Zika virus outbreak in 19 English- and Dutch-speaking Caribbean countries and territories, 2015-2016

Abstract

Background: Surveillance for zika virus was enhanced in the English- and Dutch-speaking Caribbean following emergence of zika virus in Brazil in May 2015. The first autochthonous case of zika in the Caribbean was reported by Suriname in November 2015 and since then, the virus rapidly spread throughout the region. Zika shares similar epidemiology, clinical presentation, and transmission cycle to chikungunya and dengue. However, the emergence of this new virus presented some challenges to public health professionals throughout the region. The epidemiology of laboratory-confirmed zika cases reported to the Caribbean Public Health Agency (CARPHA) for 19 English- and Dutch-speaking Caribbean countries during November 1, 2015–December 29, 2016 was documented. Methods & Materials: CARPHA Member States reported clinically suspected cases of zika and submitted serum specimens to the Agency for laboratory investigation. Real-time-polymerase-chain-reaction (RT-qPCR) was used to detect zika virus in samples taken 1 - 5 days of onset of illness. Samples taken ≥6 days of onset of illness were tested by RT-qPCR or neutralization by plaque reduction and IgM ELISA (for dengue and chikungunya virus). Due to the documented link between zika virus and congenital syndrome and zika virus and Guillain-Barré Syndrome (GBS), data on these disease outcomes were extracted and presented. Results: During the epidemic period, October 1, 2015 to December 29, 2016, 5,614 cases from 19 English- and Dutch-speaking Caribbean countries and territories were tested for arboviruses. Of these, 1,447 cases tested positive for zika virus. The majority of cases were female (83%), of which 614 (51%) were pregnant. Sixty-five percent of cases were between ages 20-44 (median 30 years, range: 5 days to 90 years). Rash, fever and arthralgia affected 87%, 63% and 60% of all reported cases, respectively. Four confirmed cases of congenital syndrome associated with zika virus infection were reported from three countries during the period. One hundred and twenty-one cases of GBS were reported from ten countries with 13 reported cases laboratory confirmed for zika virus. Conclusion: The emergence of zika virus in the English- and Dutch-speaking Caribbean underscores the threats to regional health security, the need for enhanced surveillance systems and innovative prevention and control strategies.