Zika virus epidemic 2015/2016

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The 2015/2016 Zika virus epidemic was a wave of illness in Latin America with initially flu- like symptoms, but as a result of which, however, significant damage to the fetus occurred in pregnant women . The infection process first attracted national attention at the beginning of 2015 after 39 people in the Brazilian city ​​of Camaçari (state of Bahia ) complained of fever and previously unknown symptoms with rashes , itching and pain all over the body. Diseases such as dengue , chikungunya , rubella and measles could be excluded as causes. At the Biological Institute of the Universidade Federal da Bahia in Salvador , the Zika virus was detected on April 29, 2015 using the polymerase chain reaction from blood samples from patients .

The Zika virus has been known from Africa since 1947 . At that time it was isolated from a rhesus monkey that had been kept in a research station in the Zika Forest of Entebbe , Uganda , for the purpose of detecting yellow fever viruses ; later the virus was named after this forest. After the infections with the Zika virus ("Zika fever") and the damage to fetuses associated with the virus were observed for the first time and at the same time in Latin America since the beginning of 2015, the World Health Organization (WHO) declared on February 1, 2016 the International health emergency . The emergency was declared over by the WHO on November 18, 2016.

Zika virus virions (stained red) on a sheathed nerve cell ( TEM image )

Course of spread

Spread of the Zika virus in 2012
Order of propagation
Countries in which Zika virus infections through mosquito transmission have occurred in the past (as of January 2016). confirmed infections acquired in the region Infections so far only proven serologically



The Zika virus was first detected in humans in 1952 in Uganda and Tanzania . In the following decades the virus spread widely in Africa and Asia. However, as of 2007, fewer than 15 human infections were known, all of which were found in Africa or Southeast Asia.

Oceania

The first human infections by Zika viruses outside of Africa and Asia became known from Oceania in 2007 , namely on the Yap Islands in Micronesia . An analysis of antibodies from Yap residents in 2009 found that 73 percent of the population had been infected without hospitalization. As a result, the Zika virus was classified as a so-called emergent virus , i.e. a pathogen that could possibly spread even further across the world.

In 2013/14 there was an outbreak in French Polynesia , in the course of which 30,000 people - 10 percent of the population - were infected; Presumably by travelers, the viruses were then carried to the Cook Islands , New Caledonia and Vanuatu . Between January and May 2014, infections were reported on Easter Island , the causative Zika virus probably originating from French Polynesia.

Latin America

Countries in South America with Zika virus infections (as of February 2016). More than one million confirmed cases Between 1500 and one million confirmed cases Less than 1500 confirmed cases




The head of the center, Gúbio Soarez, suspects that the cause of the first manifestation of the virus on the American continent in early 2015 was the intensive travel activity during the 2014 World Cup to neighboring Salvador. By the end of April 2015, up to 500 sick people had already been registered in Salvador. The virus strains occurring in South America are of the Asian type of the Zika virus. They are most similar to Polynesian strains, with 99.7 percent identity of the RNA sequence and 99.9 percent identity of the amino acid sequences.

In June 2015, the Zika virus was linked to Guillain-Barré syndrome among people suffering from Salvador . In October and November 2015 there were diseases in Colombia and Suriname . In December 2015, two people fell ill in Martinique and French Guiana . At the end of January 2016, diseases were reported from a total of 23 Central and South American and Caribbean countries and territories. The Organización Panamericana de la Salud , a regional organization of the World Health Organization, declared on January 25, 2016 that the Zika virus was to be expected in the entire regional distribution area of ​​the Aedes mosquitoes - this would affect the entire American double continent with the exception of Canada and Chile.

Record warmth, which occurred against the background of a particularly strong El Niño event and global warming in the second half of 2015 in northern and eastern South America, favored the spread of the disease. At higher temperatures, the range of the Aedes mosquitoes, which transmit the disease, increases, female mosquitoes bite more frequently and the development time of the pathogen is shortened.

From October 2015 to mid-January 2016, a significant increase in microcephaly cases was recorded in Brazil, which was attributed to Zika infections in the mothers; Around 3900 suspected microcephaly cases are said to have been reported to the Brazilian Ministry of Health during this period (for comparison: previously around 200 cases per year). Even if no direct connection between the accumulation of microcephaly and Zika infections can be recognized, the health authorities of Colombia, Ecuador, El Salvador and Jamaica recommended avoiding pregnancies in the next few months at the end of January 2016. By January 2016, the number of illnesses in Colombia had increased to more than 13,500.

As a result of the reporting, there are “now more abortions” , reported the Süddeutsche Zeitung at the beginning of 2016 according to the German Press Agency (dpa). Many women would not even the forecast wait to see if their babies with microcephaly would come into the world, the Brazilian newspaper quoted Folha de São Paulo several doctors.

According to virologist Jan Felix Drexler , 95% of the reported microcephaly cases come from northeastern Brazil, whereas there have been similar rates of Zika infection in other areas. The reasons for this accumulation are unclear.

Olympia in Rio de Janeiro

On May 27, 2016, a letter was sent to the World Health Organization (WHO) explaining the dangers of the Zika virus spreading worldwide by tourists. In this letter, 151 scientists from all over the world called for the 2016 Summer Olympics to be postponed within the country or the continent, or at least to be postponed, because it is irresponsible to let the Games take place and thus risk a global epidemic . The consequences would be catastrophic. Therefore, the WHO should put together a group of experts to advise the International Olympic Committee .

According to the WHO, however, there is no risk to public health. The Zika virus is not spreading any faster due to the Olympic Games, also because August is winter in the southern hemisphere .

However, the WHO expressly advises that pregnant women should generally avoid the area around Rio de Janeiro . Long, light-colored clothing should also be worn and mosquito repellent should be applied to avoid mosquito bites. Condoms should be used during sexual intercourse because of the risk of infection.

