Zika virus and congenital neurological disorders among newborns is mounting, the available information is not yet sufficient to establish such a causative link. Further investigations are, therefore, required. Until more is understood, Members States are advised to standardize and enhance surveillance for microcephaly and other neurological disorders, particularly in areas of known Zika virus transmission and areas at risk of such transmission. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

On 16 January 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of a male infant with microcephaly born in the state of Hawaii in December. The mother of the child experienced symptoms compatible with Zika virus infection during her second month of pregnancy, while residing in Brazil; however, at the time, testing for the infection was not performed. Within the first week after birth, cerebrospinal fluid and serum samples were collected from the infant. The samples showed serologic evidence of recent Zika virus infection by IgM enzyme linked immunosorbent assay (ELISA) and confirmatory plaque reduction neutralization testing (PRNT) at the U.S. Centers for Disease Control and Prevention. Serum collected from the infant’s mother during the week after the infant’s birth showed serologic evidence of recent infection with a flavivirus by IgM ELISA and confirmatory PRNT.

Microcephaly – United States of AmericaDisease Outbreak News 12 February 2016 http://www.who.int/csr/don/12-february-2016-microcephaly-usa/en/

IntroductionMicrocephaly is a neonatal malformation defined as a head size much smaller compared with other babies of the same age and sex. If this combines with poor brain growth, babies with microcephaly can develop developmental disabilities. The severity of microcephaly ranges from mild to severe. Scope of the problemMicrocephaly is a rare condition. Reported estimate incidence of microcephaly has wide variation due to the differences in the definition and target population. Although not proven, researchers are studying a potential link between this surge in microcephaly cases and Zika virus infection. DiagnosisEarly diagnosis of microcephaly can sometimes be made by fetal ultrasound. Ultrasounds have the best diagnosis possibility if they are made at the end of the second trimester, around 28 weeks, or in the third trimester of pregnancy. Babies should have their head circumference measured at least 24 hours after birth and compared with WHO growth standards. The result will be interpreted in relation to the gestational age of the baby, and also the baby’s weight and length. Suspected cases should be reviewed by a paediatrician, have brain imaging scans, and have their head circumference measured at monthly intervals in early infancy and compared with growth standards. Doctors should also test for known causes of microcephaly. Causes of microcephalyThere are many potential causes of microcephaly, but often the cause remains unknown. The most common causes include: infections in the womb: toxoplasmosis (caused by a parasite found in undercooked meat), rubella, herpes, syphilis, cytomegalovirus and HIV;exposure to toxic chemicals: maternal exposure to heavy metals like arsenic and mercury, alcohol, radiation, and smoking;genetic abnormalities such as Down syndrome; andsevere malnutrition during fetal life.Signs and symptomsMany babies born with microcephaly may demonstrate no other symptoms at birth but go on to develop epilepsy, cerebral palsy, learning disabilities, hearing loss and vision problems. Some children with microcephaly will develop entirely normally. Treatment and careThere is no specific treatment for microcephaly. A multidisciplinary team is important to assess and care for babies and children with microcephaly. Early intervention with stimulation and play programmes may show positive impacts on development. Family counselling and support for parents is also extremely important.