View source for Medicine:2015–16 Zika virus epidemic

 <!--see talk page-->
{{Infobox event
| image = Zikamain 112116 930.jpg
| caption = Countries and territories with active transmission of the Zika virus<br /> November 21, 2016<ref name="CDC All Countries and Territories">{{cite web |url=https://www.cdc.gov/zika/geo/active-countries.html |title=All Countries and Territories with Active Zika Virus Transmission |publisher=Centers for Disease Control and Prevention |date=November 21, 2016}}</ref>
| date = April 2015 – November 2016
| type =
| reported deaths =
| notes =
}}

In early 2015, a widespread [[Medicine:Epidemic|epidemic]] of [[Medicine:Zika fever|Zika fever]], caused by the [[Medicine:Zika virus|Zika virus]] in {{wipe|Brazil}}, spread to other parts of [[Earth:South America|South]] and [[Earth:North America|North America]]. It also affected several islands in the Pacific, and Southeast Asia.<ref>{{cite web|url=http://www.healthmap.org/zika/|title=Zika Map - Virus & Contagious Disease Surveillance|publisher=HealthMap}}</ref> In January 2016, the [[Organization:World Health Organization|World Health Organization]] (WHO) said the virus was likely to spread throughout most of the Americas by the end of the year.<ref name="WHO sees Zika outbreak spreading">{{cite news |url=https://www.reuters.com/article/us-health-zika-idUSKCN0V30U6 |title=WHO sees Zika outbreak spreading through the Americas |work={{wipe|Reuters}} |date=January 25, 2016}}</ref> In November 2016 WHO announced the end of the Zika epidemic.<ref name="WHO: Zika Virus No Longer International Emergency But Still a Threat">{{cite news |url=https://newsline.com/zika-virus-no-longer-international-emergency-still-threat/ |title=WHO: Zika Virus No Longer International Emergency But Still a Threat |work=Newsline |date=November 21, 2016 |access-date=November 21, 2016 |archive-url=https://web.archive.org/web/20180211072422/https://newsline.com/zika-virus-no-longer-international-emergency-still-threat/ |archive-date=February 11, 2018 |dead-url=yes |df=mdy-all }}</ref>

In February 2016, WHO declared the outbreak a [[Social:Public Health Emergency of International Concern|Public Health Emergency of International Concern]] as evidence grew that Zika can cause birth defects as well as neurological problems.<ref name="WHO Summarizes Emergency Committee">{{cite web |url=http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/ |title=WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain–Barré syndrome |publisher=[[Organization:World Health Organization|World Health Organization]] |date=February 1, 2016 |accessdate=February 2, 2016}}</ref><ref name="The emergence of zika virus">{{cite journal |doi=10.4103/0974-777X.176140 |pmid=27013839 |pmc=4785754 |title=The emergence of zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint working Group (JWG) |journal=Journal of Global Infectious Diseases |volume=8 |issue=1 |pages=3–15 |year=2016 |last1=Stawicki |first1=Stanislawp |last2=Sikka |first2=Veronica |last3=Chattu |first3=Vijaykumar |last4=Popli |first4=Raajk |last5=Galwankar |first5=Sagarc |last6=Kelkar |first6=Dhanashree |last7=Sawicki |first7=Stanleyg |last8=Papadimos |first8=Thomasj }}</ref><!--NOTE: It is no longer "suspected" that zika causes microcephaly etc., it is a fact accepted by WHO and the CDC. Please edit accordingly.--> The virus can be [[Biology:Vertical transmission|transmitted]] from an infected pregnant woman to her fetus, then can cause [[Medicine:Microcephaly|microcephaly]] and other severe brain anomalies in the infant.<ref name="RasmussenJamieson2016">{{cite journal |doi=10.1056/NEJMsr1604338 |pmid=27074377 |title=Zika Virus and Birth Defects — Reviewing the Evidence for Causality |journal=New England Journal of Medicine |volume=374 |issue=20 |pages=1981–1987 |year=2016 |last1=Rasmussen |first1=Sonja A |last2=Jamieson |first2=Denise J |last3=Honein |first3=Margaret A |last4=Petersen |first4=Lyle R }}</ref><ref name=CDC2016Cause>{{cite web|title=CDC Concludes Zika Causes Microcephaly and Other Birth Defects|url=https://www.cdc.gov/media/releases/2016/s0413-zika-microcephaly.html|website=CDC|accessdate= April 14, 2016|date=April 13, 2016}}</ref><ref name="WHO SitRep Apr 7, 2016">{{cite web | url=http://apps.who.int/iris/bitstream/10665/204961/1/zikasitrep_7Apr2016_eng.pdf?ua=1 | title=Zika Virus Microcephaly And Guillain–Barré Syndrome Situation Report | publisher=World Health Organization | date=April 7, 2016 | accessdate=April 8, 2016}}</ref> Zika infections in adults can result in [[Medicine:Guillain–Barré syndrome|Guillain–Barré syndrome]].<ref name="WHO SitRep Apr 7, 2016"/> Prior to this [[Medicine:Outbreak|outbreak]], Zika was considered a mild infection, as most Zika virus infections are asymptomatic, making it difficult to determine precise estimates of the number of cases.<ref name="ITV28Jan2016">{{cite news | url=http://www.itv.com/news/update/2016-02-01/zika-epidemic-worse-than-thought-brazil-health-minister/ | title=Brazil Health Minister: Zika epidemic worse than thought | work=ITV News | date=January 28, 2016 | accessdate=February 1, 2016}}</ref> In approximately one in five cases, Zika virus infections result in Zika fever, a minor illness that causes symptoms such as [[Medicine:Fever|fever]] and a rash.<ref>{{cite web|url=https://www.cdc.gov/zika/symptoms/|title=Zika Virus|publisher=Centers for Disease Control and Prevention}}</ref><ref>{{cite web|url=https://www.cdc.gov/zika/symptoms/symptoms.html|title=Zika Virus|publisher=Centers for Disease Control and Prevention}}</ref>

