2015–16 Zika virus epidemic

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search

2015–16 Zika virus epidemic
Zikamain 112116 930.jpg
Countries and territories with active transmission of the Zika virus
November 21, 2016[1]
Date April 2015 – November 2016

In early 2015, a widespread epidemic of Zika fever, caused by the Zika virus in Brazil, spread to other parts of South and North America. It also affected several islands in the Pacific, and Southeast Asia.[2] In January 2016, the World Health Organization (WHO) said the virus was likely to spread throughout most of the Americas by the end of the year.[3] In November 2016 WHO announced the end of the Zika epidemic.[4]

In February 2016, WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika can cause birth defects as well as neurological problems.[5][6] The virus can be transmitted from an infected pregnant woman to her fetus, then can cause microcephaly and other severe brain anomalies in the infant.[7][8][9] Zika infections in adults can result in Guillain–Barré syndrome.[9] Prior to this outbreak, Zika was considered a mild infection, as most Zika virus infections are asymptomatic, making it difficult to determine precise estimates of the number of cases.[10] In approximately one in five cases, Zika virus infections result in Zika fever, a minor illness that causes symptoms such as fever and a rash.[11][12]

The virus is spread mainly by the Aedes aegypti mosquito, which is commonly found throughout the tropical and subtropical Americas. It can also be spread by the Aedes albopictus ("Asian tiger") mosquito, which is distributed as far north as the Great Lakes region in North America.[13] Men infected with Zika can transmit the virus to their sexual partners.[6][14][15][16]

A number of countries have issued travel warnings, and the outbreak is expected to reduce tourism significantly.[6][17] Several countries have taken the unusual step of advising their citizens to delay pregnancy until more is known about the virus and its impact on fetal development.[18] Furthermore, the outbreak raised concerns regarding the safety of athletes and spectators at the 2016 Summer Olympics in Rio de Janeiro.[19][20][21]

In Brazil, the Zika virus epidemic revealed structural problems of the health system, in particular in public health services and basic sanitation.[22]

Epidemiology[edit]

As early as August 2014, physicians in Natal in northeastern Brazil began to investigate an outbreak of illness characterized by a flat pinkish rash, bloodshot eyes, fever, joint pain and headaches. While the symptoms resembled dengue fever, testing ruled out this and several other potential causes. By March 2015, the illness had spread to Salvador, Bahia and had appeared in three different states.[79] Then, in May 2015, researchers from the Federal University of Bahia and the Evandro Chagas Institute determined, using the RT-PCR technique, that the illness was an outbreak of Zika virus.[80][81]

The Zika virus was first isolated in 1947, in a rhesus monkey in a forest near Entebbe, Uganda.[82] Although serologic evidence indicated additional human exposure during subsequent decades in parts of Africa and Asia,[83] before the 2007 Yap Islands Zika virus outbreak, only 14 cases of human Zika virus disease had been documented.[82]

Researchers generally believe the virus was brought to Brazil by an infected traveler who had been exposed to the virus in French Polynesia, who was then bitten by a mosquito that then infected others.[84][85][86] Phylogenetic analysis of the first Brazilian infections have strongly indicated that the circulating virus is the Asian, rather than African, strain of the virus, and was genetically similar to the virus found in the outbreak in French Polynesia.[85][86] It appears Zika's route – from Africa and Asia to Oceania and then the Americas – may mirror that of chikungunya and dengue, both of which are now endemic in a large portion of the Americas.[87]

The specific event that brought the virus to Brazil was uncertain until March 2016. Brazilian researchers had suggested that the Zika virus arrived during the 2014 FIFA World Cup tournament.[84] French researchers speculated the virus arrived shortly afterwards, in August 2014, when canoeing teams from French Polynesia, New Caledonia, Easter Island, and the Cook Islands, which had been or were experiencing Zika outbreaks, attended the Va'a World Sprint Championships in Rio de Janeiro.[79][85] However, the outbreak in French Polynesia is known to have peaked and declined precipitously by February 2014, lending doubt to the suggestion the virus arrived later that year in Brazil with spectators and competitors.[88] In March 2016, a study published in Science, which developed a "molecular clock" based on the count of virus mutations in a relatively small sample, suggested Zika virus arrived in the Americas (most likely in Brazil) from French Polynesia between May and December 2013, well before the World Cup and Va'a Championships.[88] In the Science article, Faria and colleagues managed to trace the origins of the virus strain that is circulating in Brazil and found that this strain has little genetic variability when compared to the strain of French Polynesia; after relating the number of travellers arriving in Brazil from French Polynesia with the cases reported and the events happening in that year, the team was able to deduce that the virus arrived in Brazil in 2013 during the Confederation Cup, when Tahiti's team played against other teams in a few Brazilian cities, which attracted many tourists from both places.[89] Zika virus usually has very mild, or no symptoms, so it took almost a year for Brazil to confirm the first case of the disease. By then the outbreak was already widespread. Factors associated with the rapid spread of Zika virus in Brazil include the non-immune population, high population density, tropical climate and inadequate control of Aedes mosquitoes in the country.[90]

The above average warm temperatures of 2015-2016 caused by a strong El Nino and ongoing anthropogenic climate change created an environment conducive to the spread of the Zika Virus in Brazil[2010]. The 2015 -16 El Nino increased ocean and ground surface temperatures to above average [2010]. January 2016 brought about nine consecutive months with temperatures 1.04 °C above the global average.[91] It is important to note, however, that while South America had areas experiencing 2.0 °C above average temperatures (for 1981-2010), areas including Argentina, Southern Brazil and Uruguay experienced temperatures 0.5 °C below average.[91]

Precipitation is another crucial factor to consider as Eastern Brazil and other areas in southern South America experienced high amounts of precipitation in early 2016.[91] The environmental conditions of increased rainfall and higher average temperatures in the South American region, lead to both a longer mosquito season and a higher mosquito density[92] which created an environment in which the Zika carrying Aedes aegypti and Aedes albopictus mosquitoes can thrive. Looking forward, climate models suggest that regions favorable to the Aedes mosquitoes will grow, widening the range of Zika and other mosquito-carried diseases.[93] The potential for epidemics will spread inland and into other regions of the world, not just in tropical environments.[94]

Confirmed cases have been reported in 40 countries or territories in South America, North America, and the Caribbean,[95] as well as 16 in the western Pacific and one in Africa since the beginning of 2015 (see table).

Many countries with no cases of mosquito transmission have reported travel-related Zika cases: people who moved or came home from a Zika-affected region before they showed symptoms (see table).

Transmission[edit]

Adult Aedes aegypti mosquito, a vector or carrier of the Zika virus

Zika is a mosquito-borne disease. The resurgence of Aedes aegypti's worldwide distribution over the past 2–3 decades makes it one of the most widely distributed mosquito species.[96] In 2015, Aedes albopictus was present in tropical, subtropical, and temperate regions of the Americas, reaching as far north as the Great Lakes of North America and, internationally, living alongside Aedes aegypti in some tropical and subtropical regions.[13]

The Aedes aegypti mosquito usually bites in the morning and afternoon hours, and can be identified by the white stripes on its legs.[97] The mosquito species (Aedes aegypti, mainly, and Aedes albopictus) that can spread Zika virus can also spread dengue, chikungunya, and yellow fever.[98]

Zika can also be sexually transmitted between partners of both genders.[99] Sexual transmission of Zika has been documented in nine countries—Argentina, Canada, Chile, France, Italy, New Zealand, Peru, Portugal, and the United States—during this outbreak.[100]

Zika is transmitted from pregnant women to the fetus ("vertical transmission"), and causes microcephaly and other severe brain anomalies in infants born of women infected with the virus.[7][9]

A baby with microcephaly (left) compared to a baby with a typical head size

Zika infections in adults can cause Guillain–Barré syndrome.[9]

Diagnosis[edit]

Symptoms of Zika virus
Symptoms of Zika virus[101]

Symptoms are similar to other flaviviruses such as dengue fever or the alphavirus that causes chikungunya,[102] but are milder in form and usually last two to seven days.[6] It is estimated that 80% of cases are asymptomatic.[14] The main clinical symptoms in symptomatic patients are low-grade fever, conjunctivitis, transient joint pain (mainly in the smaller joints of the hands and feet) and maculopapular rash that often starts on the face and then spreads throughout the body.[102]

