Netherlands: Imported Zika infection via Suriname

December 13, 2015

Europe

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We have seen imported Zika virus infection in several countries over the recent past in Australia, Germany, Canada and Japan due to travel to areas where Zika is endemic (eg. Thailand) or where there was an active outbreak (eg French Polynesia) so it should no surprise to see travel-associated Zika due to travel to Latin America, where autochthonous Zika has been reported in at least nine countries this year.

Now, thanks to a ProMED Mail post today, we learn of a travel-associated Zika infection in the Netherlands in a person who traveled to Suriname (one of the nine countries mentioned above).

According to the report provided by the Center of Tropical and Travel Medicine in Amsterdam, the case was confirmed in a 60-year-old and otherwise healthy female patient, who had returned from Suriname on 29 Nov 2015, following a 3-week holiday.

Upon return to the Netherlands, she developed fever, itching in the hands and a red skin rash on the face, neck, trunk and extremities. The skin was painful upon touch and the joints of her fingers and ankles felt stiff. She also reported swelling of both lower legs. She reported multiple insect bites. She presented at our outpatient clinic at the AMC in Amsterdam, the Netherlands, on 2 Dec 2015, the 3rd day of her illness.

Physical examination showed an afebrile patient who was not acutely ill. She had a pronounced macular skin rash of her trunk, extremities, neck and face, as well as a marked conjunctival injection. In addition, she had pitting edema on both lower legs.

One day after her initial presentation, the skin rash had improved markedly. She recovered quickly. Upon follow-up on 11 Dec 2015, her only complaints were arthralgias that seemed to further improve.

The clinical diagnosis of Zika virus infection was confirmed by PCR (Erasmus MC, Rotterdam), on a sample taken on 2 Dec 2015 (the 3rd day of illness).

Last week, the US Centers for Disease Control and Prevention (CDC) issued travel notices for the affected countries.

The European Centre for Disease Prevention and Control (ECDC) in a Rapid Risk Assessment last week noted:

Few travel-associated cases of Zika virus infections have been reported in the EU. Infections followed exposure in Asia or in French Polynesia (as noted above- my addition). With the spread of the Zika virus epidemic in the Americas, the likelihood of travel-related cases of Zika virus infection in the EU is increasing.

The Aedes albopictus mosquito species is established in many parts of the EU, primarily around the Mediterranean. Onward transmission from imported cases within the continental EU is possible because Aedes albopictus is probably a competent vector for the transmission of Zika virus, even though this has not been confirmed for European mosquito populations. The risk for transmission of Zika virus infections is extremely low in the EU during winter season as the climatic conditions are not suitable for the activity of potential vectors.