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Health officials announce first Zika-related death in Puerto Rico
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A man with Zika virus infection in Puerto Rico has died of complications related to severe thrombocytopenia, according to a recent MMWR. It is the first Zika virus-associated death to be reported in the United States.
“Although Zika virus-associated deaths are rare, the first identified death in Puerto Rico highlights the possibility of severe cases, as well as the need for continued outreach to raise health care providers’ awareness of complications that might lead to severe disease or death,” Emilio Dirlikov, PhD, of the Puerto Rico Department of Health’s Office of Epidemiology and Research and the CDC’s Division of Scientific Education and Professional Development, and colleagues wrote.
Tyler M. Sharp
Tyler M. Sharp, PhD, epidemiologist at the CDC’s Dengue Branch in San Juan, told Infectious Disease News that the patient — a man in his 70s from the San Juan metropolitan area — experienced a Zika-like illness, which resolved within 1 week. Immediately after his illness, however, the patient developed hemorrhagic manifestations and was diagnosed with severe thrombocytopenia. He died less than 1 day after hospitalization.
“He did have previous medical conditions, none of which would be considered to be potentially life-threatening, nor do we think they had a direct association with the patient’s outcome,” Sharp said.
Three similar deaths linked to Zika-related thrombocytopenia also occurred in Colombia, and an additional nonfatal case was reported in Suriname, Sharp said. Although the data are limited, he said there appears to be similarities among all five cases.
“Many viral infections are associated with thrombocytopenia through a variety of different mechanisms,” Sharp said. “Dengue is well-known for causing thrombocytopenia, but we suspect that the mechanism for thrombocytopenia in this patient, and in a couple of others that we are investigating here in Puerto Rico, is distinct from the mechanism associated with thrombocytopenia in dengue patients.”
Investigations are currently underway to determine whether there is a certain population at an increased risk for thrombocytopenia caused by Zika virus infection.
Zika virus infections continue to rise
According to the MMWR report, weekly case counts of Zika virus infection have gradually increased in the country since late November. As of April 14, health officials from the Puerto Rico Department of Health (PRDH) and CDC Dengue Branch in San Juan, identified 6,157 patients with suspected arbovirus infections. Among them, 11% of patients, including 65 symptomatic pregnant women, were identified as probable or laboratory-confirmed Zika virus cases. The most common symptoms among these patients included rash (74%), myalgia (68%), headache (63%), fever (63%) and arthralgia (63%). Seventeen patients required hospitalization, including five with suspected Guillain-Barré syndrome.
“Zika virus is still circulating in Puerto Rico, along with dengue and chikungunya,” Sharp said. “It’s important, especially for [infectious disease] physicians in Puerto Rico and those seeing travelers recently returning from any area where Zika virus is circulating, to maintain these three viruses in the differential diagnosis and to order diagnostic testing to, as quickly as possible, identify the ecologic agents of any patients either with uncomplicated acute febrile illness or hemorrhagic manifestations in conjunction with acute febrile illness.”
Puerto Rican health department, CDC respond to outbreak
CDC officials recently confirmed that a causal relationship exists between Zika virus infection during pregnancy and microcephaly and other serious birth defects. In response to the ongoing outbreak, PRDH is working with Women, Infants and Children (WIC) clinics, where 90% of pregnant women received services last year. The health department and CDC collaborated with the Puerto Rico Department of Housing to contact women through WIC clinics and offer mosquito reduction services, larvicide application, and indoor and outdoor residual spraying with deltamethrin. In addition, the organizations have financed and distributed Zika prevention kits containing health information, mosquito repellent, a bed net, larvicidal tablets and condoms. To reduce unplanned pregnancies with adverse fetal outcomes, additional contraceptive services also were made available for women who do not wish to become pregnant.
Other public health response efforts include vector control strategies. An insecticide resistance study of Aedes aegypti mosquitoes conducted in February and March indicated there is high geographical variation to susceptibility, with delmethrin being the most effective pyrethroid candidate, Dirlikov and colleagues reported. Surveillance of insecticide susceptibility, however, is ongoing.
Health officials also continue to ensure the safety of Puerto Rico’s blood supply. In February, the FDA issued guidance recommending blood collection agencies in areas with active Zika virus transmission obtain whole blood and blood components from areas without active transmission. As a result, local blood collection was suspended in Puerto Rico. On April 2, however, blood collection resumed with donor screening using an investigational nucleic acid test (Roche Molecular Systems) approved by the FDA in March. To date, nine of 1,910 blood units screened for Zika yielded positive results and were removed from the blood supply. – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
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