It is difficult to diagnose Zika virus infection based on clinical signs and symptoms alone due to overlaps with other arboviruses that are endemic to similar areas.[103] The methods currently available to test for Zika antibodies cross-react with dengue antibodies. An IgM-positive result in a dengue or Zika ELISA test can only be considered indicative of a recent flavivirus infection. Plaque-reduction neutralization tests (PRINT) can be performed and may be specific.[104] The Zika virus can be identified by RT-PCR in acutely ill patients.[6]

RT-PCR testing of serum and tissue samples can be used to detect the presence of the Zika virus. However, the RT-PCR test with serum is only helpful while the virus is still in the blood which is generally within the first week of the illness. After this period other methods should be used to determine if the virus is still present in the body. A test for IgM antibodies has seen to be effective over longer periods of time, as these antibodies can be present starting 4 days after the beginning of the illness and up to 12 weeks after that. However, it is suggested that a PRINT test be performed following a test for IgM antibodies to help eliminate false positives resulting from other flaviviruses. The PRINT test looks for viral-specific neutralizing antibodies. However, this test can still produce false positive results, for Zika, in individuals who have received immunization for or had previously been exposed to other flaviviruses.[105]

Containment and control[edit]

The Americas[edit]

Several countries, including Colombia, Ecuador, El Salvador, and Jamaica, advised women to postpone getting pregnant until more was known about the risks.[18][106] Plans were announced by the authorities in Rio de Janeiro, Brazil, to try to prevent the spread of the Zika virus during the 2016 Summer Olympics in Rio.[107] The health ministry of Peru installed more than 20,000 ovitraps during the 2015 dengue outbreak. The same ovitraps will be used to monitor a potential Zika outbreak in tropical regions of Peru.[108]

symptoms of microcephaly
Symptoms of microcephaly, linked to mothers infected by Zika virus[101]

On January 15, 2016, because of the "growing evidence of a link between Zika and microcephaly" the Centers for Disease Prevention and Control (CDC) issued a travel warning advising pregnant women to consider postponing travel to Brazil as well as the following countries and territories where Zika fever had been reported: Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.[109] On January 20, the Ministry of Health of Chile published a health notice.[110] On January 22, eight more countries and territories were added to the list of those affected: Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa.[111]

On February 1, Costa Rica and Nicaragua were added to the list, bringing the number of countries and territories affected to 28.[112] The agency issued additional guidelines and suggested that women thinking about becoming pregnant consult with their physicians before traveling.[113] Canada issued a similar travel advisory.[107][114] Questions have been raised about the readability and effectiveness of the press releases issued by the WHO/PAHO, CDC, and the ministries of health of affected countries with the average readability of a press release by the WHO measured at 17.1 on the Flesch Kincaid grade level readability test [115]

On February 5, after the laboratory confirmation of a Zika virus infection in the U.S. in a non-traveler, which was linked to sexual contact with an infected partner, the CDC issued interim guidelines for prevention of sexual transmission of Zika virus for the United States.[14] These guidelines recommend that men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy.[14] The guidelines recommend that pregnant women discuss any possible Zika exposure with their male partners.[14] The guidelines recommend that non-pregnant women and their partners consider taking similar measures.[14]

On February 8, CDC elevated its response efforts to a Level 1 activation, the highest response level at the agency. The CDC then issued a statement on February 23 further encouraging adherence to this guidance after 14 reports of possible sexual transmission of the virus were under investigation.[15][16] Paraguay reported its first case of Zika in a pregnant woman on March 11.[116] On March 18, CDC cautioned men who have been infected with Zika from attempting to conceive children due to probability of virus transfer from man to woman during sexual activity which in turn can affect the fetus, under this caution, men are advised not to try conception until six months after the infection.[117]

Colombia reported its first cases of microcephaly associated to the Zika virus on April 14.[118] The CDC authorized emergency use of a Zika Virus RNA Qualitative test on April 28 to detect Zika virus in the blood of patients who have symptoms of Zika virus infection and live in or have traveled to an area with ongoing Zika virus transmission. This is the first commercial test to detect Zika virus authorized by the United States Food and Drug Administration for emergency use.[119]

On May 6, Major League Baseball announced that a series of games between the Miami Marlins and Pittsburgh Pirates scheduled to be played at the end of the month in San Juan, Puerto Rico would be relocated to Marlins Park in Miami, Florida after a number of players on each team voiced concerns regarding the threat of Zika exposure.[120] By mid-August at least 37 people had contracted the virus in neighborhoods near the city of Miami, Florida, though officials estimated that the actual number of infections was much higher due to under-reporting of mild illness.[121] It was determined in June that travelers to Dominican Republic lead New York City in positive Zika tests.[122]

The first-affected area in the continental United States, the Wynwood neighborhood of Miami, was declared Zika-free in September, 2016.[123] After the virus stopped circulating in South Beach, all of Florida was declared Zika-free in December, 2016.[124] One case of local transmission was reported in Texas up until September, 2017.[125] As of 2018, Zika remains endemic in Puerto Rico,[126] but the number of cases was reduced from about 8,000 reported per month at the peak in August 2016 to about 10 reported per month in April 2017.[127]

Asia[edit]

Following the spread of Zika infection into Southeast Asia in June 2016, Singapore, Thailand and Vietnam become the most heavily affected.[48][128] Singapore has planned to release an army of mosquitoes that contain the Wolbachia bacteria to fight the Aedes aegypti mosquito population.[129] The Association of Southeast Asian Nations (ASEAN) members have increased information sharing and joint research on the virus.[130][131] On September 30, Thailand confirmed that two babies has born with microcephaly.[132] Prior to the case, Thailand has allowed abortion for pregnant women that have been affected by birth defects.[133] Malaysia is still undecided on the issue,[134] with doctors there letting the mother make the decision whether or not to abort.[135] Rentokil, a Malaysian pest company, has designed an Integrated Mosquito Management (IMM) program to curb the spread of Aedes mosquito.[136] On October 17, Zika was declared as endemic in Vietnam by the country Health Ministry due to the number of local cases.[137] Vietnam confirmed that one baby has born with microcephaly on October 31.[138] Following the rise of local Zika infection cases in the Philippines, the virus have also been declared as endemic by the country Health Department.[139] The government of the republic hosting the “One Philippines against Zika” national summit on October 28 with church in the country has joint fight to curb the spread of the virus by issuing a pastoral guidance to help raise awareness about the mosquito-borne disease among local communities.[140][141][142] Taiwan has also seen an increase of infection, most of the cases are believed to be imported from other countries.[143] On October 27, Myanmar reported its first imported case on a pregnant foreign woman.[39]

International[edit]

Agent for endemic diseases of the city of Votuporanga, São Paulo, Brazil

Governments or health agencies such as those of Australia,[144] Canada,[145] China,[146] Hong Kong,[147] Indonesia,[148] Ireland,[106] Japan,[149] Malaysia,[150] New Zealand,[151] Philippines,[152] Singapore,[153] South Korea,[154] Taiwan,[155] the United Kingdom,[156] United States[157] as well the European Union[107] issued travel warnings. The warnings are predicted to have an effect on the tourism industry in affected countries.[158][159][160]

To prevent the transmission of the Zika virus, WHO recommends using insect repellent, wearing long-sleeved clothes to cover the body, and using screens and mosquito nets to exclude flying insects from dwellings or sleeping areas. It is also vital to eliminate any standing water near homes to minimize breeding areas for mosquitoes. Authorities can treat larger water containers with recommended larvicides.[97][161] Furthermore, the Centers for Disease Control and Prevention (CDC) recommends that containers holding water near homes either be sealed or scrubbed once per week, because mosquito eggs can stick to them.[98]

On February 1, 2016, WHO declared the cluster of microcephaly cases and other neurological disorders a Public Health Emergency of International Concern,[5] which may reduce the number of visitors to the Rio Olympics in 2016.[162] The designation has been applied in the past to the Ebola outbreak in 2014, the outbreak of polio in Syria in 2013, and the 2009 flu pandemic.[163] South Korea held an emergency meeting in response to the WHO declaration on February 2, 2016.[154] A second meeting of the WHO-convened emergency committee, held on March 8, 2016, reaffirmed the situation's status as a Public Health Emergency of International Concern. The committee reported that evidence was increasing for a causal relationship between Zika virus and microcephaly and other neurological conditions, and called for continued research, aggressive mosquito control, and improved surveillance and communication of risks to the public. The report stated that pregnant women should be advised not to travel to affected areas, and should use safe sex practices if their partners lived in or travelled to affected areas throughout their pregnancy.[164] On March 9, 2016, WHO announced that research should prioritise prevention and diagnosis, not treatment, and in particular non-live vaccines suitable for pregnant women and those of childbearing age, novel mosquito control measures, and diagnostic tests that can detect dengue and chikungunya as well as Zika.[165]

Responses[edit]

The Brazilian Army has sent more than 200,000 troops to go "house to house" in the campaign against Zika-carrying mosquitoes.
Brazilian Army soldier analyzes the water from a cistern.

