Zika virus infection in the returning traveller: what every neurologist should know

Zika virus has been associated with a wide range of neurological complications. Neurologists in areas without current active transmission of the virus may be confronted with Zika-associated neurological disease, as a large number of returning travellers with Zika virus infection have been reported and the virus continues to spread to previously unaffected regions. This review provides an overview of Zika virus-associated neurological disease and aims to support neurologists who may encounter patients returning from endemic areas

Examining Zika Virus: Transmission, Diagnosis, Treatment, and Prevention

The Zika virus is a mosquito-borne virus that was first isolated in Uganda in 1947 and has since caused outbreaks in many parts of the world. It has multiple routes of transmission and may cause acute illness and death if not treated. The Zika virus becomes a major concern if transmitted from mother to fetus as it increases the chance of birth defects and developmental problems to the unborn baby. This article highlights the importance of early diagnosis and describes Zika virus’ transmission, treatment, and prevention

Is the United States Prepared for a Major Zika Virus Outbreak?

Zika virus has emerged as a global public health crisis with active transmission in the Americas and Caribbean. The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC), and recently WHO reported there is a scientific consensus that Zika is a cause of microcephaly and Guillain-Barré syndrome (GBS). In the U.S. the Centers for Disease Control and Prevention (CDC) activated its emergency operations center at its highest capacity. President Obama requested $1.86 billion in emergency funding. Shamefully, Congress has yet to appropriate the funding needed for Zika preparedness, and the President has had to reallocate Ebola funding for Zika prevention. Although none of the continental states has reported local mosquito-borne transmission, federal authorities are amplifying the potential for Zika to affect national security. The virus already severely threatens Puerto Rico. Travelers visiting or returning to the United States could likely escalate the spread of Zika via sexual transmission. The virus may spread across a majority of US states including large cities where Aedes species mosquitos are active. Is the U.S. prepared for Zika? America\u27s highly functioning health system will help, but signs of unpreparedness remain due to insufficient resources and variable legal authorities

The Emerging Zika Pandemic: Enhancing Preparedness

The Zika virus (ZIKV), a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis, originated in the Zika forest in Uganda and was discovered in a rhesus monkey in 1947. The disease now has “explosive” pandemic potential, with outbreaks in Africa, Southeast Asia, the Pacific Islands, and the Americas. Since Brazil reported Zika virus in May 2015, infections have occurred in at least 20 countries in the Americas. Puerto Rico reported the first locally transmitted infection in December 2015, but Zika is likely to spread to the United States. The Aedes species mosquito (an aggressive daytime biter) that transmits Zika virus (as well as dengue, chikungunya, and yellow fever) occurs worldwide, posing a high risk for global transmission. Modeling anticipates significant international spread by travelers from Brazil to the rest of the Americas, Europe, and Asia. What steps are required now to shore up preparedness in the Americas and worldwide

Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016

BACKGROUND: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. OBJECTIVE: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. DESIGN: Descriptive, using GeoSentinel records. SETTING: 63 travel and tropical medicine clinics in 30 countries. PATIENTS: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. MEASUREMENTS: Frequencies of demographic, trip, and clinical characteristics and complications. RESULTS: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain–Barre syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death). LIMITATION: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable. CONCLUSION: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission

The Zika Virus Threat: How Concerns About Scientists May Undermine Efforts to Combat the Pandemic

Using data from the University of New Hampshire’s October 2016 Granite State Poll, authors Thomas Safford, Lawrence Hamilton, and Emily Whitmore investigate how New Hampshire residents view the Zika crisis. They report that most New Hampshire residents believe Zika is only a minor threat to public health in the United States, and they generally trust the CDC as a source of information about the virus. The data also show that, while there is doubt about the government’s ability to control the spread of the virus, the public feels that emergency federal funding to combat Zika should be a priority. They discuss that many Granite Staters have real concerns about the practice of science, believing scientists change their findings to get the answers they want. More importantly, individuals who questioned the integrity of scientists are less likely to believe Zika is a threat, have confidence in the government’s ability to combat the virus, trust the CDC, and to prioritize emergency funding. They conclude that these results suggest that health officials working to engage the public in efforts to control the spread of Zika must not only discuss risks associated with the virus and mechanisms of transmission, but also confront science skepticism and potential concerns about the integrity of the scientists gathering data related to Zika and other infectious diseases

Anti-ganglioside antibodies in patients with Zika virus infection-associated Guillain-Barré Syndrome in Brazil.

Zika virus infection is associated with the development of Guillain-Barré syndrome (GBS), a neurological autoimmune disorder caused by immune recognition of gangliosides and other components at nerve membranes. Using a high-throughput ELISA, we have analyzed the anti-glycolipid antibody profile, including gangliosides, of plasma samples from patients with Zika infections associated or not with GBS in Salvador, Brazil. We have observed that Zika patients that develop GBS present higher levels of anti-ganglioside antibodies when compared to Zika patients without GBS. We also observed that a broad repertoire of gangliosides was targeted by both IgM and IgG anti-self antibodies in these patients. Since Zika virus infects neurons, which contain membrane gangliosides, antigen presentation of these infected cells may trigger the observed autoimmune anti-ganglioside antibodies suggesting direct infection-induced autoantibodies as a cause leading to GBS development. Collectively, our results establish a link between anti-ganglioside antibodies and Zika-associated GBS in patients