The virus is [[Medicine:Mosquito-borne disease|spread]] mainly by the ''[[Biology:Aedes aegypti|Aedes aegypti]]'' [[Biology:Mosquito|mosquito]], which is commonly found throughout the tropical and subtropical Americas. It can also be spread by the ''[[Biology:Aedes albopictus|Aedes albopictus]]'' ("Asian tiger") mosquito, which is distributed as far north as the Great Lakes region in North America.<ref name="The global distribution of the arbovirus vectors">{{cite journal |doi=10.7554/eLife.08347 |pmid=26126267 |pmc=4493616 |title=The global distribution of the arbovirus vectors Aedes aegypti and Ae. Albopictus |journal=eLife |volume=4 |pages=e08347 |year=2015 |last1=Kraemer |first1=Moritz UG |last2=Sinka |first2=Marianne E |last3=Duda |first3=Kirsten A |last4=Mylne |first4=Adrian QN |last5=Shearer |first5=Freya M |last6=Barker |first6=Christopher M |last7=Moore |first7=Chester G |last8=Carvalho |first8=Roberta G |last9=Coelho |first9=Giovanini E |last10=Van Bortel |first10=Wim |last11=Hendrickx |first11=Guy |last12=Schaffner |first12=Francis |last13=Elyazar |first13=Iqbal RF |last14=Teng |first14=Hwa-Jen |last15=Brady |first15=Oliver J |last16=Messina |first16=Jane P |last17=Pigott |first17=David M |last18=Scott |first18=Thomas W |last19=Smith |first19=David L |last20=Wint |first20=GR William |last21=Golding |first21=Nick |last22=Hay |first22=Simon I }}</ref> Men infected with Zika can [[Medicine:Sexually transmitted infection|transmit]] the virus to their sexual partners.<ref name="The emergence of zika virus" /><ref name="Interim Guidelines for Prevention of Sexual Transmission">{{cite journal |doi=10.15585/mmwr.mm6505e1 |pmid=26866485 |title=Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=65 |issue=5 |pages=120–121 |year=2016 |last1=Oster |first1=Alexandra M |last2=Brooks |first2=John T |last3=Stryker |first3=Jo Ellen |last4=Kachur |first4=Rachel E |last5=Mead |first5=Paul |last6=Pesik |first6=Nicki T |last7=Petersen |first7=Lyle R }}</ref><ref name="cdc1">{{cite web | url=https://www.cdc.gov/media/releases/2016/s0223-zika-guidance.html | title=CDC encourages following guidance to prevent sexual transmission of Zika virus | publisher=Centers for Disease Control and Prevention | website=CDC Newsroom | date=February 23, 2016}}</ref><ref name="nyttavernise">{{cite news |last1=Tavernise |first1=Sabrina |title=C.D.C. Investigating 14 New Reports of Zika Transmission Through Sex |url=https://www.nytimes.com/2016/02/24/health/zika-virus-sexual-transmission.html |accessdate=February 24, 2016 |work={{wipe|The New York Times}} |date=February 23, 2016}}</ref>

A number of countries have issued travel warnings, and the outbreak is expected to reduce tourism significantly.<ref name="The emergence of zika virus" /><ref name="wsjtourism">{{cite news |last1=Kiernan |first1=Paul |last2=Jelmayer |first2=Rogerio |title=Zika Fears Imperil Brazil's Tourism Push |url=https://www.wsj.com/articles/zika-fears-imperil-brazils-tourism-push-1454461138 |accessdate=February 27, 2016 |work={{wipe|The Wall Street Journal}} |publisher=Dow Jones & Company |date=February 3, 2016}}</ref> Several countries have taken the unusual step of advising their citizens to delay pregnancy until more is known about the virus and its impact on fetal development.<ref name="Zika virus triggers pregnancy delay calls">{{cite news |url=https://www.bbc.com/news/world-latin-america-35388842 |title=Zika virus triggers pregnancy delay calls |work=BBC News Online |date=January 23, 2016}}</ref> Furthermore, the outbreak raised concerns regarding the safety of athletes and spectators at the 2016 Summer Olympics in Rio de Janeiro.<ref name="USAToday25Feb2016">{{cite news |last=Rogers |first=Martin |url=https://www.usatoday.com/story/sports/olympics/2016/02/24/zika-virus-rio-world-health-organization/80858758/ |title=World Health Organization: Athletes should not fear Zika virus at Rio Olympics |work=USA Today |date=February 25, 2016 }}</ref><ref name="CNN12Feb2016">{{cite news |last=Vox |first=Ford |url=http://www.cnn.com/2016/02/12/health/zika-olympics-threat |title=What real threat does Zika pose to the Rio Olympics? History has an answer |work=CNN |date=February 12, 2016 }}</ref><ref name="USA cyclist Tejay van Garderen withdraws from Olympics over Zika virus">{{cite web |url=https://www.theguardian.com/sport/2016/jun/02/tejay-van-garderen-zika-olympics-cycling |publisher=The Guardian |website=www.theguardian.com |date=June 2, 2016|title=USA cyclist Tejay van Garderen withdraws from Olympics over Zika virus}}</ref>

In Brazil, the Zika virus epidemic revealed structural problems of the health system, in particular in public health services and basic sanitation.<ref>{{cite news |last1=Buriti |first=Renata |title=Virus shines light on structural problems |url=http://www.dandc.eu/en/article/zika-proves-brazil-needs-better-sanitation-and-health-services |accessdate=November 28, 2016 |work=D+C, Development and Cooperation|date=October 30, 2016}}</ref>

== Epidemiology ==
{{anchor|ZikaCases}}
{| class="wikitable sortable floatright collapsible collapsed" style="text-align: right; width: 50%; font-size: 80%;"
|+ style="font-size: 135%;" | Number of Zika cases, 2015–16
|-
! rowspan=2 style="width: 60%" | Country
! colspan=2 style="width: 20%" | Autochthonous cases
! rowspan=2 style="width: 10%" data-sort-type="number" | Imported cases
! rowspan=2 style="width: 10%" data-sort-type="number" | Deaths{{efn|name=deaths}}
|-
! data-sort-type="number" | Confirmed
! data-sort-type="number" | Suspected
|-
! Africa !! &nbsp; !! &nbsp; !! &nbsp; !! &nbsp; 
|-
|  style="text-align: left;" | {{flag|size=30px|Angola}}<ref name="FPAngola">{{cite news | url=https://foreignpolicy.com/2017/01/13/the-zika-virus-just-quietly-spread-to-west-africa-angola-outbreak/ | title=The Zika Virus Just Quietly Spread to Southwest Africa | publisher=Foreign Policy | date=January 13, 2017 | last=Gramer | first=Robbie | language=en}}</ref>
|| 2  || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Cape Verde}}<ref name="UNCapeVerde">{{cite news | url=http://www.unmultimedia.org/radio/portuguese/2016/03/zika-em-cabo-verde-levanta-suspeitas-de-estirpe-africana-do-virus/#.VuNlfvkrLIU | title=Zika em Cabo Verde levanta suspeitas de "estirpe africana" do vírus |trans-title=Zika in Cape Verde is suspected to be "African strain" of the virus | publisher={{wipe|United Nations}} | work=United Nations Radio | date=March 11, 2016 | last=Costa | first=Denise | language=pt}}</ref>
