title: Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-April 14, 2016.
abstract: Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes, and symptoms of infection can include rash, fever, arthralgia, and conjunctivitis (1).* Zika virus infection during pregnancy is a cause of microcephaly and other severe brain defects (2). Infection has also been associated with Guillain-Barré syndrome (3). In December 2015, Puerto Rico became the first U.S. jurisdiction to report local transmission of Zika virus, with the index patient reporting symptom onset on November 23, 2015 (4). This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico. During November 1, 2015-April 14, 2016, a total of 6,157 specimens from suspected Zika virus-infected patients were evaluated by the Puerto Rico Department of Health (PRDH) and CDC Dengue Branch (which is located in San Juan, Puerto Rico), and 683 (11%) had laboratory evidence of current or recent Zika virus infection by one or more tests: reverse transcription-polymerase chain reaction (RT-PCR) or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). Zika virus-infected patients resided in 50 (64%) of 78 municipalities in Puerto Rico. Median age was 34 years (range = 35 days-89 years). The most frequently reported signs and symptoms were rash (74%), myalgia (68%), headache (63%), fever (63%), and arthralgia (63%). There were 65 (10%) symptomatic pregnant women who tested positive by RT-PCR or IgM ELISA. A total of 17 (2%) patients required hospitalization, including 5 (1%) patients with suspected Guillain-Barré syndrome. One (<1%) patient died after developing severe thrombocytopenia. The public health response to the outbreak has included increased laboratory capacity to test for Zika virus infection (including blood donor screening), implementation of enhanced surveillance systems, and prevention activities focused on pregnant women. Vector control activities include indoor and outdoor residual spraying and reduction of mosquito breeding environments focused around pregnant women's homes. Residents of and travelers to Puerto Rico should continue to employ mosquito bite avoidance behaviors, take precautions to reduce the risk for sexual transmission (5), and seek medical care for any acute illness with rash or fever.
authors.forename: Emilio
authors.initials: E
authors.lastname: Dirlikov
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Ryff
authors.forename: Jomil
authors.initials: J
authors.lastname: Torres-Aponte
authors.forename: Dana L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Janice
authors.initials: J
authors.lastname: Perez-Padilla
authors.forename: Jorge
authors.initials: J
authors.lastname: Munoz-Jordan
authors.forename: Elba V
authors.initials: EV
authors.lastname: Caraballo
authors.forename: Myriam
authors.initials: M
authors.lastname: Garcia
authors.forename: Marangely Olivero
authors.initials: MO
authors.lastname: Segarra
authors.forename: Graciela
authors.initials: G
authors.lastname: Malave
authors.forename: Regina M
authors.initials: RM
authors.lastname: Simeone
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Shapiro-Mendoza
authors.forename: Lourdes Romero
authors.initials: LR
authors.lastname: Reyes
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarado-Ramy
authors.forename: Angela F
authors.initials: AF
authors.lastname: Harris
authors.forename: Aidsa
authors.initials: A
authors.lastname: Rivera
authors.forename: Chelsea G
authors.initials: CG
authors.lastname: Major
authors.forename: Marrielle
authors.initials: M
authors.lastname: Mayshack
authors.forename: Luisa I
authors.initials: LI
authors.lastname: Alvarado
authors.forename: Audrey
authors.initials: A
authors.lastname: Lenhart
authors.forename: Miguel
authors.initials: M
authors.lastname: Valencia-Prado
authors.forename: Steve
authors.initials: S
authors.lastname: Waterman
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Sharp
authors.forename: Brenda
authors.initials: B
authors.lastname: Rivera-Garcia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011247:Pregnancy; D015980:Public Health Practice; D011647:Puerto Rico / Q000453:epidemiology; D055815:Young Adult; D000071244:Zika Virus / Q000302:isolation & purification; D000071243:Zika Virus Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*