.
.
MEDICAL: DISEASES: ZIKA VIRUS:
Zika Infections More Common in Women, CDC Says
.
.
Zika Infections More Common in Women, CDC Says
Nicola M. Parry, DVM
November 11, 2016
Medscape
http://www.medscape.com/viewarticle/871767
.
.
Incidence of Zika Virus Disease by Age and Sex Puerto Rico, November 1, 2015
October 20, 2016
Matthew Lozier, PhD1; Laura Adams, DVM1; Mitchelle Flores Febo, MS1,2;
Jomil Torres-Aponte, MS2; Melissa Bello-Pagan, MS2; Kyle R. Ryff, MPH2;
Jorge Munoz-Jordan, PhD1; Myriam Garcia3,4; Aidsa Rivera, MS1; Jennifer S.
Read, MD1; Stephen H. Waterman, MD1; Tyler M. Sharp, PhD1; Brenda
Rivera-Garcia, DVM2
Weekly / November 11, 2016 / 65(44);12191223
Morbidity and Mortality Weekly Report (MMWR)
Centers for Disease Control and Prevention
http://www.cdc.gov/mmwr/volumes/65/wr/mm6544a4.htm
Suggested citation for this article:
Lozier M, Adams L, Febo MF, et al.
Incidence of Zika Virus Disease by Age and Sex Puerto Rico,
November 1, 2015
October 20, 2016.
MMWR Morb Mortal Wkly Rep 2016;65:12191223.
DOI: http://dx.doi.org/10.15585/mmwr.mm6544a4.
.
.
Zika virus is a flavivirus transmitted primarily by Aedes species
mosquitoes; symptoms of infection include rash, arthralgia, fever, and
conjunctivitis.*, Zika virus infection during pregnancy can cause
microcephaly and other serious brain anomalies (1), and in rare cases,
Zika virus infection has been associated with Guillain-Barrsyndrome (2)
and severe thrombocytopenia (3). This report describes the incidence of
reported symptomatic Zika virus disease in the U.S. territory of Puerto
Rico by age and sex. During November 1, 2015October 20, 2016, 62,500
suspected Zika virus disease cases were reported to the Puerto Rico
Department of Health (PRDH); 29,345 (47%) were confirmed by reverse
transcriptionpolymerase chain reaction (RT-PCR) testing, or were
presumptively diagnosed based on serological testing. The highest
incidence among confirmed or presumptive cases occurred among persons aged
2029 years (1,150 cases per 100,000 residents). Among 28,219 (96.2%)
nonpregnant patients with confirmed or presumptive Zika virus disease,
incidence was higher among women (936 per 100,000 population) than men
(576 per 100,000) for all age groups =20 years, and the majority (61%) of
reported Zika virus disease cases occurred in females. Among suspected
Zika virus disease cases in nonpregnant adults aged =40 years, the
percentage that tested positive among females (52%) was higher than that
among males (47%) (p<0.01). Reasons for the higher incidence of Zika virus
disease among women aged =20 years are not known; serosurveys of persons
living near confirmed Zika virus disease cases might help to elucidate
these findings. Residents of and travelers to Puerto Rico should remove or
cover standing water, practice mosquito abatement, employ mosquito bite
avoidance behaviors, take precautions to reduce the risk for sexual
transmission, and seek medical care for any acute illness with rash or
fever.
.
Epidemiologic surveillance for Zika virus disease in Puerto Rico includes
completion of the arboviral case investigation form that records
demographic data and symptoms, and submission of clinical specimens for
diagnostic testing of all persons with one or more signs or symptoms
compatible with Zika virus disease for evidence of Zika, dengue, and
chikungunya virus infection, using the Trioplex RT-PCR or immunoglobulin M
(IgM) capture enzyme-linked immunosorbent assay (MAC-ELISA)** tests (4). A
suspected case of Zika virus disease is defined as a symptomatic illness
with at least one arboviral disease-like symptom (e.g., rash, arthralgia,
or fever) in a patient seen at a health care facility, from whom a
clinical specimen was collected, and which was reported to PRDH. A
presumptive case is defined as a positive Zika virus result by MAC-ELISA
and a negative dengue virus IgM ELISA. A confirmed case of Zika virus
disease is defined as a positive RT-PCR result for Zika virus from a
suspected case. Puerto Rico population estimates from 2015 were used to
calculate incidence of Zika virus disease.
.
During November 1, 2015October 20, 2016, specimens from 62,500 patients
with suspected Zika virus disease were evaluated by RT-PCR and/or
MAC-ELISA; 28,341 (45%) were confirmed and 1,004 (2%) presumptive cases
were identified. Among confirmed and presumptive Zika virus disease cases,
1,117 (4%) were in pregnant women. Among all confirmed and presumptive
Zika virus disease cases, the median age was 32 years (range = 16 days100
years) and 18,384 (63%) were female.