|| 2  || 7,457 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Guinea-Bissau}}<ref name="ECDCThreatsWeek27">{{cite web | url=http://ecdc.europa.eu/en/publications/Publications/Communicable-disease-threats-report-09-jul-2016.pdf | title=CDTR Week 27, 3–9 July 2016 | publisher=[[Organization:European Centre for Disease Prevention and Control|European Centre for Disease Prevention and Control]] | website=Communicable Disease Threats Reports | date=July 8, 2016 | format=PDF}}</ref><ref name="ECDCThreatsWeek33">{{cite web | url=http://ecdc.europa.eu/en/publications/Publications/communicable-disease-threats-report-21-aug-2016.pdf | title=CDTR Week 33, 14–20 August 2016 | publisher=[[Organization:European Centre for Disease Prevention and Control|European Centre for Disease Prevention and Control]] | website=Communicable Disease Threats Reports | date=August 19, 2016 | format=PDF}}</ref>
|| 10  || &nbsp; || &nbsp; || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Madagascar}}<ref name="Madagascar1">{{cite news |url=http://www.lexpressmada.com/blog/actualites/epidemie-madagascar-vulnerable-au-virus-zika-57858/ |title=Épidémie&nbsp;– Madagascar vulnérable au virus Zika |language=fr |trans-title=Epidemic&nbsp;— Madagascar vulnerable to Zika |work=L'Express de Madagascar |date=March 12, 2016 |deadurl=yes |archiveurl=https://web.archive.org/web/20160315012835/http://www.lexpressmada.com/blog/actualites/epidemie-madagascar-vulnerable-au-virus-zika-57858 |archivedate=March 15, 2016 |df=mdy-all }}</ref>
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Réunion|local}}<ref name="Réunion2">{{cite news |url=http://la1ere.francetvinfo.fr/reunion/un-nouveau-cas-de-zika-importe-la-reunion-354088.html |title=Un nouveau cas de Zika importé à La Réunion |language=fr |trans-title=A new case of Zika imported into Réunion |work=Réunion 1re |location=Saint-Denis |publisher=France Télévisions |date=April 27, 2016 }}</ref>
|| &nbsp; || &nbsp; || 2 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|South Africa}}<ref>{{cite web |url=https://www.reuters.com/article/us-health-zika-safrica-idUSKCN0VT092 |publisher=Reuters|title=South Africa confirms first case of Zika virus |date=February 20, 2016 |accessdate=March 2, 2017}}</ref>
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
! Americas<ref name="PAHOZikacases">{{cite web |url=http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090&lang=en |title=Zika suspected and confirmed cases reported by countries and territories in the Americas, 2015–2016; Cumulative cases |publisher=[[Organization:Pan American Health Organization|Pan American Health Organization]] |date=November 23, 2016}}</ref> !! Confirmed !! Suspected !! Imported !! Deaths
|-
| style="text-align: left;" |{{flag|size=30px|Anguilla}}
|| 7 || 44 || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Antigua and Barbuda}}
|| 14 || 393 || 2 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Argentina}}
|| 26 || 1,821 || 27 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Aruba}}
|| 28 || 614 || 7 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Bahamas}}
|| 21 || &nbsp; || 3 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Barbados}}
|| 37 || 653 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Belize}}
|| 49 || 537 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Bermuda}}
|| &nbsp; || &nbsp; || 5 || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Bolivia}}
|| 129 || 718 || 4 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Bonaire}}
|| 60 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Brazil}}{{efn|name=brazilest}}
|| 109,596 || 200,465 || &nbsp; || 6
|-
| style="text-align: left;" |{{flag|size=30px|Canada}}
|| &nbsp; || &nbsp; || 374 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Cayman Islands}}
|| 29 || 201 || 10 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Chile}}
|| &nbsp; || &nbsp; || 29 || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Colombia}}
|| 8,826  || 96,546 || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Costa Rica}}
|| 1,453 || 2,618 || 32 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Cuba}}
|| 3 || &nbsp; || 30 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Curaçao}}
|| 820 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Dominica}}
|| 79 || 1,150 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Dominican Republic}}
|| 327 || 4,893 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Ecuador}}
|| 812 || 2,722 || 15 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|El Salvador}}
|| 51 || 11,353 || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|French Guiana|local}}
|| 483 || 9,700 || 10 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Grenada}}
|| 108 || 314 || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Guadeloupe|local}}
|| 379 || 30,845 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Guatemala}}
|| 466 || 2,785 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Guyana}}
|| 6 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Haiti}}
|| 5 || 2,955 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Honduras}}
|| 298 || 31,863 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Jamaica}}
|| 186 || 7,052 || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Martinique|local}}
|| 12 || 36,680 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Mexico}}
|| 6,642 || &nbsp; || 15 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Nicaragua}}
|| 2,044 || &nbsp; || 3 || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Panama}}
|| 517 || 2,089 || 42 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Paraguay}}
|| 12 || 583 || &nbsp; || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Peru}}
|| 145 || &nbsp; || 18 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Puerto Rico}}<ref name="USA6" /><!-- for number of imported cases -->
|| 34,070 || &nbsp; || 121 || 5
|-
|  style="text-align: left;" | {{flag|size=30px|Saba}}
|| 9 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Saint Barthélemy|local}}