Lack of Durable Cross-Neutralizing Antibodies Against Zika Virus from Dengue Virus Infection

Cross-reactive antibodies elicited by dengue virus (DENV) infection might affect Zika virus infection and confound serologic tests. Recent data demonstrate neutralization of Zika virus by monoclonal antibodies or human serum collected early after DENV infection. Whether this finding is true in late DENV convalescence (>6 months after infection) is unknown. We studied late convalescent serum samples from persons with prior DENV or Zika virus exposure. Despite extensive cross-reactivity in IgG binding, Zika virus neutralization was not observed among primary DENV infections. We observed low-frequency (23%) Zika virus cross-neutralization in repeat DENV infections. DENV-immune persons who had Zika virus as a secondary infection had distinct populations of antibodies that neutralized DENVs and Zika virus, as shown by DENV-reactive antibody depletion experiments. These data suggest that most DENV infections do not induce durable, high-level Zika virus cross-neutralizing antibodies. Zika virus–specific antibody populations develop after Zika virus infection irrespective of prior DENV immunity

Zika Virus Mutation and The Spreading to Indonesia

More than 13 countries in the Americas have reported sporadic Zika virus infection that show very rapid geographic expansion. While in Indonesia, the euphoria is also increasingly prevalent virus discussed especially after the discovery of Jambi positive patients infected with the virus Zika on January 26, 2016 last.Viruses transmitted by mosquito bites to humans are the same mosquito transmits dengue fever, chikungunya and yellow fever with symptoms that have similar resemblance to the zika virus. Based on similarity of symptoms of infection with dengue virus, can be analyzed using sequence alignment to get identical percentage, local alignment calculation, genetic mutation and the spread of the zika virus to Indonesia. From the whole process, Smith Waterman algorithm can be used to align dengue virus type 1, type 2, type 3, and type 4 with zika virus (Jambi). Mutations between dengue virus and zika virus on average 28% of dissimilarity sequences in the same position between the sequence. Overall, the dengue virus type 1 mutation to the zika virus was 28.2723%, the dengue virus type 2 mutation to the zika virus was 28.1984%, the dengue virus type 3 mutation to the zika virus 27.9373% and the mutation of dengue virus type 4 to the zika virus of 28.7206%. By looking at all mutations, from the simulation results note that the mutations of both viruses include mutation type I. The phylogenetic tree showed the spread of the Zika virus to Indonesia, originally from South Africa, the islands of Chile, Caledonia, the Philippines, Yap Micronesia, Thailand, Cambodia, and finally reached Indonesia. Zika virus jambi suspected of dengue virus mutation because a few years earlier there was a dengue virus outbreaks in a long time in Jambi, it turns out the virus zika jambi is not from mutation dengue virus but the virus comes from the Asian region

The Zika outbreak of the 21st century.

The Zika virus outbreak has captivated the attention of the global audience and information has spread rapidly and wildly through the internet and other media channels. This virus was first identified in 1947, when it was isolated from a sentinel rhesus monkey placed by British scientists working at the Yellow Fever Research Laboratory located in the Zika forest area of Uganda, hence its name, and is transmitted primarily by the mosquito vector, Aedes aegypti. The fact that the rhesus macaque is an Asian species being placed in an African forest brings to mind the possibility of rapid adaptation of the virus from an African to Asian species, an issue that has not been considered. Whether such adaptation has played any role in acquiring pathogenicity due to cross species transmission remains to be identified. The first human infection was described in Nigeria in 1954, with only scattered reports of about a dozen human infections identified over a 50-year period. It was not until 2007 that Zika virus raised its ugly head with infections noted in three-quarters of the population on the tiny island of Yap located between the Philippines and Papua New Guinea in the western Pacific Ocean, followed by a major outbreak in French Polynesia in 2013. The virus remained confined to a narrow equatorial band in Africa and Asia until 2014 when it began to spread eastward, first toward Oceania and then to South America. Since then, millions of infected individuals have been identified in Brazil, Colombia, Venezuela, including 25 additional countries in the Americas. While the symptoms associated with Zika virus infection are generally mild, consisting of fever, maculopapular rash, arthralgia and conjunctivitis, there have been reports of more severe reactions that are associated with neurological complications. In pregnant women, fetal neurological complications include brain damage and microcephaly, while in adults there have been several cases of virus-associated Guillain-Barre syndrome. The virus was until recently believed to only be transmitted via mosquitoes. But when the Zika virus was isolated from the semen specimens from a patient in Texas, this provided the basis for the recent report of possible sexual transmission of the Zika virus. Due to the neurological complications, various vectors for infection as well as the rapid spread throughout the globe, it has prompted the World Health Organization to issue a global health emergency. Various governmental organizations have recommended that pregnant women do not travel to countries where the virus is epidemic, and within the countries affected by the virus, recommendations were provided for women of childbearing age to delay pregnancy. The overall public health impact of these above findings highlights the need for a rapid but specific diagnostic test for blood banks worldwide to identify those infected and for the counseling of women who are pregnant or contemplating pregnancy. As of this date, there are neither commercially licensed diagnostic tests nor a vaccine. Because cross-reactivity of the Zika virus with dengue and Chikungunya virus is common, it may pose difficulty in being able to quickly develop such tests and vaccines. So far the most effective public health measures include controlling the mosquito populations via insecticides and preventing humans from direct exposure to mosquitoes