In January 2016, it was announced that, in response to the Zika virus outbreak, Brazil's National Biosafety Committee approved the releases of more genetically modified Aedes aegypti mosquitoes throughout their country.[166] Previously, in July 2015, Oxitec had published results of a test in the Juazeiro region of Brazil, of so-called "self-limiting" mosquitoes, to fight dengue, chikungunya, and Zika viruses. They concluded that mosquito populations were reduced by over 90% in the test region.[166][167][168] Male genetically modified mosquitoes mate with females in the wild and transmit a self-limiting gene that causes the resulting offspring to die before reaching adulthood and thus diminishes the local mosquito population.[166][168] In January 2016 the technique was being used to try to combat the Zika virus in the town of Piracicaba, São Paulo.[169]

On February 1, 2016, the WHO declared the current Zika virus outbreak an international public health emergency,[5][170] and the Brazilian President released a decree that increased local and federal pest control agents' access to private property required by mobilization actions for the prevention and elimination of Aedes mosquito outbreaks in the country.[171]

Some experts have proposed combatting the spread of the Zika virus by breeding and releasing mosquitoes that have either been genetically modified to prevent them from transmitting pathogens or that have been infected with the Wolbachia bacterium, thought to inhibit the spread of viruses.[172][173] Another proposed technique consists of using radiation to sterilize male larvae so that when they mate, they produce no progeny.[174] Male mosquitoes do not bite or spread disease.[175]

In February, the Brazilian federal government mobilized 60% of the country's Armed Forces, or about 220,000 soldiers, to warn and educate the populations of 350 municipalities on how to reduce mosquito breeding grounds.[176]

A joint statement on the sharing of data and results on the Zika outbreak in the Americas and future public health emergencies was issued on February 10, 2016, by a group of more than 30 global health bodies.[177] The statement reinforces a similar consensus statement issued by WHO in September 2015.[178] The statement calls for free access to all data as rapidly and widely as possible.[179]

In February 2016, Google announced that they were donating $1 million via UNICEF to fight the spread of the Zika virus and offering professional personnel to help to determine where it will hit next.[180]

Prevention and treatment[edit]

While there are no known cures for Zika, there have been recent developments in Zika vaccination. Three vaccine designs are showing high confidence levels of protection against the Zika virus. Scientists have conducted tests on the rhesus monkey, and human trials begun in late 2016.[181]

This preventative treatment is promising, but it will take years before it is available for widespread usage.[182]

The three approaches to the vaccine include an inactive Zika virus test and the other two involve replicas of the virus's genetic code. During these vaccination tests, complete protection against the virus was deemed possible with none being linked to major side-effects.

British experts are clear that any of the vaccines would take considerable time to develop. Dr Ed Wright, a senior lecturer and virologist at the University of Westminster, said: "All of the vaccines currently under development are many years away from being licensed and available for widespread public use." Jonathan Ball, professor of molecular virology at the University of Nottingham, said: "We knew that these vaccines worked in mice and now the researchers have shown that they also protect non-human primates from Zika virus infection." "The next step will be to see if these vaccines are safe and the scientists hope to start early trials in humans to address this."[183]

Kineta, a Seattle-based biotech company, is actively working on treatments and has received an undisclosed amount of funding from National Institute of Allergy and Infectious Disease, one of the National Institutes of Health, to carry on the research. Kineta CEO Dr Shawn Iadonato said in a statement. "We are eager to expand testing of our broad spectrum antivirals in Zika virus as they have shown compelling efficacy across other flaviviruses such as Dengue and West Nile and have the potential for long-term development."[184]

As of July 26, 2016, Inovio Pharmaceuticals, Inc. dosed the first subject in its multi-center phase I trial to evaluate Inovio's Zika DNA vaccine (GLS-5700). In addition to the previously announced US FDA approval for the conduct of the study, Health Canada’s Health Products and Food Branch has also approved this study, which will be conducted at clinical sites in Miami, Philadelphia, and Quebec City. The phase I, open-label, dose-ranging study of 40 healthy adult volunteers is evaluating the safety, tolerability and immunogenicity of GLS-5700 administered with the CELLECTRA®-3P device, Inovio's proprietary intradermal DNA delivery device. In preclinical testing, this synthetic vaccine induced robust antibody and T cell responses – the immune responses necessary to fight viral infections – in small and large animal models.[185]

Challenges to US response[edit]

In May 2017, the Government Accountability Office published a report, "Emerging Infectious Diseases: Actions Needed to Address the Challenges of Responding to Zika Virus Disease Outbreak", to correspond with an associated House subcommittee hearing. The GAO said that even though scientific breakthroughs have increased in recent years, the United States remains unprepared to handle a Zika virus outbreak.[186]

Timothy Persons, head scientist at the GAO, listed areas of limited research that damage the United States’ ability to effectively respond to a Zika outbreak, including an accurate record of the number of cases in the United States, components associated with transmission from mothers to children (especially regarding pregnancy), risk of transmission through bodily fluid as related to the potential for sexual transmission of the virus, impact of prior exposure to Zika and other arboviruses, and both short-term and long-term outcomes. Recent outbreaks have been connected to an alarming a spike in microcephaly, a birth defect that inhibits the proper development of a baby’s brain, and Guillain-Barré syndrome, which causes paralysis.[186]

Other challenges include the lack of a safe and effective vaccine, a complicated diagnostic process, and faltering support for research funding in the federal government. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said "There aren’t any federally licensed vaccines or specific therapeutics currently available to prevent or treat Zika." Zika is often difficult to distinguish from other illnesses that are spread by mosquitoes, like dengue, West Nile, and chikungunya, among others. President Trump’s budget proposal for 2018 proposed stripping $800 billion from Medicaid over ten years. Democratic Representative Frank Pallone of New Jersey said that this decision "endangers our ability to manage public health emergencies like Zika."[186]

Controversies[edit]

Some efforts to contain the spread of Zika virus have been controversial. Oxitec, the company behind the "self-limiting" mosquitoes, which pass on a fatal gene to their offspring, released in Brazil, has faced criticism from environmental groups, who fear that releasing a new mosquito strain into the wild will damage the ecosystem. In the short term, the concern is that a drop in the mosquito population could affect the populations of other species. Supporters claim that the environmental impact of the "self-limiting" mosquitoes will be minimal, since only one species of mosquito is being targeted and the genetically-modified mosquitoes are still safe for predators to eat. Oxitec Product Development Manager Derric Nimmo likened the process to "going in with a scalpel and taking away Aedes aegypti, leaving everything untouched."[187] Since Aedes aegypti is an imported invasive species in Brazil, some experts expect that its eradication will have little impact on the environment. However, other environmentalists emphasize that the long-term consequences of eliminating an entire species cannot be predicted.[188]

Government recommendations that women delay pregnancy have also proven to be controversial. Human and reproductive rights groups have deemed the recommendations irresponsible and difficult to follow, since women alone are tasked with avoiding pregnancy despite having little control to do so.[189] A 2012 study suggests that 56% of pregnancies in Latin America and the Caribbean are unplanned (compared to an average unplanned pregnancy rate of 40% worldwide).[190] Access to contraceptives might be limited in regions where the Roman Catholic Church is predominant, such as in El Salvador.[191] Anti-abortion laws in much of the region leave women with no recourse once they become pregnant. Aside from three countries where abortion is widely available (French Guiana, Guyana, and Uruguay) and three countries where abortion is allowed in cases of fetal malformation (Colombia, Mexico, and Panama), most of the region only permits abortion in the cases of rape, incest, or danger to the mother's health. In El Salvador, abortion is illegal under all circumstances.[189]

On February 5, 2016, the UN High Commissioner for Human Rights urged Latin American governments to consider repealing their policies regarding contraception and abortion, emphasizing that "upholding human rights is essential to an effective public health response."[192] On February 16, 2016, the Vatican condemned the UN for its call to action, deeming it "an illegitimate response" to the Zika crisis and emphasizing that "a diagnosis of microcephaly in a child should not warrant a death sentence."[193]