|| 61 || 900 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Saint Kitts and Nevis}}
|| 26 || 532 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Saint Lucia}}
|| 50 || 822 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Saint Martin|local}}
|| 200 || 2,825 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Saint Vincent and the Grenadines}}
|| 38 || 156 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Sint Eustatius}}
|| 16 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Sint Maarten}}
|| 62 || 168 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Suriname}}
|| 723 || 2,755 || &nbsp; || 4
|-
|  style="text-align: left;" | {{flag|size=30px|Trinidad and Tobago}}
|| 643 || &nbsp; || 1 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Turks and Caicos Islands}}
|| 12 || 115 || 3 || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|United States}}<ref name="ECDCThreatsWeek47" /><!--ECDC ref for number of local cases --><ref name="USA6">{{cite web | url=https://www.cdc.gov/zika/reporting/case-counts.html | title=Zika Cases in the United States | publisher=Centers for Disease Control and Prevention | website=Zika virus | date=November 29, 2017}}</ref>
|| 236 || &nbsp; || 5,590 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Uruguay}}
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Venezuela}}
|| 2,380 || 59,147 || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|British Virgin Islands}}
|| 38 || 51 || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|U.S. Virgin Islands}}<ref name="USA6" /><!--for confirmed and imported cases-->
|| 603 || 803 || 2 || &nbsp;
|-
! Asia !! Confirmed !! Suspected !! Imported !! Deaths
|-
| style="text-align: left;" |{{flag|size=30px|China}}<ref name="China3">{{cite news |url=http://english.cri.cn/12394/2016/09/13/3521s940148.htm |title=Chinese mainland confirms 23rd Zika case |author=Fei Fei |publisher=CRIENGLISH.com |date=September 13, 2016 }}</ref>
|| &nbsp; || &nbsp; || 23 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Hong Kong}}<ref name="HongKong1">{{cite news |url=http://outbreaknewstoday.com/1st-imported-zika-virus-case-reported-in-hong-kong-traveled-to-st-barts-59643/ |title=1st imported Zika virus case reported in Hong Kong, traveled to St. Barts |work=Outbreak News Today |date=August 25, 2016 }}</ref>
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Israel}}<ref name="Israel2">{{cite news |last=Schuster |first=Ruth |url=http://www.haaretz.com/israel-news/science/1.722472 |title=Number of Known Zika Cases in Israel Climbs to 9 |work=Haaretz |date=May 31, 2016 }}</ref>
|| &nbsp; || &nbsp; || 9 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Japan}}<ref name="Japan2">{{cite news |url=http://www.japantimes.co.jp/news/2016/06/10/national/science-health/zika-case-no-7-confirmed-in-japanese-returnee-from-latin-america/#.V1y_0JBHarV |title=Zika case No. 7 confirmed in Japanese returnee from Latin America |work=The Japan Times |date=June 10, 2016 }}</ref>
|| &nbsp; || &nbsp; || 7 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Malaysia}}<ref name="Malaysia4">{{cite news |url=http://www.nst.com.my/news/2016/12/197763/eighth-confirmed-zika-case-malaysia-67-year-old-man-petaling-jaya-infected |title=Eighth confirmed Zika case in Malaysia, 67-year-old man from Petaling Jaya infected |author=Hashini Kavishtri Kannan |publisher=New Straits Times |date=December 18, 2016 }}</ref>
|| 8 || &nbsp; || 2 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Maldives}}<ref name="WHO Maldives 2016-0208">{{cite web |url=http://www.who.int/csr/don/8-february-2016-zika-maldives/en/ |title=Zika virus infection&nbsp;– Maldives |website=Disease Outbreak News |publisher=[[Organization:World Health Organization|World Health Organization]] |date=February 8, 2016 |accessdate=February 11, 2016}}</ref>
|| 1 || &nbsp; || &nbsp; || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Myanmar}}<ref name="Myanmar">{{cite news |url=http://www.mmtimes.com/index.php/national-news/yangon/23384-first-zika-case-confirmed-in-yangon.html |title=First Zika case confirmed in Yangon |author1=Myint Kay Thi|author2=Pyae Thet Phyo|author3=Kyawt Darly Lin|author4=Zar Zar Soe |publisher=Myanmar Times |date=October 31, 2016 }}</ref>
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" | {{flag|size=30px|Philippines}}<ref name="Philippines3">{{cite news |url=http://www.philstar.com/headlines/2016/09/06/1620915/doh-confirms-6th-zika-case-philippines |title=DOH confirms 6th Zika case in Philippines |author1=Sheila Crisostomo |author2=Christina Mendez |publisher=The Philippine Star |date=September 6, 2016 }}</ref><ref>{{cite news |url=http://cnnphilippines.com/news/2016/12/06/doh-39-zika-cases.html |title=DOH: PH now has 39 Zika cases, including 3 pregnant women |publisher=CNN Philippines |date=December 6, 2016 }}</ref>
|| 39 || &nbsp; || 6 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Singapore}}<ref name="Singapore3">{{cite news |last=Chia |first=Lianne |url=http://www.channelnewsasia.com/news/singapore/singapore-s-zika-journey-two-months-on/3236784.html |title=Singapore's Zika journey: Two months on |work=Channel NewsAsia |date=October 27, 2016 }}</ref>
|| 435 || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|South Korea}}<ref name="SKorea1">{{cite news |url=http://wap.business-standard.com/article/news-ians/14th-zika-virus-infection-in-south-korea-116092400481_1.html |title=14th Zika virus infection in South Korea |work=IANS |publisher=Business Insider |date=September 24, 2016 }}</ref>
|| &nbsp; || &nbsp; || 14 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Taiwan}}<ref name="Taiwan8">{{cite news |url=http://m.focustaiwan.tw/news/asoc/201610170010.aspx |title=Taiwan reports one more imported Zika case |author1=Chen Wei-ting |author2=Frances Huang |work=Focus Taiwan |date=October 17, 2016 }}</ref>