.
The overall estimated incidence of confirmed and presumptive Zika virus
disease was 844 cases per 100,000 residents. The highest incidences were
in persons aged 2029 years (1,150 cases per 100,000 residents), and 1019
years (1,111 per 100,000) (Figure 1) when pregnant women were included.
When Zika virus-infected pregnant women, who might be more likely to seek
health care and be tested for suspected Zika virus disease than women in
the general population, were excluded, incidence of Zika virus disease
among all persons was 812 per 100,000; 17,267 (61%) of persons with
confirmed or presumptive Zika virus disease were female. Incidence among
males and nonpregnant females aged 19 years was 795 per 100,000, and
increased with age, peaking at 1,073 per 100,000 among persons aged 1019
years. Among males, the highest incidence was in persons aged 1019 years
(1,026 per 100,000) and declined as age increased. Although incidence in
nonpregnant females aged 1019 (1,123 per 100,000) was similar to that in
males of the same age, incidence in females continued to increase with age
and peaked among women aged 3039 years (1,256 per 100,000). Incidence
decreased among women in older age groups, but remained well above the
incidence for males (Figure 1).
.
Among all cases of Zika virus disease in nonpregnant persons, 61% were in
females; in all age groups females accounted for the majority of cases.
The proportion of female Zika virus disease cases was significantly higher
than the proportion of females in the general population in Puerto Rico
for all age groups except infants and persons aged =80 years.
.
To account for potential differences in who sought medical care and
reporting of a suspected case, the percentage of suspected Zika virus
disease cases among nonpregnant persons that tested positive for Zika
virus infection was compared by sex and age group. Among suspected cases
reported to PRDH, the proportion of cases in males and females who tested
positive was not significantly different among infants and persons aged
1039 years (Figure 2). However, the proportion of suspected cases in
persons who tested positive was significantly higher among females than
males aged 19 years and =40 years. Among suspected cases in persons aged
=40 years, the largest difference in the proportion of persons testing
positive for Zika virus disease between females and males was among
persons aged 6069 years; in this age group, among suspected cases, 51% of
females and 42% of males tested positive (p<0.001).
.
Discussion
.
Puerto Ricos database of Zika virus disease cases includes the largest
number of laboratory-confirmed cases in the world. The findings of the age
and sex distribution of Zika virus disease cases in Puerto Rico reported
in this analysis are consistent with patterns observed among suspected
cases in other countries, and notably, differs from the patterns observed
during previous outbreaks of other arbovirus diseases in Puerto Rico.
Whereas cases of dengue in 2010 (5) and chikungunya in 2014 (6) were
approximately equally distributed among men and women in Puerto Rico, more
than 60% of nonpregnant Zika virus disease cases occurred in women. This
disparity was most prominent among women aged =20 years. In addition,
among suspected cases, a higher proportion of females aged =40 years
tested positive for Zika virus infection than did males of the same age.
It is not known why Zika virus disease incidence is higher among women
aged =20 years.
.
Similar observations have been made in Bahia state (Brazil) and El
Salvador, where, overall, the reported incidence of clinically suspected
Zika virus disease cases was 75% higher in females than in males (7). In
addition, rates of probable Zika virus disease cases in Bahia state and El
Salvador were highest in women aged 2049 years (7), the same age group
most highly affected in Puerto Rico. During the 2007 Zika virus disease
outbreak in Yap State, Micronesia, the attack rate among confirmed cases
was highest among persons aged 3039 years, and the overall attack rate for
persons seeking care was higher among women than among men (8). Similar to
Puerto Rico, 61% of confirmed or probable Zika virus infections in Yap
occurred among females (8). The skewing of the distribution of Zika virus
disease cases toward women in Brazil was postulated to be because of more
exposure to Aedes mosquitoes in the home, more severe symptoms among women
in certain age groups, differences in health careseeking behavior,
reporting biases by health care workers, and sexual transmission (7,9).
Although male-to-female and female-to-male (10) sexual transmission has
been documented, data from Rio de Janeiro suggest that differences in
infection rates between men and women might be explained by male-to-female
sexual transmission (9). The same explanations might be responsible for
the observed trends in Puerto Rico. The relative contribution of sexual
transmission of Zika virus to rates of Zika virus disease is only
beginning to be explored, including relative risk of developing disease in
men and women, and through sexual transmission versus mosquito-borne
transmission.
.
