February 16, 2016

Ron Rosenberg, ScD

Division of Vector-Borne Diseases

National Center for Emerging & Zoonotic Infectious Diseases

The Yap Epidemic Duffy et al, 2009, N Engl J Med 360:2536

• April - July, 2007 • Macropapular rash, conjunctivitis, fever, arthralgia • dengue IgM negative

• Lab diagnosis protocol • Positive: PCR+ or IgM+, PRNT90 >20 & dengue PRNT90 >4 • Probable: IgM+, PRNT90 >20 & dengue PRNT90 <4

• Sought care (n=185): • 49 confirmed, 59 probable, 72 suspect Zika

• Household survey (n=557): • 74% IgM+, 19% ill

• Aedes hensilli: 36% of containers

Zika Virus - Basics

Genus Flavivirus (Family Flaviviridae)

26 vector-borne human pathogens, 1 non-arbovirus

tick & mosquito vectors

neuroinvasive or hemorrhagic

Discovery

Rockefeller Foundation dedicated to arbovirus discovery

1947 (sentinel macaque), 1948 (mosquito), 1954 (human)

Sequence: Kuno & Chang, January, 2007 (Arch. Virol. 152:687)

1947 Discovery

The Spread of Zika Virus Discovery

1947 Discovery

The Spread of Zika Virus Discovery

1954 1st Human

1947 Discovery

The Spread of Zika Virus Discovery

1954 1st Human

1954-2007 Asia

1947 Discovery

The Spread of Zika Virus Discovery

1954 1st Human

1954-2007 Asia

2007-2014 Pacific

1947 Discovery

The Spread of Zika Virus Discovery

1954 1st Human

1954-2007 Asia

2007-2014 Pacific

2015 Americas

South Pacific Outbreaks

• 2013 – French Polynesia

• Estimated 28,000 (11% population) – clinically similar to Yap, but…

• First suspect association Guillan-Barré syndrome

• 2015 retrospective case review: increase in microcephaly

• 2014 – New Caledonia, Cook Islands, Solomons, Easter Island

• Asian genotype – Yap, Cambodia

Kraemer MUG, et alii, eLife 2015;4:e08347

Actual & Potential Geographic Distribution of Aedes aegypti

Some Things We Need or Need to Know

• Infection course • Length of viremia, asymptomatic infectivity, antibody profile

• Birth defects, GBS • Incidence • Risk factors (co-morbidities) • Has mutation increased risk?

• Risk of non-vectored transmission • Transfusion, transplantation • Sexual

• Diagnostics • Serology – poor specificity in dengue endemic areas • RNA in urine?

• Ecology • Animal reservoirs • Vector species

• and 200 other obscure or “non-pathogenic” arboviruses….

For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.