On February 18, 2016, after a trip to Latin America, Pope Francis stated that "avoiding pregnancy is not an absolute evil" in cases such as the Zika virus outbreak. His comments sparked speculation that the use of contraception may be morally permissible in the prevention of the Zika virus.[194]

Scientific Communication and Concerns during the 2015-16 Zika virus epidemic[edit]

The 2015-2016 Zika virus outbreak became an important topic on many social media sites, especially on Twitter. An analysis of Twitter posts on February 2, 2016 showed that 50 tweets per minute were posted about Zika, many of which contained the hashtags #salud, which means health in Spanish as well as #who, which served as a reference to the World Health Organization.[195]

The epidemic also caused a rise in tweets from college students upset that their spring break trips and study abroad plans had been changed or cancelled due to the virus’ spread.[195]

Many studies have been conducted on the connections and impact of social media mentions of Zika. One analysis found that the primary topics discussed on Twitter before the peak of the outbreak regarding Zika included Zika’s impact, reactions to Zika, pregnancy and microcephaly, transmission routes of Zika, and case reports.[196] During the summer of 2016 when Zika was spreading at a much faster rate, this social media analysis determined that the major topics on Twitter regarding Zika had become concerns about the spread of Zika, criticism of Congress, news about Zika, and scientific information about Zika.[196] The same study also found that tweets from reputable institutions and people holding scientific credentials demonstrated the ability of Twitter as a source to spread information quickly on the internet.[196] Another study found that the Centers for Disease Control and Prevention as well as the general public showed similar concerns about Zika. The CDC’s posts on Twitter during the outbreak focused on symptoms and education for Zika.[197] However, the public had more of a tendency to focus concern on the consequences of Zika on women and infants, such as microcephaly.[197]

While there was concern for children on social media, this concern was lacking in countries largely impacted by Zika virus, such as Brazil. In Brazil, struggling mothers of infants with microcephaly caused by Zika have used support systems on social media on the cellphone chat app called Whatsapp or on Facebook pages that can help connect mothers in need of supplies and money to donors.[198]

The heavy traditional news and social media coverage of the virus spreading did cause concern over lack of reliability. Research has found that between May and June 2016, four out of five social media posts about Zika provided accurate information, but inaccurate posts were much more popular. This led many researchers to worry about the quality of information being spread and shared on social media.[199] Google Trends showed that Zika did not become a trending topic for the media until January 2016.[200] A study done found that 81 percent of the most popular posts on Facebook about Zika did contain truthful information, but posts spreading false information were far more popular.[199] Initial media reports on Zika in the United States focused on reassuring viewers and readers that Zika was not a threat in the United States.[200] Studies have found that real-time social media updates are desirable methods for communication during the emergence of infectious diseases. However, misinformation is common and data control in the cyber world has become a growing necessity.[197]

Many people criticized the lack of governmental response from the U.S. Government in the wake of the crisis.[201] The United States was criticized for a lack of preparedness in terms of an ability to contain a virus outbreak in the United States. The Obama Administration requested an emergency supplemental appropriation of $1.86 billion for both domestic and international response to the crisis.[202] In response to this request, Congress redirected $589 million from funds previously dedicated to Ebola instead of allocating new funds.[202] Another criticism regarding Zika funding had to do with the fact that Congress members still took vacation in July 2016 before allocating any of the funds requested in February 2016.[203]

In August 2016, the Centers for Disease Control and Prevention reported that they had spent $194 million of the initial $222 million allocation to fight Zika virus.[204] Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases said that the NIAID was running out of funds, which would substantially slow down the development of vaccines.[205] Although the government faced criticism for not responding strongly enough to the Zika outbreak, the government eventually provided funding of $1.1 billion for Zika in October 2016. It took congress nearly seven months to agree to this allocation, which left many prevention and education projects without funding for a substantial amount of time.[206] Senate Democrats urged Republicans to approve the full amount of funding more quickly rather than waiting for major transmission of Zika virus to begin in the United States.[207]

In 2017, public health experts are still concerned about the failure of the Zika response in the United States.[208] Many officials failed to provide information about Zika’s sexual transmission. New York City subway systems had posters about mosquitos while all local cases reported had been picked up elsewhere or transmitted sexually.[208] Many experts believe that the United States lacked severely in providing the public with information to prevent sexual transmission of the virus.[208]

See also[edit]

References[edit]