Potential explanations for the higher reported incidence of Zika virus
disease in nonpregnant women than men aged =20 years include possible
differences in the rates of infection, differences in who sought care
following symptomatic infection, and susceptibility to development of
disease after infection. These differences might be explained by
conducting serosurveys to estimate the rate of Zika virus infection among
all age groups, and associating the relative frequencies by which infected
persons report symptoms, seek medical care, and are reported as suspected
cases. CDC and PRDH are currently conducting serosurveys among persons
living near confirmed Zika virus disease cases to help answer these
questions.
.
The findings of this report are subject to at least three limitations.
First, incidence rates could be skewed by health careseeking bias, because
women are more likely to seek medical care. Second, women of childbearing
age might have been more likely to seek care because a Zika virus
infection during pregnancy can cause microcephaly and other serious brain
anomalies. In an effort to remove these biases, the percentage of
suspected Zika virus disease cases among nonpregnant persons that tested
positive for Zika virus infection were calculated and found to be higher
among women than among men. Finally, underreporting of suspected Zika
virus disease cases to PRDH could result in these data not accurately
reflecting the actual distribution of Zika virus disease in Puerto Rico.
.
This investigation revealed that Zika virus infections occur in males and
females in all age groups in Puerto Rico. To reduce the risk for
infection, all residents of and travelers to Puerto Rico should remove or
cover standing water and employ mosquito bite avoidance behaviors,
including using mosquito repellents, wearing long-sleeved shirts and
pants, and ensure that homes are properly enclosed (e.g., screening
windows and doors, closing windows, and using air conditioning). To reduce
the risk for sexual transmission, especially to pregnant women, sexual
partners who reside in or traveled to Puerto Rico should abstain from sex,
or use condoms consistently and correctly each time they have sex. Women
and their partners who want to delay or avoid pregnancy in the context of
the Zika outbreak should work with a health care provider to find a birth
control method that is safe and effective.*** Such measures can also help
avoid unintended pregnancies and reduce the risk for congenitally acquired
Zika virus infection. Clinicians who suspect Zika virus disease in
patients who reside in or have recently returned from areas with ongoing
Zika virus transmission should work with their state and local health
authorities to test patients for Zika virus infection.
.
.
Additional information is available at
http://www.cdc.gov/zika/index.html.
.
Corresponding author: Matthew Lozier, mlozier@xxxxxxx, 787-706-2264.
.
1 Division of Vector-Borne Diseases, National Center for Emerging and
Zoonotic Infectious Diseases, CDC; 2Office of Epidemiology and Research,
Puerto Rico Department of Health; 3Biological and Chemical Emergencies
Laboratory, Office of Public Health Preparedness and Response, Puerto Rico
Department of Health; 4Public Health Laboratory, Puerto Rico Department of
Health.
.
.
.
* http://www.cdc.gov/zika.
http://www.salud.gov.pr/Sobre-tu-Salud/Pages/Condiciones/Zika.aspx.
http://www.salud.gov.pr/Estadisticas-Registros-y-Publicaciones.
http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM491592.pdf.
**
http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM488044.pdf.
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF.
http://jid.oxfordjournals.org/content/210/4/535.full.pdf+html.
http://www.cdc.gov/zika/prevention/protect-yourself-during-sex.html.
*** http://www.cdc.gov/zika/pregnancy/women-and-their-partners.html.
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
Cao-Lormeau VM, Blake A, Mons S, et al. Guillain-BarrSyndrome outbreak
associated with Zika virus infection in French Polynesia: a case-control
study. Lancet 2016;387:15319. CrossRef PubMed
Sharp TM, Muz-Jord J, Perez-Padilla J, et al. Zika virus infection
associated with severe thrombocytopenia. Clin Infect Dis 2016;63:1198201.
PubMed
Adams L, Bello-Pagan M, Lozier M, et al. Update: ongoing Zika virus
transmissionPuerto Rico, November 1, 2015July 7, 2016. MMWR Morb Mortal
Wkly Rep 2016;65:7749. CrossRef PubMed
Sharp TM, Hunsperger E, Santiago GA, et al. Virus-specific differences in
rates of disease during the 2010 Dengue epidemic in Puerto Rico. PLoS Negl
Trop Dis 2013;7:e2159. CrossRef PubMed
Sharp TM, Roth NM, Torres J, et al. Chikungunya cases identified through
passive surveillance and household investigationsPuerto Rico, May 5-August
12, 2014. MMWR Morb Mortal Wkly Rep 2014;63:11218. PubMed
Dos Santos T, Rodriguez A, Almiron M, et al. Zika virus and the
Guillain-BarrSyndromecase series from seven countries. N Engl J Med
2016;375:1598601. CrossRef PubMed
Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island,
Federated States of Micronesia. N Engl J Med 2009;360:253643. CrossRef
PubMed
Coelho FC, Durovni B, Saraceni V, et al. Higher incidence of Zika in adult
women than adult men in Rio de Janeiro suggests a significant contribution
of sexual transmission from men to women. Int J Infect Dis 2016;51:12832.