|| &nbsp; || &nbsp; || 13 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Thailand}}<ref name="Thailand1">{{cite news |url=http://news.xinhuanet.com/english/2016-09/02/c_135655121.htm |title=Two more Zika cases reported in northern Thailand |work=Xinhua |date=September 2, 2016 }}</ref><!-- Xinhua report says three deaths --><ref name="Thailand2">{{cite news |url=http://news.thaivisa.com/thailand/thai-health-min-number-of-zika-patients-approaching-400/155856/ |archive-url=https://web.archive.org/web/20161006145209/http://news.thaivisa.com/thailand/thai-health-min-number-of-zika-patients-approaching-400/155856/ |dead-url=yes |archive-date=October 6, 2016 |title=Thai Health Min: Number of Zika patients approaching 400 |work=Thai Visa News |date=October 5, 2016 }}</ref><ref>{{cite web|url=http://www.ibtimes.sg/thailand-detects-33-new-zika-virus-cases-4732|title=Thailand detects 33 new Zika virus cases}}</ref>
|| 680 || &nbsp; || &nbsp; || 3
|-
|  style="text-align: left;" | {{flag|size=30px|Vietnam}}<ref name="hundreds confirmed cases">{{cite news |url=http://vietnamnews.vn/society/health/348369/zika-on-the-rise-in-hcm-city.html |title=Zika on the rise in HCM City |work=Vietnam News Agency |publisher=Việt Nam News |date=December 21, 2016 }}</ref>
|| 141 || &nbsp; || &nbsp; || &nbsp;
|-
! Europe<ref name="ECDCThreatsWeek47">{{cite web | url=http://ecdc.europa.eu/en/publications/Publications/communicable-disease-threats-report-26-nov-2016.pdf | title=CDTR Week 47, 20–26 November 2016 | publisher=[[Organization:European Centre for Disease Prevention and Control|European Centre for Disease Prevention and Control]] | website=Communicable Disease Threats Reports | date=November 25, 2016 | format=PDF |quote=Since June 2015 (week 26), 20 countries (Austria, Belgium, the Czech Republic, Denmark, Finland, France, Hungary, Ireland, Italy, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom) have reported 1,996 travel-associated Zika virus infections through The European Surveillance System (TESSy). Over the same time period, eight EU/EEA Member States reported 99 Zika cases among pregnant women.}}</ref> !! Confirmed !! Suspected !! Imported !! Deaths
|-
| style="text-align: left;" |{{flag|size=30px|Austria}}<ref name="ECDC9Mar2016">{{cite web | url=http://ecdc.europa.eu/en/publications/Publications/zika-virus-rapid-risk-assessment-9-march-2016.pdf | title=Zika virus disease epidemic: potential association with microcephaly and Guillain–Barré syndrome | publisher=[[Organization:European Centre for Disease Prevention and Control|European Centre for Disease Prevention and Control]] | website=Rapid Risk Assessments | date=March 9, 2016 | location=Stockholm}}</ref>
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Canary Islands}}<ref name="CanaryIslands1">{{cite news |url=http://outbreaknewstoday.com/canary-islands-report-3rd-imported-zika-case-87563/ |title=Canary Islands report 3rd imported Zika case |work=Outbreak News Today |date=April 16, 2016 }}</ref>
|| &nbsp; || &nbsp; || 3 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Czech Republic}}<ref name="Czech2">{{cite news |url=http://www.praguemonitor.com/2016/03/24/fourth-case-zika-reported-czech-republic |title=Fourth case of Zika reported in Czech Republic |work=Prague Daily Monitor |date=March 24, 2016 }}</ref>
|| &nbsp; || &nbsp; || 4 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Denmark}}<ref name="ECDC9Mar2016" />
|| &nbsp; || &nbsp; || 4 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Finland}}<ref name="ECDC9Mar2016" />
|| &nbsp; || &nbsp; || 2 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|France}}<ref name="France1">{{cite web | url=http://www.invs.sante.fr/fr/Dossiers-thematiques/Maladies-infectieuses/Maladies-a-transmission-vectorielle/Zika/Donnees-epidemiologiques | title=Données épidémiologiques | publisher=Institut de Veille Sanitaire | website=Zika | date=October 20, 2016 | language=French |trans-title=Epidemiological data}}</ref>
|| &nbsp; || &nbsp; || 1,071 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Germany}}<ref name="Germany2">{{cite news |url=http://news.xinhuanet.com/english/2016-06/01/c_135405396.htm |title=12 Zika cases registered in Germany in May |work=New China |date=June 1, 2016 }}</ref>
|| &nbsp; || &nbsp; || 56 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Ireland}}<ref name="Ireland2">{{cite web |url=http://www.hpsc.ie/A-Z/Vectorborne/Zika/CasesinIreland/ |title=Zika cases reported in Ireland |publisher=Health Protection Surveillance Center |date=October 21, 2016 |deadurl=yes |archiveurl=https://web.archive.org/web/20160516001759/http://www.hpsc.ie/A-Z/Vectorborne/Zika/CasesinIreland/ |archivedate=May 16, 2016 |df=mdy-all }}</ref>
|| &nbsp; || &nbsp; || 15 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Italy}}<ref name="Italy2">{{cite web | url=http://www.quotidianosanita.it/allegati/allegato5765465.pdf | title=Oggetto: attività di disinfestazione per la tutela della sanità pubblica | publisher=Ministero della Salute | date=June 16, 2016 | format=PDF | language=Italian}}</ref>
|| &nbsp; || &nbsp; || 63 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Madeira}}<ref name="Madeira1">{{cite news |url=http://outbreaknewstoday.com/madeira-reports-two-imported-zika-cases-93202/ |title=Madeira reports two imported Zika cases |work=Outbreak News Today |date=March 27, 2016 }}</ref>
|| &nbsp; || &nbsp; || 2 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Malta}}<ref name="ECDC9Mar2016" />
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Netherlands}}<ref>{{cite web | url=http://www.rivm.nl/Onderwerpen/Z/Zikavirus |title=Zikavirus|trans-title=Zikavirus | publisher=Rijksinstituut voor Volksgezondheid en Milieu | website=Public Health | access-date=October 26, 2016 | language=Dutch}}</ref>
|| &nbsp; || &nbsp; || 95 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Norway}}<ref name="Norway1">{{cite news | url=http://www.vg.no/nyheter/utenriks/zikaviruset/ti-gravide-har-vaert-zika-smittet-i-norge/a/23765013/ | title=Ti gravide har vært zika-smittet i Norge |trans-title=Ten pregnant has been Zika-infected in Norway | work=VG | date=August 13, 2016 | accessdate=August 13, 2016 | last=Sæther | first=Anne Stine | language=Norwegian}}</ref>