  1. ^ "All Countries and Territories with Active Zika Virus Transmission". Centers for Disease Control and Prevention. November 21, 2016. 
  2. ^ "Zika Map - Virus & Contagious Disease Surveillance". HealthMap. 
  3. ^ "WHO sees Zika outbreak spreading through the Americas". Reuters. January 25, 2016. 
  4. ^ "WHO: Zika Virus No Longer International Emergency But Still a Threat". Newsline. November 21, 2016. 
  5. ^ a b c "WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain–Barré syndrome". World Health Organization. February 1, 2016. Retrieved February 2, 2016. 
  6. ^ a b c d e Sikka, Veronica; Chattu, Vijay Kumar; Popli, Raaj K.; et al. (February 11, 2016). "The emergence of zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint working Group (JWG)". Journal of Global Infectious Diseases. 8 (1): 3–15. doi:10.4103/0974-777X.176140. ISSN 0974-8245. PMC 4785754Freely accessible. PMID 27013839. 
  7. ^ a b Rasmussen, Sonja A.; Jamieson, Denise J.; Honein, Margaret A.; Petersen, Lyle R. (April 13, 2016). "Zika Virus and Birth Defects — Reviewing the Evidence for Causality". New England Journal of Medicine. 374 (20): 1981–7. doi:10.1056/NEJMsr1604338. ISSN 0028-4793. PMID 27074377. 
  8. ^ "CDC Concludes Zika Causes Microcephaly and Other Birth Defects". CDC. April 13, 2016. Retrieved April 14, 2016. 
  9. ^ a b c d "Zika Virus Microcephaly And Guillain–Barré Syndrome Situation Report" (PDF). World Health Organization. April 7, 2016. Retrieved April 8, 2016. 
  10. ^ "Brazil Health Minister: Zika epidemic worse than thought". ITV News. January 28, 2016. Retrieved February 1, 2016. 
  11. ^ "Zika Virus". Centers for Disease Control and Prevention. 
  12. ^ "Zika Virus". Centers for Disease Control and Prevention. 
  13. ^ a b Kraemer, Moritz U.G.; Sinka, Marianne E.; Duda, Kirsten A.; et al. (July 7, 2015). "The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus". ELife. 4: e08347. doi:10.7554/eLife.08347. ISSN 2050-084X. PMC 4493616Freely accessible. PMID 26126267. 
  14. ^ a b c d e f Oster, Alexandra M.; Brooks, John T.; Stryker, Jo Ellen; et al. (2016). "Interim Guidelines for Prevention of Sexual Transmission of Zika Virus – United States, 2016". Morbidity and Mortality Weekly Report. 65 (5): 120–121. doi:10.15585/mmwr.mm6505e1. ISSN 0149-2195. PMID 26866485. 
  15. ^ a b "CDC encourages following guidance to prevent sexual transmission of Zika virus". CDC Newsroom. Centers for Disease Control and Prevention. February 23, 2016. 
  16. ^ a b Tavernise, Sabrina (February 23, 2016). "C.D.C. Investigating 14 New Reports of Zika Transmission Through Sex". The New York Times. Retrieved February 24, 2016. 
  17. ^ Kiernan, Paul; Jelmayer, Rogerio (February 3, 2016). "Zika Fears Imperil Brazil's Tourism Push". The Wall Street Journal. Dow Jones & Company. Retrieved February 27, 2016. 
  18. ^ a b "Zika virus triggers pregnancy delay calls". BBC News Online. January 23, 2016. 
  19. ^ Rogers, Martin (February 25, 2016). "World Health Organization: Athletes should not fear Zika virus at Rio Olympics". USA Today. 
  20. ^ Vox, Ford (February 12, 2016). "What real threat does Zika pose to the Rio Olympics? History has an answer". CNN. 
  21. ^ "USA cyclist Tejay van Garderen withdraws from Olympics over Zika virus". www.theguardian.com. The Guardian. June 2, 2016. 
  22. ^ Buriti, Renata (October 30, 2016). "Virus shines light on structural problems". D+C, Development and Cooperation. Retrieved November 28, 2016. 
  23. ^ Gramer, Robbie (January 13, 2017). "The Zika Virus Just Quietly Spread to Southwest Africa". Foreign Policy. 
  24. ^ Costa, Denise (March 11, 2016). "Zika em Cabo Verde levanta suspeitas de "estirpe africana" do vírus" [Zika in Cape Verde is suspected to be "African strain" of the virus]. United Nations Radio (in Portuguese). United Nations. 
  25. ^ "CDTR Week 27, 3–9 July 2016" (PDF). Communicable Disease Threats Reports. European Centre for Disease Prevention and Control. July 8, 2016. 
  26. ^ "CDTR Week 33, 14–20 August 2016" (PDF). Communicable Disease Threats Reports. European Centre for Disease Prevention and Control. August 19, 2016. 
  27. ^ "Épidémie – Madagascar vulnérable au virus Zika" [Epidemic — Madagascar vulnerable to Zika]. L'Express de Madagascar (in French). March 12, 2016. Archived from the original on March 15, 2016. 
  28. ^ "Un nouveau cas de Zika importé à La Réunion" [A new case of Zika imported into Réunion]. Réunion 1re (in French). Saint-Denis: France Télévisions. April 27, 2016. 
  29. ^ "South Africa confirms first case of Zika virus". Reuters. February 20, 2016. Retrieved March 2, 2017. 
  30. ^ "Zika suspected and confirmed cases reported by countries and territories in the Americas, 2015–2016; Cumulative cases". Pan American Health Organization. November 23, 2016. 
  31. ^ a b c d "Zika Cases in the United States". Zika virus. Centers for Disease Control and Prevention. November 29, 2017. 
  32. ^ a b "CDTR Week 47, 20–26 November 2016" (PDF). Communicable Disease Threats Reports. European Centre for Disease Prevention and Control. November 25, 2016. Since June 2015 (week 26), 20 countries (Austria, Belgium, the Czech Republic, Denmark, Finland, France, Hungary, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom) have reported 1,996 travel-associated Zika virus infections through The European Surveillance System (TESSy). Over the same time period, eight EU/EEA Member States reported 99 Zika cases among pregnant women. 
  33. ^ Fei Fei (September 13, 2016). "Chinese mainland confirms 23rd Zika case". CRIENGLISH.com. 
  34. ^ "1st imported Zika virus case reported in Hong Kong, traveled to St. Barts". Outbreak News Today. August 25, 2016. 
  35. ^ Schuster, Ruth (May 31, 2016). "Number of Known Zika Cases in Israel Climbs to 9". Haaretz. 
  36. ^ "Zika case No. 7 confirmed in Japanese returnee from Latin America". The Japan Times. June 10, 2016. 
  37. ^ Hashini Kavishtri Kannan (December 18, 2016). "Eighth confirmed Zika case in Malaysia, 67-year-old man from Petaling Jaya infected". New Straits Times. 
  38. ^ "Zika virus infection – Maldives". Disease Outbreak News. World Health Organization. February 8, 2016. Retrieved February 11, 2016. 
  39. ^ a b Myint Kay Thi; Pyae Thet Phyo; Kyawt Darly Lin; Zar Zar Soe (October 31, 2016). "First Zika case confirmed in Yangon". Myanmar Times. 
  40. ^ Sheila Crisostomo; Christina Mendez (September 6, 2016). "DOH confirms 6th Zika case in Philippines". The Philippine Star. 
  41. ^ "DOH: PH now has 39 Zika cases, including 3 pregnant women". CNN Philippines. December 6, 2016. 
  42. ^ Chia, Lianne (October 27, 2016). "Singapore's Zika journey: Two months on". Channel NewsAsia. 
  43. ^ "14th Zika virus infection in South Korea". IANS. Business Insider. September 24, 2016. 
  44. ^ Chen Wei-ting; Frances Huang (October 17, 2016). "Taiwan reports one more imported Zika case". Focus Taiwan. 
  45. ^ "Two more Zika cases reported in northern Thailand". Xinhua. September 2, 2016. 
  46. ^ "Thai Health Min: Number of Zika patients approaching 400". Thai Visa News. October 5, 2016. Archived from the original on October 6, 2016. 
  47. ^ "Thailand detects 33 new Zika virus cases". 
  48. ^ a b "Zika on the rise in HCM City". Vietnam News Agency. Việt Nam News. December 21, 2016. 
  49. ^ a b c d e f g "Zika virus disease epidemic: potential association with microcephaly and Guillain–Barré syndrome" (PDF). Rapid Risk Assessments. Stockholm: European Centre for Disease Prevention and Control. March 9, 2016. 
  50. ^ "Canary Islands report 3rd imported Zika case". Outbreak News Today. April 16, 2016. 
  51. ^ "Fourth case of Zika reported in Czech Republic". Prague Daily Monitor. March 24, 2016. 
  52. ^ "Données épidémiologiques" [Epidemiological data]. Zika (in French). Institut de Veille Sanitaire. October 20, 2016. 
  53. ^ "12 Zika cases registered in Germany in May". New China. June 1, 2016. 
  54. ^ "Zika cases reported in Ireland". Health Protection Surveillance Center. October 21, 2016. Archived from the original on May 16, 2016. 
