title: Zika virus infections imported to Italy: clinical, immunological and virological findings, and public health implications.
abstract: We report the first two cases of laboratory confirmed Zika virus (ZIKV) infections imported into Italy from French Polynesia. Both patients presented with low grade fever, malaise, conjunctivitis, myalgia, arthralgia, ankle oedema, and axillary and inguinal lymphadenopathy. One patient showed leukopenia with relative monocytosis and thrombocytopenia. The diagnosis was based on ZIKV seroconversion in both cases and on ZIKV RNA detection in one patient from acute serum sample. Sera from both patients exhibited cross-reactivity with dengue virus antigens. Our immunological analysis demonstrated that recovery from ZIKV infection is associated with restoration of normal numbers of immune cells in the periphery as well as with normal function of antigen-presenting cells. ZIKV is an emerging arbovirus, which has recently spread extensively in tourist destinations on several West Pacific islands. Returning viremic travelers may ignite autochthonous infections in countries like Italy, which are infested by Aedes albopictus, a suitable vector for ZIKV. The role of clinicians is crucial and includes early diagnosis and timely notification of public health authorities in order to quickly implement adequate focal vector control measurements.
authors.affiliation: Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy. Electronic address: lorenzo.zammarchi@unifi.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zammarchi
authors.affiliation: Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy. Electronic address: giulia.stella441@gmail.com.
authors.forename: Giulia
authors.initials: G
authors.lastname: Stella
authors.affiliation: Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy. Electronic address: antoniamantella@libero.it.
authors.forename: Antonia
authors.initials: A
authors.lastname: Mantella
authors.affiliation: SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy. Electronic address: bartolozzid@aou-careggi.toscana.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Bartolozzi
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. Electronic address: tappe@bnitm.de.
authors.forename: Dennis
authors.initials: D
authors.lastname: Tappe
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. Electronic address: guenther@bnitm.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. Electronic address: oestereich@bnitm.de.
authors.forename: Lisa
authors.initials: L
authors.lastname: Oestereich
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. Electronic address: cadar@bnitm.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cadar
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany; Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, 20251 Hamburg, Germany. Electronic address: cesar.munoz-fontela@hpi.uni-hamburg.de.
authors.forename: César
authors.initials: C
authors.lastname: Muñoz-Fontela
authors.affiliation: Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy. Electronic address: alessandro.bartoloni@unifi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, Hamburg, Germany. Electronic address: jonassi@gmx.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schmidt-Chanasit
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007962:Leukocytes / Q000276:immunology; D008297:Male; D025202:Molecular Diagnostic Techniques; D011114:Polynesia; D012367:RNA, Viral / Q000097:blood; D012698:Serologic Tests; D014195:Travel; D000071243:Zika Virus Infection / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology* / Q000821:virology
chemical_list: D012367:RNA, Viral
keywords: Dengue; Immunity; Italy; Polynesia; Travel; Zika