CrossRef PubMed
Davidson A, Slavinski S, Komoto K, Rakeman J, Weiss D. Suspected
female-to-male sexual transmission of Zika virusNew York City, 2016. MMWR
Morb Mortal Wkly Rep 2016;65:7167. CrossRef PubMed
Top
FIGURE 1. Age group, sex, and incidence
of laboratory-positive Zika virus disease cases (n = 29,345)* Puerto
Rico, November 1, 2015October 20, 2016
.
.
The complete article may be read at the URL above.
.
.
Sincerely,
David Dillard
Temple University
(215) 204 - 4584
jwne@xxxxxxxxxx
http://workface.com/e/daviddillard
Net-Gold
https://groups.io/g/Net-Gold
http://groups.yahoo.com/group/net-gold
http://listserv.temple.edu/archives/net-gold.html
https://groups.io/org/groupsio/Net-Gold/archives
http://net-gold.3172864.n2.nabble.com/
Temple University and Google Sites Research Guides
AND Discussion Group Directory
http://tinyurl.com/ngda2hk
OR
https://sites.google.com/site/researchguidesonsites/
RESEARCH PAPER WRITING
http://guides.temple.edu/research-papers
EMPLOYMENT
http://guides.temple.edu/employment-guide
INTERNSHIPS
http://guides.temple.edu/employment-internships
HOSPITALITY
http://guides.temple.edu/hospitality-guide
DISABILITIES AND EMPLOYMENT
http://guides.temple.edu/c.php?g=134557
INDOOR GARDENING
https://groups.io/g/indoor-gardening
Educator-Gold
http://groups.yahoo.com/group/Educator-Gold/
K12ADMINLIFE
http://groups.yahoo.com/group/K12AdminLIFE/
PUBLIC HEALTH RESOURCES INCLUDING EBOLA
http://guides.temple.edu/public-health-guide
STATISTICS SOURCES RESEARCH GUIDE
http://guides.temple.edu/statistics-sources
Social Work and Social Issues Discussion Group
https://groups.io/g/social-work
Tourism Discussion Group
https://groups.io/g/Tourism
Digital Scholarship Discussion Group
https://groups.io/g/DigitalScholarship/threads
https://listserv.temple.edu/cgi-bin/wa?A0=DIGITAL-SCHOLARSHIP
https://groups.yahoo.com/neo/groups/digital-scholarship/info
https://digitalscholarshipandscholarlypublication.wordpress.com/
Copyright Research Guide
Copyright, Intellectual Property and Plagiarism Sources
http://guides.temple.edu/copyright-plagiarism
Fair Use
http://guides.temple.edu/fair-use
Blog
https://educatorgold.wordpress.com/
Articles by David Dillard
https://sites.google.com/site/daviddillardsarticles/
Information Literacy (Russell Conwell Guide)
http://tinyurl.com/78a4shn
Nina Dillard's Photographs on Net-Gold
http://www.flickr.com/photos/neemers/
Twitter: davidpdillard
Temple University Site Map
https://sites.google.com/site/templeunivsitemap/home
Bushell, R. & Sheldon, P. (eds),
Wellness and Tourism: Mind, Body, Spirit,
Place, New York: Cognizant Communication Books.
Wellness Tourism: Bibliographic and Webliographic Essay
David P. Dillard
http://tinyurl.com/o4pn4o9
Rail Transportation
https://groups.io/org/groupsio/RailTransportation
INDOOR GARDENING
Improve Your Chances for Indoor Gardening Success
http://tech.groups.yahoo.com/group/IndoorGardeningUrban/
SPORT-MED
https://www.jiscmail.ac.uk/lists/sport-med.html
http://groups.yahoo.com/group/sports-med/
http://listserv.temple.edu/archives/sport-med.html
HEALTH DIET FITNESS RECREATION SPORTS TOURISM
https://groups.yahoo.com/neo/groups/healthrecsport/info
http://listserv.temple.edu/archives/health-recreation-sports-tourism.html
.
.
Please Ignore All Links to JIGLU
in search results for Net-Gold and related lists.
The Net-Gold relationship with JIGLU has
been terminated by JIGLU and these are dead links.
http://groups.yahoo.com/group/Net-Gold/message/30664
http://health.groups.yahoo.com/group/healthrecsport/message/145
Temple University Listserv Alert :
Years 2009 and 2010 Eliminated from Archives
https://sites.google.com/site/templeuniversitylistservalert/
.
.