  55. ^ "Oggetto: attività di disinfestazione per la tutela della sanità pubblica" (PDF) (in Italian). Ministero della Salute. June 16, 2016. 
  56. ^ "Madeira reports two imported Zika cases". Outbreak News Today. March 27, 2016. 
  57. ^ "Zikavirus" [Zikavirus]. Public Health (in Dutch). Rijksinstituut voor Volksgezondheid en Milieu. Retrieved October 26, 2016. 
  58. ^ Sæther, Anne Stine (August 13, 2016). "Ti gravide har vært zika-smittet i Norge" [Ten pregnant has been Zika-infected in Norway]. VG (in Norwegian). Retrieved August 13, 2016. 
  59. ^ "University of Warsaw Confirms First Cases of Zika Virus in Poland". Sputnik News. August 16, 2016. 
  60. ^ "Doença por vírus Zika" [Zika virus disease] (in Portuguese). Serviço Nacional de Saúde. May 19, 2016. 
  61. ^ "Al treilea caz de Zika confirmat în România" [Third case of Zika confirmed in Romania]. Digi24 (in Romanian). July 28, 2016. 
  62. ^ Zubkov, Ivan (September 7, 2016). "Девятый турист вернулся в Россию с вирусом Зика" [Ninth tourist returned to Russia with Zika virus]. Izvestia (in Russian). 
  63. ^ "Casos diagnosticados" [Diagnosed cases]. Public Health (in Spanish). Ministerio de Sanidad, Servicios Sociales e Igualdad. October 24, 2016. 
  64. ^ "Confirmed cases of Zika virus soar in Switzerland". thelocal.ch. July 26, 2016. 
  65. ^ "Zika virus (ZIKV): clinical and travel guidance". Health protection – collection. Public Health England. October 26, 2016. 
  66. ^ "Zika Outbreak Situation Report" (PDF). reliefweb. American Samoa Department of Health. June 23, 2016. 
  67. ^ Branley, Alison (October 24, 2016). "Zika: Number of Australian cases rises to 76 as north Queensland prepares for mosquito breeding season". ABC Online. Australia. 
  68. ^ a b "CDTR Week 42, 16–22 October 2016" (PDF). Communicable Disease Threats Reports. European Centre for Disease Prevention and Control. October 21, 2016. 
  69. ^ Dipitika, Sharon (May 18, 2016). "332 dengue fever cases recorded from January this year". Fijivillage. 
  70. ^ "Zika in Kosrae, Federated States of Micronesia, Situation Report #7" (PDF). reliefweb. Kosrae EpiNet Team. June 24, 2016. 
  71. ^ "Zika in Republic of the Marshall Islands, 2015-2016" (PDF). ReliefWeb Updates. Government of the Marshall Islands. April 20, 2016. 
  72. ^ "Nauru latest Pacific country to discover zika". Radio New Zealand News. April 28, 2016. 
  73. ^ a b c "Zika virus infection outbreak, Brazil and the Pacific region" (PDF). Stockholm: European Centre for Disease Prevention and Control. May 25, 2015. p. 4. Retrieved February 12, 2016. 
  74. ^ "Zika virus infection weekly report" (PDF). Public Health Surveillance. Institute of Environmental Science and Research. August 31, 2016. Archived from the original (PDF) on September 17, 2016. 
  75. ^ "Zika virus infection – Papua New Guinea". Disease Outbreak News. World Health Organization. April 22, 2016. 
  76. ^ "Samoa records 10 Zika cases". Xinhua. March 21, 2016. 
  77. ^ "Tonga says Zika clean-up working". Radio New Zealand. March 5, 2016. 
  78. ^ Herriman, Robert (April 28, 2015). "Zika virus reported on Vanuatu for the first time". Outbreak News Today. 
  79. ^ a b McNeil, Jr., Donald G.; Romero, Simon; Tavernise, Sabrina (February 6, 2016). "How a Medical Mystery in Brazil Led Doctors to Zika". The New York Times. Retrieved March 6, 2016. 
  80. ^ "Identificado vírus causador de doença misteriosa em Salvador e RMS – notícias em Bahia". GloboNews (in Portuguese). São Paulo. April 29, 2015. 
  81. ^ "Zika virus – Brazil: confirmed". ProMED-mail. International Society for Infectious Diseases. May 19, 2015. 
  82. ^ a b Duffy, Mark R.; Chen, Tai-Ho; Hancock, W. Thane (June 11, 2009). "Zika virus outbreak on Yap Islands, Federated States of Micronesia". The New England Journal of Medicine. 360 (24): 2536–2543. doi:10.1056/NEJMoa0805715. PMID 19516034. 
  83. ^ Hayes, Edward B. (September 2009). "Zika virus outside Africa". Emerging Infectious Diseases. Centers for Disease Control and Prevention. 15 (9): 1347–1350. doi:10.3201/eid1509.090442. ISSN 1080-6059. PMC 2819875Freely accessible. PMID 19788800. 
  84. ^ a b Romero, Simon (January 29, 2016). "Tears and Bewilderment in Brazilian City Facing Zika Crisis". The New York Times. Retrieved February 1, 2016. 
  85. ^ a b c Musso, Didier (October 2015). "Zika Virus Transmission from French Polynesia to Brazil". Emerging Infectious Diseases. Centers for Disease Control and Prevention. 21 (10): 1887. doi:10.3201/eid2110.151125. Retrieved March 8, 2016. 
  86. ^ a b Murthy, Bhavini (January 28, 2016). "Origin of Zika Virus Outbreak in Brazil May Be Linked to Major Sporting Events". ABC News. Retrieved March 6, 2016. 
  87. ^ Musso, D; Cao-Lormeau, VM; Gubler, DJ (July 18, 2015). "Zika virus: following the path of dengue and chikungunya?". The Lancet. 386 (9990): 243–4. doi:10.1016/S0140-6736(15)61273-9. PMID 26194519. 
  88. ^ a b McNeil, Donald G., Jr. (March 24, 2016). "One Traveler May Have Brought Zika to the Americas in 2013". The New York Times. Retrieved March 24, 2016. 
  89. ^ Faria, N. R.; Azevedo, R. d. S. d. S.; Kraemer, M. U. G.; et al. (March 24, 2016). "Zika virus in the Americas: Early epidemiological and genetic findings". Science. 352 (6283): 345–9. Bibcode:2016Sci...352..345F. doi:10.1126/science.aaf5036. ISSN 0036-8075. PMC 4918795Freely accessible. PMID 27013429. 
  90. ^ Ai, Jing-Wen; Zhang, Ying; Zhang, Wenhong (February 23, 2016). "Zika virus outbreak: 'a perfect storm'". Emerging Microbes and Infections. Shanghai Shangyixun Cultural Communication. 5 (3): e21. doi:10.1038/emi.2016.42. ISSN 2222-1751. 
  91. ^ a b c Global Climate Report - January 2016. Retrieved March 16, 2018, from https://www.ncdc.noaa.gov/sotc/global/201601
  92. ^ Samy, A. M., Elaagip, A. H., Kenawy, M. A., Ayres, C. F. J., Peterson, A. T., & Soliman, D. E. (2016). Climate Change Influences on the Global Potential Distribution of the Mosquito Culex quinquefasciatus, Vector of West Nile Virus and Lymphatic Filariasis. PLoS ONE, 11(10), e0163863. http://doi.org/10.1371/journal.pone.0163863
  93. ^ Khormi, H. M., & Kumar, L. (2014). Climate change and the potential global distribution of Aedes aegypti: spatial modelling using GIS and CLIMEX. Geospatial health, 8(2), 405-415.
  94. ^ Liu-Helmersson, J., Quam, M., Wilder-Smith, A., Stenlund, H., Ebi, K., Massad, E., & Rocklöv, J. (2016). Climate change and Aedes vectors: 21st century projections for dengue transmission in Europe. EBioMedicine, 7, 267-277.
  95. ^ "Geographic distribution of confirmed autochthonous cases of Zika virus (vector-borne transmission) in countries and territories of the Americas, 2015-2016". Epidemic Diseases–Zika in the Americas. Pan American Health Organization. May 26, 2016. Retrieved May 30, 2016. 
  96. ^ "Aedes aegypti". European Centre for Disease Prevention and Control. 
  97. ^ a b "Zika virus fact sheet". World Health Organization. February 2016. Retrieved February 15, 2016. 
  98. ^ a b "Help Control Mosquitoes that Spread Dengue, Chikungunya, and Zika Viruses" (PDF). Fact Sheets. Centers for Disease Control. August 2015. 
  99. ^ "Clinical Guidance for Healthcare Providers for Prevention of Sexual Transmission of Zika Virus". CDC. 2017-07-21. Retrieved 2017-10-30. 
  100. ^ "Canada reports 1st sexually transmitted Zika case, 9th country to report person-to-person transmission". Outbreak News Today. April 26, 2016. 
  101. ^ a b "Understanding Zika". Retrieved February 8, 2016. 
  102. ^ a b Musso, D.; Nilles, E.J.; Cao-Lormeau, V.-M. (2014). "Rapid spread of emerging Zika virus in the Pacific area". Clinical Microbiology and Infection. 20 (10): O595–6. doi:10.1111/1469-0691.12707. PMID 24909208. 
  103. ^ Fauci, Anthony S.; Morens, David M. (February 18, 2016). "Zika Virus in the Americas – Yet Another Arbovirus Threat". New England Journal of Medicine. 374 (7): 601–604. doi:10.1056/NEJMp1600297. PMID 26761185. 
  104. ^ "Revised diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health Laboratories" (PDF). Division of Vector-Borne Diseases. Centers for Disease Control and Prevention. February 7, 2016. 