Germany

In the first month after the introduction of an official reporting requirement for the Zika virus in May 2016, the authorities in Germany registered twelve cases of illness. Between October 2015 and the beginning of June 2016, the number of officially recorded Zika diseases in Germany rose to 56.

other areas

In December 2015, infections were reported from the Caribbean ( Puerto Rico , Haiti ), and the World Health Organization reported the first viral infection in the US Virgin Islands on January 29, 2016.

Travelers who stayed in regions where the Zika virus is widespread were repeatedly only registered as infected after returning home. For example, in May 2013, a Canadian woman fell ill after a stay in Thailand . In March 2014, a Zika virus infection was detected in an Australian holidaymaker after a stay in the Cook Islands . In June 2015, the virus was detected in a Finnish returnees from the Maldives . Various other abducted cases have also been known from other European countries since 2013. In July 2016, a newborn with suspected zika virus-associated microcephaly was registered in Spain. The mother was infected while traveling through Latin America and did not decide to terminate the pregnancy . Although this was not the first case of possible Zika virus-related microcephaly in Europe, it was the first birth of a damaged child.

In July 2016, four cases of Zika virus infection were diagnosed in Miami-Dade and Broward Counties in South Florida . All four cases were not imported rice infections, so it appeared possible that the Zika virus was transmitted by native mosquito populations. The CDC assessed it as “likely” that the virus had been transmitted by Aedes aegypti mosquitoes in Miami a few weeks earlier in the four cases mentioned . The Florida government announced increased mosquito control measures. In November 2016, a local broadcast from Cameron County , Texas became known.

At the end of August 2016, an outbreak was reported from Singapore with several dozen local transmissions.

World Health Organization global outlook and pandemic alert

In an article published on January 27, 2016 in the medical journal The Journal of the American Medical Association (JAMA), the authors, two respected US epidemiologists and virologists, accused the World Health Organization (WHO) of being overly passive and warned against a Zika -Virus pandemic . There is a threat of a worldwide spread at least to the tropical countries, z. B. also in connection with globally attended major events such as the Summer Olympics in Rio de Janeiro in August 2016. The WHO must therefore consider declaring a " Public Health Emergency of International Concern " ( PHEIC). A vaccination against the Zika virus, on the other hand, can be expected in three years at the earliest, even with intensified research, but perhaps not until many years later.

The following day the World Health Organization announced that it would immediately convene an International Health Regulations Emergency Committee for the Zika epidemic. At the same time it became known that the WHO predicts three to four million diseases. Based on the deliberations of the Emergency Committee, the WHO declared on February 1, 2016 a "public health emergency of international proportions". As a result, the WHO was able to coordinate aid measures for the affected regions as well as research projects and to raise and distribute financial donations. In particular, the connection between the increased incidence of microcephaly in newborns and the Zika virus infection, which was only suspected at the time, but not yet scientifically proven, should be examined more closely. The possible connection between Zika virus infection and neurological diseases such as Guillain-Barré syndrome should also be clarified.

This phase of the “health emergency” was declared over by the WHO on November 18, 2016.

Travel warnings

On March 8, 2016, the WHO recommended that pregnant women avoid Zika epidemic areas. Pregnant women whose sexual partners lived or traveled to the epidemic areas should only have protected sexual intercourse.

The German Society for Tropical Medicine and International Health as well as the German Foreign Office , the Austrian Federal Ministry of Health and the Expert Committee for Travel Medicine of Switzerland recommend that pregnant women avoid traveling to known Zika virus outbreak areas as far as possible and that they ensure consistent mosquito protection when traveling inevitably ( Status: February 2016).

The Robert Koch Institute (RKI) advises women planning a pregnancy to refrain from avoidable travel to Zika virus outbreak areas. However, “[...] there is no evidence that a survived Zika virus infection poses a risk for later pregnancies. However, it makes sense to wait after exposure to a new pregnancy until the theoretical maximum duration of viraemia after asymptomatic infection has ended. The Centers for Disease Control and Prevention (CDC) in the USA recommend eight weeks after the last exposure (or, in the case of symptomatic infections, eight weeks after the onset of symptoms) with plenty of buffer. ”The British National Travel Health Network and Center (NaTHNaC) recommends this four weeks (28 days).

On August 2, 2016, the CDC issued a historically unique travel warning. She advised pregnant women and their partners not to attend Wynwood, a small community north of Miami.

On August 19, 2016, the CDC issued an official travel warning for South Florida. Pregnant women and their partners are not advised to travel to Miami-Dade County, including Miami Beach . People who traveled there after July 14, 2016 were advised to use condoms during sexual intercourse. Pregnant women who lived there or who traveled there frequently were advised to see a doctor and have a test for Zika virus infection. Women with symptoms or evidence of zika virus infection should wait at least 8 weeks after the onset of symptoms before attempting a pregnancy. For men, a waiting period of 6 months after infection before conceiving a child was recommended.

The travel warnings for pregnant women regarding risk areas were upheld by the CDC after the WHO declared the "health emergency" phase over in November 2016.

protection

So far, there is no vaccination or disease prevention medication . Many scientists believe that it could be years before a vaccine is available. In November 2016 there should be the first tests of a possible vaccine on monkeys and mice. The only protective measures that apply are therefore general protection against mosquito bites or even avoidance of corresponding climatic zones. Based on reports of sexual transmission of the virus, general protective measures against sexually transmitted diseases, such as the use of condoms in particular, apply .

It is not yet known whether an infection, once passed, leads to at least temporary immunity.

See also

Web links

Commons : Zika virus  - collection of pictures, videos and audio files

Individual evidence

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