Zika-Virus Fever

in Cape Verde

Zika-Fever Outbreak on the southern Cape Verde Islands
no more cases since June 2016

by Dr. Pitt Reitmaier - Tropical Hygiene and Medicine

In the beginning of November 2015 Zika-Virus as the cause of before unclear infections was proven on the Cape Verde Islands, for the first time in history, by serological lab-tests. (Institut Pasteur / Dakar)

Since September 2015 approximately 1,000 cases of an unknown virosis with rash, joint pain, non-purulent conjunctivitis, muscle and headache, pain behind the eyes, and vomiting, similar to mild forma of Dengue Haemorrhagic Fever had seeked assistence by the health services of the countrys capital Cidade da Praia. The vast majority of patients came from the urban areas of the city of Praia.
Zika-Virus disease is considered benign and heals spontaneously in about a week. Lethal cases and serious complications are extremely rare. Most infections show no or so mild symptoms that sufferers do not seek health services. The number of infection is about fife times higher than the Number of patients seen by health services.

To date there is no specific therapy nor a vaccine available.

Zika is considered an "emerging disease", fostered by climate change, intensive travel and littering in poor suburban settings. Litter is a favourable habitat for the transmitting misquito. The disease has spread to moderate clinate zones in the last years. In Miami / Florida / USA in summer 2016 a considerable number of autochtonous cases has been registerd. The is increasing evidence for an advanced process of adaptation to cooler, non-tropic temperatures for the asatic tiger mosquito stegomyia albipictus. In the districts of St. Georgen near Freiburg / Breisgau (Black forest) as in the district of Heidelberg, the mosquito was able to reproduce over the mild winter of 2015-16 from one year to the next.

In 2014/15/16 Zika-virus was the cause of an epidemic in Brazil with millions of cases. In North America and Europe imported cases were detected as well. The Ministry of Health of Brazil has postulated a relationship between Zika fever and a high incidence of microcephaly in neonates in late 2015. Concluding scientific evidence for a causal relationship is not available to date. Other frequent diseases and co-factores in the mother also lead to microcephaly among the newborn. In previous Zika epidemics in other countries cases of microcephaly were not followed up with the same attention. But evidence is growing and physicians can not wate for the final proof and must show ways to avoid and prevent an infection to pregnant women.

On 22 01 2016, US health authorities have released a provisional travel - warning for pregnant women under the impression of an autochthonous case of Zika-positive newborn with microcephaly that had occurred in Hawaii. Cape Verde, without distinction between affected and not affected islands, appeares on the list of Zika infection areas. The Foreign Office of the Federal Republic of Germany and travel-medicine-institutions in German language followed in May 2016 with a Merkblatt zu den Risiken durch Zika-Virus

The special importance of a Zika-Virosis-Outbreak

in the Cape Verde archipelago is not limited to the risk to aquire a relative mild disease and the much more important neurological consequences in the newborn. The mosquito-vector Stegomyia (formerly called aedes) can transmit even more dangerous diseases like Dengue, Chikungunya, Yellow Fever, West Nile Fever and other arbo-viroses. Where Zika viruses is transmitted, these diseases can be transmitted as well. Stegomyia mosquitoes use even smallest accumulations of water in sub-pots of flowers, in cans, bottles, plastic bottles, tetra packs and car tires in trashed cities and multiply even in polluted water. They are "civilization followers". World literature also refers to a small number of transmissions through unprotected sex in the world literature.

Geographical center of the epidemic

was the capital Praia with> 80% of cases of Santiago Island. As of ealry December 2015, the total number of clinically diagnosed cases had grown to 5,000 on the islands of Santiago, Maio and Fogo. By this time, the peak of the epidemic was passed in Santiago and the number of new cases per week declined. Fogo went on for a few weeks with constant numbers of new cases of ca 25 / day concentrated in the city of São Filipe .. On 30 01 2016 a secondary focus was reported from the village of Rabil on Boa Vista island that reached a total of 190 cases that quickly disappeared.

Development

By end of January 2016 the peak of the epidemic curve had passed on all islands affected and it was expected that the seasonal drought would reduce it to a few singular cases by March - April 2016. So it occurred.
Of the approximately 140 women who were diagnosed Zika cases during pregnancy,three children were born with microcephaly, two in Cabo Verde and one in the US. Serological tests show a link between Zika infection of mothers and their offspring.

Important facts:

• First suspected cases occurred In September 2015.
• As expected on a subtropical arid archipelago,the Zika virus outbreak only affected part of the islands.
• Origin and center was the capital Praia (> 120000 inhabitants.) In Santiago.
• Secondary centers of autochthonous transmission were the southern islands Maio and Fogo and briefly Rabil in Boa Vista.
• The northern islands have only seen afew imported cases, no autochthonous transmission.
• This geographic distribution corresponds well to the image, as it was found during the dengue outbreak of 2009 when Sal, São Nicolau, São Vicente and Santo Antao were only minimally or not affected at all.
• The readyness of the population to participate in cleaniing campaigns, is significantly lower than dur9ing the dengue epidemic 2009.
• The Zika-epidemic in Cabo Verde was caused by the same virus strain, which has been observed in Brazil 2014/15.
• Since June 2016 no more cases of Zika were observed all over Cape Verde.

Recommendations:
- avoid mosquito-bites

• wear light-coloured long trousers and long-sleeved blouses, shirts and socks.
• use mosquito nets, mosquito coils and air conditioning
• Apply repellents throughout the day.
• Take care of your immediate residencial environment, your house / flat in respect of waste and water pockets: Change all standing water accumulation in and around the household (flower vases, cisterns and siphons of sink, showers and toilets and, watering cans, mop bucket, gutters etc.) at least once a week.

- in case you fall ill with a fever that might be Zika:

• use only Paracetamol as a pain-killer, no others, especially no ASS = Aspirin® and no Ibuprofen®.

- for pregnant women:

• Shift to regions / islands without autochthonous transmission of the virus
• Delay the journey to the time after pregnancy
• if the trip can not be postponed, practice mosquito bite avoidance consequently.
• use condoms when sleeping with a partner who traveled to a Zika infection, until the end of pregnancy.

- for couples without contraception / desiring a pregnancy:

• Shift to regions / islands without autochthonous transmission of the virus
• Postpone the pregnancy to the time after the yourney
• Use condoms while in a Zika-Infection-area and for the followng 8 weeks
• in case you fall ill with a fever that might be Zika, postpone the pregrnacy for two years.

 

All information to the best of our knowledge and belief - No warranty !
For individual recommendation, please contact your physician!

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