|| &nbsp; || &nbsp; || 30 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Poland}}<ref name="Poland1">{{cite news |url=http://sputniknews.com/europe/20160816/1044335375/poland-zika-virus.html |title=University of Warsaw Confirms First Cases of Zika Virus in Poland |work=Sputnik News |date=August 16, 2016 }}</ref>
|| &nbsp; || &nbsp; || 2 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Portugal}}<ref name="Portugal2">{{cite web |url=https://www.sns.gov.pt/noticias/2016/05/19/doenca-por-virus-zika-atualizado-a-18052016/ |title=Doença por vírus Zika |language=pt |trans-title=Zika virus disease |publisher=Serviço Nacional de Saúde |date=May 19, 2016 }}</ref>
|| &nbsp; || &nbsp; || 17 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Romania}}<ref name="Romania1">{{cite news | url=http://www.digi24.ro/Stiri/Digi24/Actualitate/Stiri/Al+treilea+caz+de+Zika+confirmat+in+Romania | title=Al treilea caz de Zika confirmat în România |trans-title=Third case of Zika confirmed in Romania | work=Digi24 | date=July 28, 2016 | language=ro}}</ref>
|| &nbsp; || &nbsp; || 3 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Russia}}<ref name="Russia2">{{cite news |last=Zubkov |first=Ivan |url=http://izvestia.ru/news/631145 |title=Девятый турист вернулся в Россию с вирусом Зика |language=Russian |trans-title=Ninth tourist returned to Russia with Zika virus |work=Izvestia |date=September 7, 2016 }}</ref>
|| &nbsp; || &nbsp; || 9 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Slovakia}}<ref name="ECDC9Mar2016" />
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Slovenia}}<ref name="ECDC9Mar2016" />
|| &nbsp; || &nbsp; || 1 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Spain}}<ref name="Spain1">{{cite web | url=http://www.msssi.gob.es/en/profesionales/saludPublica/zika/casosDiagnosticados/home.htm | title=Casos diagnosticados |trans-title=Diagnosed cases | publisher=Ministerio de Sanidad, Servicios Sociales e Igualdad | website=Public Health | date=October 24, 2016 | language=Spanish}}</ref>
|| &nbsp; || &nbsp; || 297 || &nbsp;
|-
| style="text-align: left;" |{{flag|size=30px|Sweden}}<ref name="ECDC9Mar2016" />
|| &nbsp; || &nbsp; || 2 || &nbsp;
|-
| style="text-align: left;" |{{flag|Switzerland|size=30px}}<ref name="Switz2">{{cite news |url=https://www.thelocal.ch/20160726/confirmed-cases-of-zika-virus-soar-in-switzerland |title=Confirmed cases of Zika virus soar in Switzerland |work= thelocal.ch |date=July 26, 2016 }}</ref>
|| &nbsp; || &nbsp; || 28 || &nbsp;
|-
| style="text-align: left;" |{{nowrap|{{flag|size=30px|United Kingdom}}}}<ref name="UK2">{{cite web | url=https://www.gov.uk/guidance/zika-virus#zika-cases-diagnosed-in-the-uk | title=Zika virus (ZIKV): clinical and travel guidance | publisher=[[Organization:Public Health England|Public Health England]] | website=Health protection – collection | date=October 26, 2016}}</ref>
|| &nbsp; || &nbsp; || 244 || &nbsp;
|-
! Oceania !! Confirmed !! Suspected !! Imported !! Deaths
|-
|  style="text-align: left;" | {{flag|size=30px|American Samoa}}<ref name="USA6" /><ref name="AmericanSamoa2">{{cite web |url=http://reliefweb.int/sites/reliefweb.int/files/resources/zika%20sitrep%206.23.16.pdf |format=PDF |title=Zika Outbreak Situation Report |website=reliefweb |publisher=American Samoa Department of Health |date=June 23, 2016 }}</ref>
|| 54 || 706 || 7 || &nbsp;
|-
| style="text-align: left;" | {{flag|Australia|size=30px}}<ref name="Australia2">{{cite news |last=Branley |first=Alison |url=http://www.abc.net.au/news/2016-10-24/queensland-preparing-for-mosquito-season-as-zika-cases-rise/7960948 |title=Zika: Number of Australian cases rises to 76 as north Queensland prepares for mosquito breeding season |work=ABC Online |location=Australia |date=October 24, 2016 }}</ref>
|| &nbsp; || &nbsp; || 76 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Fiji}}<ref name="ECDCThreatsWeek42">{{cite web | url=http://ecdc.europa.eu/en/publications/Publications/communicable-disease-threats-report-22-oct-2016.pdf | title=CDTR Week 42, 16–22 October 2016 | publisher=[[Organization:European Centre for Disease Prevention and Control|European Centre for Disease Prevention and Control]] | website=Communicable Disease Threats Reports | date=October 21, 2016 | format=PDF}}</ref><ref name="Fiji2">{{cite news |last=Dipitika |first=Sharon |url=http://fijivillage.com/news/332-dengue-fever-cases-recorded-from-January-this-year-25rsk9/ |title=332 dengue fever cases recorded from January this year |work=Fijivillage |date=May 18, 2016 }}</ref>
|| 17 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Kosrae}} (FSM)<ref name="Kosrae2">{{cite web |url=http://reliefweb.int/sites/reliefweb.int/files/resources/Kosrae%20Zika%20SitRep%206-24-2016.pdf |format=PDF |title=Zika in Kosrae, Federated States of Micronesia, Situation Report #7 |website=reliefweb |publisher=Kosrae EpiNet Team |date=June 24, 2016 }}</ref>
|| 12 || 82 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Marshall Islands}}<ref name="Marshall2">{{cite web |url=http://reliefweb.int/sites/reliefweb.int/files/resources/RMI%20Zika%20SitRep%20%28April20%202016%29.pdf |format=PDF |title=Zika in Republic of the Marshall Islands, 2015-2016 |website=ReliefWeb Updates |publisher=Government of the Marshall Islands |date=April 20, 2016 }}</ref>
|| 2 || 34 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Nauru}}<ref name="Nauru1">{{cite news |url=http://www.radionz.co.nz/international/pacific-news/302578/nauru-latest-pacific-country-to-discover-zika |title=Nauru latest Pacific country to discover zika |work=Radio New Zealand News |date=April 28, 2016}}</ref>
|| &nbsp; || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|New Caledonia|local}}<ref name="ecdc-25-May-2015" />
|| 73 || &nbsp; || &nbsp; || &nbsp;
|-
