In 2015–2016, simultaneous circulation of dengue, Zika and chikungunya in the municipality of Rio de Janeiro (Brazil) was reported. We conducted an ecological study to analyse the spatial distribution of dengue, Zika and chikungunya cases and to investigate socioeconomic factors associated with individual and combined disease incidence in 2015–2016. We then constructed thematic maps and analysed the bivariate global Moran indices. Classical and spatial models were used. A distinct spatial distribution pattern for dengue, Zika and chikungunya was identified in the municipality of Rio de Janeiro. The bivariate global Moran indices (P < 0.05) revealed negative spatial correlations between rates of dengue, Zika, chikungunya and combined arboviruses incidence and social development index and mean income. The regression models (P < 0.05) identified a negative relationship between mean income and each of these rates and between sewage and Zika incidence rates, as well as a positive relationship between urban areas and chikungunya incidence rates. In our study, spatial analysis techniques helped to identify high-risk and social determinants at the local level for the three arboviruses. Our findings may aid in backing effective interventions for the prevention and control of epidemics of these diseases.

In the absence of partisan ownership of an issue, what factors shape public preferences for federal, state and local policy action? The Zika virus provides a unique context in which to examine this question, as it is a new threat to public health in the United States and lacks clear partisan ownership. We examine (1) which Zika policies do citizens support, (2) at which level(s) of government and (3) what factors explain citizen assignment of policy responsibility to different levels of government? Using nationally representative survey data, we find that the three most popular policy responses to Zika are travel warnings, research funding and public education, with the federal government being the preferred policy actor. In the absence of clear partisan issue ownership, we find that Republicans are significantly more likely to prefer state policy action, while partisanship has no impact on public preferences for federal or local policy action.

Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015–December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV–ZIKV coinfection was present in 28 cases (82.3%), DENV–CHIKV in three (8.8%) and DENV–ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV–CHIKV cases and five CHIKV–ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV–ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.

In recent years, CRISPR-Cas9 has become one of the simplest and most cost-effective genetic engineering techniques among scientists and researchers aiming to alter genes in organisms. As Zika came to the fore as a global health crisis, many suggested the use of CRISPR-Cas9 gene drives in mosquitoes as a possible means to prevent the transmission of the virus without the need to subject humans to risky experimental treatments. This paper suggests that using gene drives or other forms of genome editing in nonhumans (like mosquitos) for the purposes of disease prevention raises important issues about informed consent. Additionally, it examines the consequences this line of inquiry could have for the use of gene drives as a tool in public health and suggests that the guidance offered by informed consent protocols could help the scientific community deploy gene drives in a way that ensures that ongoing research is consistent with our ethical priorities.

Zika virus infection in humans has been linked to severe neurological sequels and foetal malformations. The rapidly evolving epidemics and serious complications made the frequent updates of Zika virus mandatory. Web search query has emerged as a low-cost real-time surveillance system to anticipate infectious diseases’ outbreaks. Hence, we developed a prediction model that could predict Zika-confirmed cases based on Zika search volume in Google Trends. We extracted weekly confirmed Zika cases of two epidemic countries, Brazil and Colombia. We got the weekly Zika search volume in the two countries from Google Trends. We used standard time-series regression (TSR) to predict the weekly confirmed Zika cases based on the Zika search volume (Zika query). The basis TSR model – using 1-week lag of Zika query and using 1-week lag of Zika cases as a control for autocorrelation – was the best for predicting Zika cases in Brazil and Colombia because it balanced the performance of the model and the advance time in the prediction. Our results showed that we could use Google search queries to predict Zika cases 1 week earlier before the outbreak. These findings are important to help healthcare authorities evaluate the outbreak and take necessary precautions.

Zika virus (ZIKV) infection is an emergent worldwide public health problem. Historically, 84 countries have reported vector-borne ZIKV transmission, 61 of which report on-going transmission. It is a Flavivirus transmitted through arthropods belonging to the Aedes genus. Since 2015, ZIKV infections have increased dramatically; with 1.3 million people infected during 2015 in Brazil alone. This paper's objective is to highlight the conjectural epidemiological points of the virus’ dissemination. The digital archives Pubmed, MEDLINE, EMBASE and Cochrane were searched for papers that assessed aspects of ZIKV transmission and epidemiology. The first isolation occurred in Uganda in 1947. Since then, important outbreaks were documented globally. Consequently, an emergent public health problem arose from a rapidly increasing incidence and its association with the development of neurological diseases such as microcephaly and Guillain–Barré syndrome. Key factors in the successful containment of outbreaks include surveillance of mosquitos in the neighbourhood, an early mosquito control treatment, an assertive information campaign, and the involvement of the local population and healthcare workers. As such, while ZIKV seems to be spreading globally in a similar manner to other arboviruses, such as Dengue and Chikungunya viruses, it can also be rapidly contained due to the pre-existing availability of necessary resources and regulatory tools as control measures. This review aims to provide a description of those characteristics of ZIKV infection that may be useful in the construction of effective outbreak control strategies.