  105. ^ Karwowski, Mateusz P.; Nelson, Jennifer M.; Staples, J. Erin; Fischer, Marc; Fleming-Dutra, Katherine E.; Villanueva, Julie; Powers, Ann M.; Mead, Paul; Honein,, Margaret A.; Moore, Cynthia A.; Rasmussen, Sonja A. (May 2016). "Zika Virus Disease: A CDC Update for Pediatric Health Care Providers". Pediatrics. 137 (5): e20160621. doi:10.1542/peds.2016-0621. PMID 27009036. Retrieved May 27, 2016. 
  106. ^ a b "Pregnant Irish women warned over Zika virus in central and South America". RTÉ News. January 22, 2016. 
  107. ^ a b c "Zika: Olympics plans announced by Rio authorities". BBC News. January 24, 2016. 
  108. ^ Post, Colin (January 25, 2016). "Northern Peru braces for mosquito-borne Zika virus". Peru Reports. 
  109. ^ Lowes, Robert (January 15, 2016). "CDC Issues Zika Travel Alert". Medscape Medical News. 
  110. ^ "Recomendaciones por Dengue Zika Chikungunya" (in Spanish). Chile Ministry of Health. January 20, 2016. Archived from the original on March 15, 2016. 
  111. ^ Branswell, Helen (January 22, 2016). "CDC expands Zika travel advisory to include more countries". Stat News. 
  112. ^ Mohney, Gillian (February 2, 2016). "Latest on Zika Virus: WHO's Recommendations, CDC Advisory Expanded to 28 Countries". ABC News. Retrieved February 28, 2016. 
  113. ^ Petersen, Emily E.; Staples, J. Erin; et al. (January 22, 2016). "Interim Guidelines for Pregnant Women During a Zika Virus Outbreak – United States, 2016". Morbidity and Mortality Weekly Report. 65 (2): 30–33. doi:10.15585/mmwr.mm6502e1. PMID 26796813. 
  114. ^ "Zika virus infection in the Americas". Government of Canada. February 3, 2016. 
  115. ^ Zika pandemic online trends, incidence and health risk communication: a time trend study Gbenga Adebayo, Yehuda Neumark, Anat Gesser-Edelsburg et al. BMJ Global Health Aug 2017, 2 (3) e000296; http://gh.bmj.com/content/2/3/e000296
  116. ^ "Paraguay: primer caso de zika en embarazada". ABC.com. March 11, 2016. 
  117. ^ Branswell, Helen (March 25, 2016). "Couples exposed to Zika virus are urged to delay pregnancy". Stat News. 
  118. ^ Casey, Nicholas; Díaz, María Eugenia (April 15, 2016). "Colombia Reports First Cases of Microcephaly Linked to Zika Virus". New York Times. 
  119. ^ "Zika Virus Response Updates from FDA". Retrieved April 29, 2016. 
  120. ^ Almasy, Steve (May 6, 2016). "MLB moves games from Puerto Rico due to Zika concerns". CNN. Retrieved June 1, 2016. 
  121. ^ Doucleff, Michaeleen. "How Big, Really, Is The Zika Outbreak In Florida?". NPR. Retrieved August 23, 2016. 
  122. ^ Santora, Mark (June 29, 2016). "Travelers to Dominican Republic Lead New York City in Positive Zika Tests". New York Times. 
  123. ^ Miami Neighborhood Declared Zika Free As CDC Lifts Warning
  124. ^ Florida Has Officially Been Declared Zika-Free
  125. ^ Is Zika Gone for Good?
  126. ^ Zika, Lyme drive big increase in bug-borne disease in U.S.
  127. ^ Puerto Rico Declares Zika Outbreak Over, CDC Maintains Travel Warning
  128. ^ "Zika virus: The outbreak in Asia". BBC News. October 11, 2016. Retrieved October 21, 2016. 
  129. ^ Tan, Joanna (October 16, 2016). "In fight against Zika, Singapore releases more mosquitoes". The National (UAE). Retrieved October 21, 2016. 
  130. ^ "ASEAN Health Ministers respond to Zika virus". ASEAN. September 20, 2016. Retrieved October 21, 2016. 
  131. ^ "Asean pledges to boost data-sharing on Zika". Bangkok Post. Today Online. September 24, 2016. Retrieved October 21, 2016. 
  132. ^ "Zika virus: Thailand babies diagnosed with microcephaly". Al Jazeera. October 1, 2016. Retrieved November 1, 2016. 
  133. ^ Amy Sawitta Lefevre (October 6, 2016). "Abortion legal in Thai birth defect cases linked to Zika, officials say". Reuters. ETHealthworld. Retrieved October 21, 2016. 
  134. ^ "Malaysia: Govt, Muslim clerics split over abortion in Zika cases". Asian Correspondent. September 1, 2016. Retrieved October 21, 2016. 
  135. ^ Soorian, A. (October 1, 2016). "Let the mother decide". New Straits Times. Retrieved October 21, 2016. 
  136. ^ "Rentokil Malaysia Battling Rising Dengue and Zika Cases with Integrated Mosquito Management Programme". Digital Journal. Retrieved October 21, 2016. 
  137. ^ "Zika disease becomes endemic in Vietnam: health official". Tuổi Trẻ. October 17, 2016. 
  138. ^ "VN confirms first Zika-tied birth defect case". Vietnam News Agency. Việt Nam News. October 31, 2016. Retrieved November 1, 2016. 
  139. ^ Jee Y. Geronimo (October 4, 2016). "DOH: Zika virus endemic in PH". Rappler. Retrieved November 21, 2016. 
  140. ^ "DOH continues campaign against Zika as 3 new confirmed cases emerge". Department of Health (Philippines). Retrieved November 1, 2016. 
  141. ^ "Zika virus, Microcephaly and Guillain-Barré syndrome Situation Report, 27 October 2016". ReliefWeb. October 27, 2016. Retrieved November 1, 2016. 
  142. ^ "Church in Philippines joins fight against Zika". Vatican Radio. October 29, 2016. Retrieved November 1, 2016. 
  143. ^ "As CECC for Zika Virus confirms 13th imported Zika case, travelers returning from Zika-affected areas advised to take precautions against mosquito bites, follow "1+6 Principle" and seek immediate medical attention when symptoms develop". Centers for Disease Control (Taiwan). October 17, 2016. Retrieved October 21, 2016. 
  144. ^ "Zika virus – information for clinicians and public health practitioners". Australian Health Department. Australia. Retrieved October 21, 2016. 
  145. ^ "Zika virus infection: Global Update". Government of Canada. Canada. Retrieved October 21, 2016. 
  146. ^ Huaxia (September 7, 2016). "China alerts travellers against Zika". Xinhua News Agency. China. 
  147. ^ Chiu, Peace; Elizabeth, Cheung (September 7, 2016). "Hong Kong issues travel warning for Singapore on Zika virus fears". South China Morning Post. Hong Kong. 
  148. ^ Vatvani, Chandni (August 31, 2016). "Indonesia mulls 'travel advisory' for Singapore over Zika outbreak". Channel NewsAsia. Jakarta. 
  149. ^ "Japan to step up screening for Zika virus". The Japan Times. Kyodo, Associated Press. February 2, 2016. 
  150. ^ Anis, Mazwin Nik (February 3, 2016). "Zika virus: Health Ministry issues travel advisory". The Star. Malaysia. 
  151. ^ Burton, Nina (January 24, 2016). "Zika virus prompts travel warning for Kiwis". 3News. New Zealand. 
  152. ^ "DOH cautions public on Zika virus". Sun Star. Manila. January 31, 2016. 
  153. ^ Priscilla (September 3, 2016). "Singapore's ZIKA outbreak & precautions for runners: Comments by Running Doctor Derek Li". PrisChew Dot Com. 
  154. ^ a b "S. Korea holds emergency meeting on Zika virus threat". Yonhap News Agency. February 2, 2016. 
  155. ^ "As first imported case of Zika virus infection identified in Taiwan, Taiwan CDC to list Zika virus infection as Category II Notifiable Infectious Disease and raises travel notice level for Central and South America and six countries in Southeast Asia". Centers for Disease Control (Taiwan). January 19, 2016. Retrieved October 21, 2016. 
  156. ^ "Zika virus: Advice for those planning to travel to outbreak areas". ITV News. January 22, 2016. 
  157. ^ H. Sun, Lena (September 29, 2016). "CDC issues Zika travel notice for 11 Southeast Asian countries". The Washington Post. 
  158. ^ "Tourist industry on edge as Zika virus spreads". BBC News. February 3, 2016. 
  159. ^ Harpaz, Beth J. (February 3, 2016). "Zika affects plans for destination weddings, babymoons". Associated Press. Associated Press. 
  160. ^ Dastin, Jeffrey (February 8, 2016). "Zika virus discourages many Americans from Latin America travel". Reuters. 
  161. ^ "WHO Declares Public Health Emergency of International Concern". Pro-MED-mail. International Society for Infectious Diseases. February 1, 2016. 
  162. ^ Calamur, Krishnadev (February 1, 2016). "An Emergency Meeting on the Zika Virus". The Atlantic. 
  163. ^ "WHO statement on the 2nd meeting of IHR Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations". WHO. March 8, 2016. Retrieved March 8, 2016. 
  164. ^ "WHO and experts prioritize vaccines, diagnostics and innovative vector control tools for Zika R&D". WHO. March 9, 2016. Retrieved March 13, 2016. 