| style="text-align: left;" | {{flag|New Zealand|size=30px}}<ref name="NewZealand5">{{cite web | url=https://surv.esr.cri.nz/PDF_surveillance/ZikaWeekly/20160831ZikaWeekly.pdf | title=Zika virus infection weekly report | publisher=[[Organization:Institute of Environmental Science and Research|Institute of Environmental Science and Research]] | website=Public Health Surveillance | date=August 31, 2016 | format=PDF | deadurl=yes | archiveurl=https://web.archive.org/web/20160917104716/https://surv.esr.cri.nz/PDF_surveillance/ZikaWeekly/20160831ZikaWeekly.pdf | archivedate=September 17, 2016 | df=mdy-all }}</ref>
|| &nbsp; || &nbsp; || 97 || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Papua New Guinea}}<ref name="PNG2">{{cite web |url=http://www.who.int/csr/don/22-april-2016-zika-png/en/ |title=Zika virus infection&nbsp;– Papua New Guinea |website=Disease Outbreak News |publisher=World Health Organization |date=April 22, 2016 }}</ref>
|| 6 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Samoa}}<ref name="Samoa2">{{cite news |url=http://news.xinhuanet.com/english/2016-03/21/c_135209573.htm |title=Samoa records 10 Zika cases |work=Xinhua |date=March 21, 2016 }}</ref>
|| 10 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Solomon Islands}}<ref name="ECDCThreatsWeek42" /><ref name="ecdc-25-May-2015">{{cite web |title=Zika virus infection outbreak, Brazil and the Pacific region |url=http://ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-Zika%20virus-south-america-Brazil-2015.pdf |date=May 25, 2015 |publisher=[[Organization:European Centre for Disease Prevention and Control|European Centre for Disease Prevention and Control]] |location=Stockholm |accessdate=February 12, 2016 |page=4}}</ref>
|| 302 || &nbsp; || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Tonga}}<ref name="Tonga2">{{cite news |url=http://www.radionz.co.nz/international/pacific-news/298167/tonga-says-zika-clean-up-working |title=Tonga says Zika clean-up working |work=Radio New Zealand |date=March 5, 2016 }}</ref>
|| 36 || 2,010 || &nbsp; || &nbsp;
|-
|  style="text-align: left;" | {{flag|size=30px|Vanuatu}}<ref name="ecdc-25-May-2015" /><ref name="Vanuatu1">{{cite news |last=Herriman |first=Robert |url=http://outbreaknewstoday.com/zika-virus-reported-on-vanuatu-for-the-first-time-21381/ |title=Zika virus reported on Vanuatu for the first time |work=Outbreak News Today |date=April 28, 2015 }}</ref>
|| &nbsp; || &nbsp; || &nbsp; || &nbsp;
|-
| colspan=5 style="text-align: left;" <!--font-size: 85%"--> | {{notelist|refs=
{{efn|name=deaths|Numbers shown do not include infant deaths or stillbirths.}}
{{efn|name=brazilest|In 2015, Brazil estimated a minimum of 497,593 and a maximum of 1,482,701 cases.
{{cite web | url=http://portalsaude.saude.gov.br/images/pdf/2016/janeiro/22/microcefalia-protocolo-de-vigilancia-e-resposta-v1-3-22jan2016.pdf | title=Protocolo de vigilância e resposta à ocorrência de microcefalia |trans-title=Protocol for surveillance and response to the occurrence of microcephaly | publisher=Ministério da Saúde, Secretaria de Vigilância em Saúde | website=Emergência de Saúde Pública de Importância Nacional | date=January 22, 2016 | page=17 | language=pt}}
}}
<!--{{efn|name=totals|Because numbers in the columns may be from more than one source, the sum of the numbers in each column may not equal the totals listed here, which are from a single source.}}-->
}}
|}

As early as August 2014, physicians in Natal in northeastern Brazil began to investigate an outbreak of illness characterized by a flat pinkish rash, bloodshot eyes, fever, joint pain and headaches. While the symptoms resembled [[Medicine:Dengue fever|dengue fever]], testing ruled out this and several other potential causes. By March 2015, the illness had spread to [[Place:Salvador, Bahia|Salvador]], [[Place:Bahia|Bahia]] <ref name="CardosoPaploski2015">{{cite journal |doi=10.3201/eid2112.151167 |pmid=26584464 |title=Outbreak of Exanthematous Illness Associated with Zika, Chikungunya, and Dengue Viruses, Salvador, Brazil |journal=Emerging Infectious Diseases |volume=21 |issue=12 |pages=2274–2276 |year=2015 |last1=Cardoso |first1=Cristiane W |last2=Paploski |first2=Igor A D |last3=Kikuti |first3=Mariana |last4=Rodrigues |first4=Moreno S |last5=Silva |first5=Monaise M O |last6=Campos |first6=Gubio S |last7=Sardi |first7=Silvia I |last8=Kitron |first8=Uriel |last9=Reis |first9=Mitermayer G |last10=Ribeiro |first10=Guilherme S }}</ref> and had appeared in three different states.<ref name=McNeil6Feb>{{cite news |url=https://www.nytimes.com/2016/02/07/health/zika-virus-brazil-how-it-spread-explained.html |title=How a Medical Mystery in Brazil Led Doctors to Zika |work={{wipe|The New York Times}} |date=February 6, 2016 |accessdate=March 6, 2016 |first1=Donald G. |last1=McNeil, Jr. |first2=Simon |last2=Romero |first3=Sabrina |last3=Tavernise}}</ref> Then, in May 2015, researchers from the [[Organization:Federal University of Bahia|Federal University of Bahia]] and the [[Organization:Evandro Chagas Institute|Evandro Chagas Institute]] determined, using the [[Biology:Reverse transcription polymerase chain reaction|RT-PCR technique]], that the illness was an outbreak of Zika virus.<ref name="Identificado vírus causador">{{cite news |url=http://g1.globo.com/bahia/noticia/2015/04/identificado-virus-causador-de-doenca-misteriosa-em-salvador-e-rms.html |title=Identificado vírus causador de doença misteriosa em Salvador e RMS&nbsp;– notícias em Bahia |date=April 29, 2015 |work=GloboNews |location=São Paulo |language=pt}}</ref><ref name="Zika virus&nbsp;– Brazil: confirmed">{{cite web |url=http://www.promedmail.org/direct.php?id=3370768 |title=Zika virus&nbsp;– Brazil: confirmed |publisher=[[Organization:International Society for Infectious Diseases|International Society for Infectious Diseases]] |website=[[Medicine:ProMED-mail|ProMED-mail]] |date=May 19, 2015}}</ref>

