Background: The first cases of Zika (ZIKV) in the Americas were reported in Easter Island, Chile in 2014. The epidemic spread to Brazil and Central America in 2015. We describe the extent and distribution of the countrywide ZIKV epidemic in the Dominican Republic.
Methods: The DR Ministry of Health (MoH) instituted active surveillance, monitoring and mandatory reporting of suspected cases of ZIKV in 2015 through the National System of Epidemiologic Surveillance (SINAVE). In the pre-epidemic period, the MoH conducted active search and blood testing of suspected cases in communities rumored to have cases of the disease. During the epidemic, the MoH conducted weekly monitoring of all cases of febrile exanthems, flaccid paralysis and meningitis, and also conducted rapid surveys in highly populated areas to identify local outbreaks. Data from SINAVE was exported and analyzed using SAS.
Results: A total of 5226 cases ZIKV were reported to the MoH from January 2016 to December 2016 (figure). Cases were 74% female, of whom 1275 (33%) were pregnant. Most of the cases (51%) were diagnosed in the age group of 20 to 39, and did not differ by gender. The majority (58%) of cases were reported from a metropolitan area. Almost all cases (82%) were treated in the outpatient setting, while 17% were hospitalized. Only 3 patients died and 95% had an uncomplicated course. There were 285 cases of Guillain Barr Syndrome (GBS; Figure), with the epidemic curve showing a peak 2-4 weeks following the peak of the epidemic. Compared to patients with suspected ZIKV (n=1054), those with GBS were more likely to be male (47% vs. 19%, p<0.001), aged ≥40 years (53% vs. 19%, p<0.001),, more likely to have complications (18% vs. 6%, p<0.001) and comorbidity (2% vs. 0.2%, p=0.04) Seventeen (6%) of confirmed GBS cases resulted in death.
Figure. Cases of Zika and GBS, Dominican Republic, 2016
Conclusion: The DR reported one of the largest ZIKV outbreaks in the Americas. The epidemic started early in 2016 and had all but subsided by May 2017. Although most cases had an uncomplicated course, incidence of GBS was high.
S. Khosla, None
S. Mehta, None
M. Brito, None