  165. ^ a b c Kim, Meeri (January 29, 2016). "How mosquitoes with 'self-destruct' genes could save us from Zika virus". The Washington Post. 
  166. ^ "Oxitec mosquito works to control Aedes aegypti in dengue hotspot". Press release. Oxitec. July 2, 2015. 
  167. ^ a b Olson, Ken E.; Carvalho, Danilo O.; McKemey, Andrew R.; et al. (2015). "Suppression of a Field Population of Aedes aegypti in Brazil by Sustained Release of Transgenic Male Mosquitoes" (PDF). PLOS Neglected Tropical Diseases. 9 (7): e0003864. doi:10.1371/journal.pntd.0003864. ISSN 1935-2735. PMC 4489809Freely accessible. PMID 26135160. 
  168. ^ Pollack, Andrew (January 30, 2016). "New Weapon to Fight Zika: The Mosquito". New York Times. Retrieved March 16, 2016. 
  169. ^ Tavernise, Sabrina; McNeil, Jr., Donald G. (February 1, 2016). "W.H.O. Declares Zika Virus an International Health Emergency". The New York Times. 
  170. ^ "Decreto Nº 8.662" [Decree No. 8662] (in Portuguese). Palácio do Planalto, Presidência da República. February 1, 2016. Archived from the original on March 2, 2016. Retrieved February 4, 2016. 
  171. ^ Kelland, Kate (March 18, 2016). "WHO backs trials of genetically modified mosquitoes to fight Zika". The Globe and Mail. Archived from the original on March 18, 2016. Retrieved March 19, 2016. 
  172. ^ Jason Gale (February 4, 2016). "The Best Weapon for Fighting Zika? More Mosquitoes". Bloomberg News. 
  173. ^ Tirone, Jonathan (February 12, 2016). "UN Readies Nuclear Solution to Destroy the Zika Virus". Bloomberg Business. 
  174. ^ "Mosquito Biology". Michigan Mosquito Control Association. Archived from the original on March 30, 2013. Retrieved February 23, 2016. 
  175. ^ Martín, María (February 13, 2016). "Brasil destina 60% das suas Forças Armadas na luta contra um mosquito" [Brazil deploys 60% of its armed forces in the fight against mosquitoes]. El Pais (in Portuguese). Río de Janeiro. 
  176. ^ "Data sharing in public health emergencies". Wellcome Trust Blog. February 10, 2016. Retrieved February 21, 2016. 
  177. ^ "Developing global norms for sharing data and results during public health emergencies". World Health Organization. September 2015. Retrieved February 21, 2016. 
  178. ^ "Sharing data during Zika and other global health emergencies". Wellcome Trust Blog. February 10, 2016. Retrieved February 21, 2016. 
  179. ^ "Google donates $1M to help fight Zika virus spread". The Baltimore Sun. March 3, 2016. 
  180. ^ Hamzelou, Jessica. "Zika vaccine trials begin – but fears remain over virus's impact". New Scientist. Retrieved 12 October 2016. 
  181. ^ Bednarczyk, Robert. "Why a Zika vaccine is a long way off". the conversation. Retrieved 12 October 2016. 
  182. ^ "Zika vaccines show early promise". BBC News. August 4, 2016. Retrieved August 8, 2016. 
  183. ^ "Kineta awarded funding to test Zika treatment". Puget Sound Business Journal. August 5, 2016. Retrieved August 8, 2016. 
  184. ^ "Inovio Pharmaceuticals Doses First Subject in Zika Vaccine Clinical Trial". Inovio Pharmaceuticals. July 26, 2016. Retrieved August 8, 2016. 
  185. ^ a b c Riley, Kim (2017-05-24). "Challenges hobble U.S. public health response to Zika virus". Homeland Preparedness News. Retrieved 2017-09-12. 
  186. ^ Kim, Meeri (January 29, 2016). "How mosquitoes with 'self-destruct' genes could save us from Zika virus". The Washington Post. ISSN 0190-8286. Retrieved March 20, 2016. 
  187. ^ "Support grows for genetically modified mosquitoes in Zika fight". CBS News. February 16, 2016. Retrieved March 20, 2016. 
  188. ^ a b Alter, Charlotte (January 29, 2016). "Governments: Avoid Pregnancy Because of Zika. But How?". Time. Retrieved March 20, 2016. 
  189. ^ Partlow, Joshua (January 22, 2016). "As Zika virus spreads, El Salvador asks women not to get pregnant until 2018". The Washington Post. ISSN 0190-8286. Retrieved March 20, 2016. 
  190. ^ "Upholding women's human rights essential to Zika response — Zeid". News and Events. United Nations. February 5, 2016. Retrieved March 20, 2016. 
  191. ^ "Holy See on Zika Virus: International Community Should Exercise Due Diligence, But Not Panic". Zenit. February 17, 2016. Retrieved March 20, 2016. 
  192. ^ Bailey, Sarah Pulliam; Boorstein, Michelle (February 17, 2016). "Pope Francis suggests contraception could be permissible in Zika fight". The Washington Post. ISSN 0190-8286. Retrieved March 20, 2016. 
  193. ^ a b "Zika virus a trending topic on social media platforms". Reuters. 2016-02-03. Retrieved 2017-12-09. 
  194. ^ a b c Hagen, Loni; Keller, Thomas; Neely, Stephen; DePaula, Nic; Robert-Cooperman, Claudia (2017). "Crisis Communications in the Age of Social Media". Social Science Computer Review: 089443931772198. doi:10.1177/0894439317721985. 
  195. ^ a b c Joob, Beuy; Wiwanitkit, Viroj (2016-12-01). "Zika live Twitter chat". American Journal of Infection Control. 44 (12): 1756–1757. doi:10.1016/j.ajic.2016.08.019. ISSN 0196-6553. 
  196. ^ Phillips, Dom (2016-03-09). "Poor Brazilian mothers join hands, turn to social media amid microcephaly crisis". Washington Post. ISSN 0190-8286. Retrieved 2017-12-09. 
  197. ^ a b "If you're reading this, you might not like it. Because it's accurate". NBC News. Retrieved 2017-12-09. 
  198. ^ a b Leetaru, Kalev. "The Zika Virus And How Algorithms And Media Effects Impact Our Understanding Of Global Issues". Forbes. Retrieved 2017-12-09. 
  199. ^ Greer, Scott L. "US response to Zika: Fragmented and uneven". The Conversation. Retrieved 2017-12-09. 
  200. ^ a b "On Zika Preparedness And Response, The US Gets A Failing Grade". doi:10.1377/hblog20160428.054662. 
  201. ^ "We're screwed on outbreaks like Zika as long as we have to rely on Congress for money". Vox. Retrieved 2017-12-09. 
  202. ^ Tavernise, Sabrina (2016-08-30). "U.S. Funding for Fighting Zika Virus Is Nearly Spent, C.D.C. Says". The New York Times. ISSN 0362-4331. Retrieved 2017-12-09. 
  203. ^ "Q&A: Zika vaccine waits on Congress". USA TODAY. Retrieved 2017-12-09. 
  204. ^ "Congress Ends Spat, Agrees To Fund $1.1 Billion To Combat Zika". NPR.org. Retrieved 2017-12-09. 
  205. ^ Herszenhorn, David M. (2016-06-08). "Congress Will Work on $1.1 Billion Measure to Fight Zika, McConnell Says". The New York Times. ISSN 0362-4331. Retrieved 2017-12-09. 
  206. ^ a b c Jr, Donald G. McNeil (2017). "How the Response to Zika Failed Millions". The New York Times. ISSN 0362-4331. Retrieved 2017-12-09. 
  • Messina, J. P., Kraemer, M. U., Brady, O. J., Pigott, D. M., Shearer, F. M., Weiss, D. J., ... & Brownstein, J. S. (2016). Mapping global environmental suitability for Zika virus. Elife, 5.
  • Muñoz, Á. G., Thomson, M. C., Goddard, L., & Aldighieri, S. (2016). Analyzing climate variations at multiple timescales can guide Zika virus response measures. GigaScience, 5, 41. http://doi.org/10.1186/s13742-016-0146-1
  • Paz, S., & Semenza, J. C. (2016). El Niño and climate change—contributing factors in the dispersal of Zika virus in the Americas? The Lancet, 387(10020), 745. doi:10.1016/s0140-6736(16)00256-7
  • Yang, & Sarfaty. (2016). Zika virus: A call to action for physicians in the era of climate change. Preventive Medicine Reports, 4, 444-446. doi: 10.1016/j.pmedr.2016.07.011
  • Caminade,C.,Turner, J., Metelmann,S., Hesson,J.C., Blagrove,M.S.C., Solomon,T., Morse,A.P., Baylis, M.(2017) Global Risk Model for Vector Borne Transmission of Zika revels the role of El Niño 2015. Proceedings of the National Academy of Sciences, 114, 7, E1301-E1302; published ahead of print January 30, 2017. https://doi.org/10.1073/pnas.1700746114
  • Manore CA, Ostfeld RS, Agusto FB, Gaff H, LaDeau SL. (2017) Defining the Risk of Zika and Chikungunya Virus Transmission in Human Population Centers of the Eastern United States. PLOS Neglected Tropical Diseases 11, 1, e0005255. https://doi.org/10.1371/journal.pntd.0005255
  • McSweeny, R. (2016, December 20). Zika outbreak fuelled by El Nino and climate change. Retrieved March 29, 2018, from https://www.carbonbrief.org/zika-virus-outbreak-fuelled-by-el-nino-and-climate-change

External links[edit]