The Zika virus was largely unknown to many health care systems before the outbreak of 2015. The unique public health threat posed by the Zika virus and the evolving understanding of its pathology required continuous communication between a health care delivery system and a local public health department. By leveraging an existing relationship, NYC Health+Hospitals worked closely with New York City Department of Health and Mental Hygiene to ensure that Zika-related processes and procedures within NYC Health+Hospitals facilities aligned with the most current Zika virus guidance. Support given by the public health department included prenatal clinical and laboratory support and the sharing of data on NYC Health+Hospitals Zika virus screening and testing rates, thus enabling this health care delivery system to make informed decisions and practices. The close coordination, collaboration, and communication between the health care delivery system and the local public health department examined in this article demonstrate the importance of working together to combat a complex public health emergency and how this relationship can serve as a guide for other jurisdictions to optimize collaboration between external partners during major outbreaks, emerging threats, and disasters that affect public health. (Disaster Med Public Health Preparedness. 2018;12:689-691)

In this study, we analyzed the patterns of socioeconomic and demographic factors along with health services provider availability for the current Zika outbreak in Miami-Dade County, South Florida. We used Center for Consumer Information & Insurance Oversight (CCIIO) Machine-Readable Public Use Files (MR-PUFs) to examine provider availability in combination with socioeconomic and demographic factors that could potentially lead to healthcare disparities between any underserved population of the Wynwood neighborhood and the broader population of Miami-Dade County. MR-PUFs contain public provider-level data from states that are participating in the Federally Facilitated Marketplace. According to CCIIO, an issuer of a Qualified Health Plan that uses a provider network must maintain a network that is sufficient in the number and types of providers, including providers that specialize in mental-health and substance-use disorder services, to assure that all services will be accessible to enrollees without unreasonable delay. (Disaster Med Public Health Preparedness. 2018;12:455–459)

The global community needs to easily identify and respond to new and reemerging threats, such as H1N1, Ebola, and most recently Zika. Clinicians are often the first-line providers to recognize these threats, but yet have few opportunities to learn from each other in real time. In this concept article, we describe the ways clinical information is traditionally shared during a public health emergency and then introduce new mechanisms to facilitate physician communication and learning as a part of the response to Zika. (Disaster Med Public Health Preparedness. 2017;11:259–261)

Zika virus infection was declared a public health emergency of international concern in February 2016 in response to the outbreak in Brazil and its suspected link with congenital anomalies. In this study, we use notification data and disease natural history parameters to estimate the basic reproduction number (R0) of Zika in Rio de Janeiro, Brazil. We also obtain estimates of R0 of dengue from time series of dengue cases in the outbreaks registered in 2002 and 2012 in the city, when DENV-3 and DENV-4 serotypes, respectively, had just emerged. Our estimates of the basic reproduction number for Zika in Rio de Janeiro based on surveillance notifications (R0 = 2·33, 95% CI: 1·97–2·97) were higher than those obtained for dengue in the city (year 2002: R0 = 1·70 [1·50–2·02]; year 2012: R0 = 1·25 [1·18–1·36]). Given the role of Aedes aegypti as vector of both the Zika and dengue viruses, we also derive R0 of Zika as a function of both dengue reproduction number and entomological and epidemiological parameters for dengue and Zika. Using the dengue outbreaks from previous years allowed us to estimate the potential R0 of Zika. Our estimates were closely in agreement with our first Zika's R0 estimation from notification data. Hence, these results validate deriving the potential risk of Zika transmission in areas with recurring dengue outbreaks. Whether transmission routes other than vector-based can sustain a Zika epidemic still deserves attention, but our results suggest that the Zika outbreak in Rio de Janeiro emerged due to population susceptibility and ubiquitous presence of Ae. aegypti.

The control of dengue constitutes a great challenge for public health; however, the methods normally used have shown themselves to be insufficient to keep the indices of infestation of Aedes aegypti under control. Recently, beyond the large number of cases and deaths associated with dengue, new risks have arisen such as those represented by chikungunya fever and Zika. In the light of the great significance of these problems within the public health context, two areas in a municipality in the interior of the State of São Paulo, Brazil were selected in 2014. One of them, Bairro Cidade Nova, was submitted to the conventional method of nebulization with portable equipment, and the other, Bairro Jardim Europa, received the application of the insecticide by means of heavy-equipment coupled to the vehicle. During the project, 1355 mosquito eggs were collected, 1105 of them in Bairro Cidade Nova and 205 in Bairro Jardim Europa. After the applications with heavy-equipment in the months of March and April, the number of cases of the disease reported in the month of April for Bairro Jardim Europa was less than half that of Bairro Cidade Nova, which had received the conventional treatment. The nebulization with the heavy-equipment may constitute a viable and effective strategy for achieving better results in the control of Ae. aegypti.

The rapid spread of Zika virus represents a threat to public health and demands significant preparation from hospitals and health care systems. Establishment of procedures for the identification of cases of Zika virus infection is a fundamental aspect of response planning. We describe the steps taken in the development and implementation of a protocol for the diagnosis and management of suspected cases of Zika virus infection in a large academic medical center. (Disaster Med Public Health Preparedness. 2017;11:256–258)

In January 2016, the World Health Organization warned that Zika virus is “spreading explosively” in the Americas and that up to 4 million infections could be present worldwide within a year. Soon thereafter, some politicians and authors publicly advocated for quarantine of travelers returning from regions where mosquitoes carrying Zika virus are prevalent. The public health tool of quarantine can be used to prevent the spread of infection by restricting the movement of persons who have been exposed to a deadly disease that can be transmitted from person to person before symptom onset. With 80% of Zika virus infections being asymptomatic, no rapid test being available to detect the virus, and primary transmission being via the bites of certain mosquitoes, application of quarantine in this setting is not scientifically sound or practically feasible. Rather, public health interventions should focus on preventing bites from infected mosquitoes, counseling pregnant women on the risks of fetal microcephaly and other birth defects, and identifying patients with signs and symptoms of Guillain-Barré syndrome. As was seen in the Ebola virus disease outbreak of 2014, non-evidence-based factors can influence policy decisions. Public health experts must ensure that policy makers are informed that quarantine is not a scientifically sound approach for the control of Zika virus. (Disaster Med Public Health Preparedness. 2016;0:1–3)