Descriptive analysis of surveillance data for Zika virus disease and Zika virus-associated neurological complications in Colombia, 2015–2017

Abstract

Zika virus (ZIKV) is a mosquito-borne pathogen that recently caused a major epidemic in the Americas. Although the majority of ZIKV infections are asymptomatic, the virus has been associated with birth defects in fetuses and newborns of infected mothers as well as neurological complications in adults. We performed a descriptive analysis on approximately 106,000 suspected and laboratory-confirmed cases of Zika virus disease (ZVD) that were reported during the 2015–2017 epidemic in Colombia. We also analyzed a dataset containing patients with neurological complications and recent febrile illness compatible with ZVD. Females had higher cumulative incidence of ZVD than males. Compared to the general population, cases were more likely to be reported in young adults (20 to 39 years of age). We estimated the cumulative incidence of ZVD in pregnant females at 3,120 reported cases per 100,000 population (95% CI: 3,077–3,164), which was considerably higher than the incidence in both males and non-pregnant females. ZVD cases were reported in all 32 departments. Four-hundred and eighteen patients suffered from ZIKV-associated neurological complications, of which 85% were diagnosed with Guillain-Barré syndrome. The median age of ZIKV cases with neurological complications was 12 years older than that of ZVD cases. ZIKV-associated neurological complications increased with age, and the highest incidence was reported among individuals aged 75 and older. Even though neurological complications and deaths due to ZIKV were rare in this epidemic, better risk communication is needed for people living in or traveling to ZIKV-affected areas.

Estimating Zika virus attack rates and risk of Zika virus-associated neurological complications in Colombian capital cities with a Bayesian model

“…Our findings that females were more likely than males to be reported as ZVD cases to the surveillance system but less likely to be reported as cases with NC are consistent with our previous work [ 41 ]. The same trend in reporting rates was found for most cities, but no important differences in the risk of NC by sex were found at the city level (possibly due to lack of power).…”

“…Overall, younger individuals had higher ZVD reporting rates than older individuals, assuming the same IARs, while older individuals were more likely to be reported as cases with NC. These findings were also expected based on our previous work [ 41 ] and GBS epidemiology. We obtained similar results at the city level for reporting rates by age, but few cities had important differences in the risk of NC, which, again, could be related to small sample sizes and lack of power.…”

Temperature and sex shape Zika virus pathogenicity in the adult Brat brain: A Drosophila model for virus-associated neurological diseases

“…ZIKV is known to cause severe congenital and autoimmune neurological complications such as microcephaly in infants and Guillain-Barré syndrome in adults. 49 , 50 , 51 , 52 ZIKV infection is especially linked to apoptotic cell death and cell-cycle disruption, providing a plausible mechanism for cellular stress responses and the resulting neurological defects. 53 , 54 More specifically, ZIKV has been shown to reduce neural progenitor cell proliferation, induce their premature differentiation, and activate apoptosis to target them along with immature neurons.…”

Guillain-Barré syndrome in an era of global infections and 21st century vaccination

“…During the 2013 French Polynesian outbreak a spike of GBS cases occurred, before a major epidemic started in South America in October 2015 [5]. Of 109 000 Colombian cases, 418 had neurological complications of which 85% were GBS [5], a rate of 2 cases per 1000. The median time from infection to symptoms was 7 days (interquartile range [IQR] 3–17) [6 ▪ ].…”

“…ZIKV appeared in Nigeria in 1954 and recorded in sporadic outbreaks over decades. During the 2013 French Polynesian outbreak a spike of GBS cases occurred, before a major epidemic started in South America in October 2015 [5]. Of 109 000 Colombian cases, 418 had neurological complications of which 85% were GBS [5], a rate of 2 cases per 1000.…”