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MEDICAL: DISEASES: ZIKA VIRUS:
Outbreak of Zika Virus Disease American Samoa, 2016
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Outbreak of Zika Virus Disease American Samoa, 2016
Jessica M. Healy, PhD; M. Catherine Burgess, MS; Tai-Ho Chen, MD; W. Thane
Hancock, MD; Karrie-Ann E. Toews, MPH; Magele Scott Anesi, MPH; Ray T.
Tulafono Jr; Mary Aseta Mataia; Benjamin Sili; Jacqueline Solaita; A
Christian Whelen, PhD; Rebecca Sciulli, MSc; Remedios B. Gose, MSPH;
Vasiti Uluiviti, MSc; Morgan Hennessey, DVM; Fara Utu; Motusa Tuileama
Nua; Marc Fischer, MD
Disclosures
Morbidity and Mortality Weekly Report. 2016;65(41):1146-1147.
Sunday, November 13, 2016
Medscape
http://www.medscape.com/viewarticle/870816
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Morbidity and Mortality Weekly Report (MMWR)
CDCMMWR
Notes from the Field: Outbreak of Zika Virus Disease American Samoa, 2016
Weekly
October 21, 2016
65(41);11461147
Morbidity and Mortality Weekly Report (MMWR)
http://www.cdc.gov/mmwr/volumes/65/wr/mm6541a4.htm#suggestedcitation
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Notes from the Field: Outbreak of Zika Virus Disease American Samoa, 2016
Weekly / October 21, 2016 / 65(41);11461147
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Jessica M. Healy, PhD1,2,3; M. Catherine Burgess, MS4; Tai-Ho Chen, MD3;
W. Thane Hancock, MD4; Karrie-Ann E. Toews, MPH4; Magele Scott Anesi,
MPH5; Ray T. Tulafono Jr6; Mary Aseta Mataia5; Benjamin Sili5; Jacqueline
Solaita5; A Christian Whelen, PhD7; Rebecca Sciulli, MSc7; Remedios B.
Gose, MSPH7; Vasiti Uluiviti, MSc8; Morgan Hennessey, DVM1,9; Fara Utu5;
Motusa Tuileama Nua5; Marc Fischer, MD9 (View author affiliations)
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View suggested citation
Suggested citation for this article: Healy JM, Burgess MC, Chen T, et al.
Notes from the Field: Outbreak of Zika Virus Disease American Samoa,
2016. MMWR Morb Mortal Wkly Rep 2016;65:11461147. DOI:
http://dx.doi.org/10.15585/mmwr.mm6541a4.
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During December 2015 January 2016, the American Samoa Department of Health
(ASDoH) detected through surveillance an increase in the number of cases
of acute febrile rash illness. Concurrently, a case of
laboratory-confirmed Zika virus infection, a mosquito-borne flavivirus
infection documented to cause microcephaly and other severe brain defects
in some infants born to women infected during pregnancy (1,2) was reported
in a traveler returning to New Zealand from American Samoa. In the absence
of local laboratory capacity to test for Zika virus, ASDoH initiated
arboviral disease control measures, including public education and vector
source reduction campaigns. On February 1, CDC staff members were deployed
to American Samoa to assist ASDoH with testing and surveillance efforts.
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To track the progression of the outbreak in the absence of confirmed case
results, trends in the number of suspected Zika virus disease cases were
monitored through syndromic surveillance using automated searches of the
electronic health record (EHR) system at the one hospital and four health
care clinics in the territory. Suspected cases were identified among
persons having =1 admission diagnosis of Zika, dengue, chikungunya, viral
exanthem, acute fever, or rash. During JanuaryJuly 2016, among a total
population of 55,502 persons, 756 suspected cases were identified for an
overall incidence of 13.6 per 1,000 persons. The incidence of suspected
cases was highest (18.4 per 1,000) in Ituau County (population = 4,676).
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To establish laboratory capabilities, ASDoH collaborated with the Pacific
Island Health Officer Association, the Hawaii Department of Health, and
CDC. During JanuaryJuly 2016, serum specimens were collected from 98
pregnant women who had sought testing, regardless of their symptoms, as
well as from 90 nonpregnant female and male patients within 5 days of at
least one sign or symptom of Zika virus disease, including fever, rash,
arthralgia, or conjunctivitis. Weekly shipments of two to 25 specimens
(median = eight specimens per week) were sent to the Hawaii Department of
Health laboratory for testing and to CDCs Arboviral Diseases Branch for
confirmatory testing; among the 188 specimens collected, two were damaged
during shipping and could not be tested. Fifty-one (27%) of the 186
specimens tested had evidence of recent Zika virus infection by real-time,
reverse transcriptionpolymerase chain reaction (rRT-PCR) (n = 25) or by
sequential testing using immunoglobulin M antibody capture enzyme-linked
immunosorbent assay (MAC-ELISA) and neutralizing antibody titers against
Zika virus that were =fourfold higher than titers against dengue virus (n
= 26) (3).
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Among the 98 pregnant women who were tested, 19 (19%) had laboratory
evidence of recent Zika virus infection, including 18 of 70 (26%)
symptomatic women and one of 28 (4%) asymptomatic woman. One case of
dengue virus infection was identified by MAC-ELISA and neutralizing
antibody testing; no cases of chikungunya were identified. The overall
incidence of confirmed Zika virus infection was 0.92 per 1,000 persons and
was highest (2.77 per 1,000) in Leasina County (population = 1,807). The
weekly number of both suspected infections identified through syndromic
surveillance and confirmed infections peaked during January 2430; the
month with the highest number of confirmed cases was February (Figure). In
any week, there were four to 34 (median = 11) times as many suspected
cases as confirmed cases identified.
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A registry of all currently pregnant women identified in the territory was
created to facilitate monitoring for adverse outcomes and implementing
targeted prevention efforts. Pregnancies beginning as early as May 2015
were identified through EHR searches, and newly identified pregnancies
were reported by the four prenatal clinics on the island. Data from 674
women were entered in the registry, including all 98 pregnant women who
were tested. Initial medical record review indicated that the majority of
pregnant women who sought prenatal care did so during their third
trimester of pregnancy. To encourage women to seek earlier prenatal care,
public messaging and clinic fee waivers were implemented. To reduce the
risk of Zika virus transmission, prenatal health clinics distributed Zika
prevention kits containing mosquito repellents, bed nets, and condoms to
674 pregnant women.
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This report details the introduction of Zika virus into American Samoa and
the challenges presented during the response. Off-island testing by the
Hawaii Department of Health and CDC facilitated identification of 51
confirmed Zika virus infections. Because of delays inherent in off-island
testing, the existing ASDoH EHR system was used to identify suspected
cases for outbreak tracking, and to identify pregnancies for monitoring.
The trend in suspected cases approximated the trend in confirmed cases
over time, but not by county. Collaboration among multiple public health
agencies helped to mitigate these challenges and highlights the importance
of continued strengthening and coordination of epidemiologic and
laboratory capacity in the Pacific Islands.
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Corresponding author: Jessica M. Healy, jhealy@xxxxxxx, 619-692-5571.
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References
Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth
defectsreviewing the evidence for causality. N Engl J Med 2016;374:19817.
CrossRef PubMed
Broutet N, Krauer F, Riesen M, et al. Zika virus as a cause of neurologic
disorders. N Engl J Med 2016;374:15069. CrossRef PubMed
CDC. Zika virus disease and Zika virus infection, 2016 case definition.
Atlanta, GA: CDC; 2016.
https://wwwn.cdc.gov/nndss/conditions/
zika-virus-disease-and-zika-virus-congenital-infection/
case-definition/2016/
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