The [[Medicine:Zika virus|Zika virus]] was first isolated in 1947, in a rhesus monkey in a forest near Entebbe, Uganda.<ref name="DuffyChen2009">{{cite journal |doi=10.1056/NEJMoa0805715 |pmid=19516034 |title=Zika Virus Outbreak on Yap Island, Federated States of Micronesia |journal=New England Journal of Medicine |volume=360 |issue=24 |pages=2536–2543 |year=2009 |last1=Duffy |first1=Mark R |last2=Chen |first2=Tai-Ho |last3=Hancock |first3=W. Thane |last4=Powers |first4=Ann M |last5=Kool |first5=Jacob L |last6=Lanciotti |first6=Robert S |last7=Pretrick |first7=Moses |last8=Marfel |first8=Maria |last9=Holzbauer |first9=Stacey |last10=Dubray |first10=Christine |last11=Guillaumot |first11=Laurent |last12=Griggs |first12=Anne |last13=Bel |first13=Martin |last14=Lambert |first14=Amy J |last15=Laven |first15=Janeen |last16=Kosoy |first16=Olga |last17=Panella |first17=Amanda |last18=Biggerstaff |first18=Brad J |last19=Fischer |first19=Marc |last20=Hayes |first20=Edward B }}</ref> Although serologic evidence indicated additional human exposure during subsequent decades in parts of Africa and Asia,<ref name="Zika virus outside Africa">{{cite journal |doi=10.3201/eid1509.090442 |pmid=19788800 |pmc=2819875 |title=Zika Virus Outside Africa |journal=Emerging Infectious Diseases |volume=15 |issue=9 |pages=1347–1350 |year=2009 |last1=Hayes |first1=Edward B }}</ref> before the 2007 Yap Islands Zika virus outbreak, only 14 cases of human Zika virus disease had been documented.<ref name="DuffyChen2009" />

Researchers generally believe the virus was brought to Brazil by an infected traveler who had been exposed to the virus in French Polynesia, who was then bitten by a mosquito that then infected others.<ref name="Romero29Jan">{{cite news |url=https://www.nytimes.com/2016/01/30/world/americas/tears-and-bewilderment-in-brazilian-city-facing-zika-crisis.html |title=Tears and Bewilderment in Brazilian City Facing Zika Crisis |work={{wipe|The New York Times}} |date=January 29, 2016 |accessdate=February 1, 2016 |first=Simon |last=Romero}}</ref><ref name="Zika Virus Transmission from French Polynesia to Brazil">{{cite journal |doi=10.3201/eid2110.151125 |pmid=26403318 |pmc=4593458 |title=Zika Virus Transmission from French Polynesia to Brazil |journal=Emerging Infectious Diseases |volume=21 |issue=10 |pages=1887 |year=2015 |last1=Musso |first1=Didier }}</ref><ref name="Murthy28Jan">{{cite news |url=http://abcnews.go.com/Health/zika-virus-outbreak-brazil-linked-major-sporting-events/story?id=36575321 |title=Origin of Zika Virus Outbreak in Brazil May Be Linked to Major Sporting Events |work=ABC News |date=January 28, 2016 |accessdate=March 6, 2016 |last=Murthy |first=Bhavini}}</ref> [[Biology:Phylogenetics|Phylogenetic]] analysis of the first Brazilian infections have strongly indicated that the circulating virus is the Asian, rather than African, strain of the virus, and was genetically similar to the virus found in the outbreak in French Polynesia.<ref name="Zika Virus Transmission from French Polynesia to Brazil"/><ref name="Murthy28Jan"/> It appears Zika's route&nbsp;– from Africa and Asia to Oceania and then the Americas&nbsp;– may mirror that of [[Medicine:Epidemiology of chikungunya|chikungunya]] and dengue, both of which are now [[Medicine:Endemic (epidemiology)|endemic]] in a large portion of the Americas.<ref name="Zika virus: following the path of dengue and chikungunya?">{{cite journal |doi=10.1016/S0140-6736(15)61273-9 |pmid=26194519 |title=Zika virus: Following the path of dengue and chikungunya? |journal=The Lancet |volume=386 |issue=9990 |pages=243–244 |year=2015 |last1=Musso |first1=Didier |last2=Cao-Lormeau |first2=Van Mai |last3=Gubler |first3=Duane J }}</ref>

The specific event that brought the virus to Brazil was uncertain until March 2016. Brazilian researchers had suggested that the Zika virus arrived during the 2014 FIFA World Cup tournament.<ref name="Romero29Jan"/> French researchers speculated the virus arrived shortly afterwards, in August 2014, when canoeing teams from French Polynesia, [[Earth:New Caledonia|New Caledonia]], Easter Island, and the Cook Islands, which had been or were experiencing Zika outbreaks, attended the [[Engineering:Va'a|Va'a]] World Sprint Championships in Rio de Janeiro.<ref name="McNeil6Feb"/><ref name="Zika Virus Transmission from French Polynesia to Brazil"/> However, the outbreak in French Polynesia is known to have peaked and declined precipitously by February 2014, lending doubt to the suggestion the virus arrived later that year in Brazil with spectators and competitors.<ref name=McNeil24Mar/> In March 2016, a study published in ''Science'', which developed a "[[Biology:Molecular clock|molecular clock]]" based on the count of virus mutations in a relatively small sample, suggested Zika virus arrived in the Americas (most likely in Brazil) from French Polynesia between May and December 2013, well before the World Cup and Va'a Championships.<ref name=McNeil24Mar>{{cite news|url=https://www.nytimes.com/2016/03/25/health/one-traveler-may-have-brought-zika-to-the-americas-in-2013.html|title=One Traveler May Have Brought Zika to the Americas in 2013|work=The New York Times|date=March 24, 2016|accessdate=March 24, 2016|first=Donald G., Jr.|last=McNeil}}</ref> In the ''Science'' article, Faria and colleagues managed to trace the origins of the virus strain that is circulating in Brazil and found that this strain has little genetic variability when compared to the strain of French Polynesia; after relating the number of travellers arriving in Brazil from French Polynesia with the cases reported and the events happening in that year, the team was able to deduce that the virus arrived in Brazil in 2013 during the Confederation Cup, when Tahiti's team played against other teams in a few Brazilian cities, which attracted many tourists from both places.<ref name="FariaAzevedo2016">{{cite journal |doi=10.1126/science.aaf5036 |pmid=27013429 |pmc=4918795 |title=Zika virus in the Americas: Early epidemiological and genetic findings |journal=Science |volume=352 |issue=6283 |pages=345–349 |year=2016 |last1=Faria |first1=N. R |last2=Azevedo |first2=R. d. S. d. S |last3=Kraemer |first3=M. U. G |last4=Souza |first4=R |last5=Cunha |first5=M. S |last6=Hill |first6=S. C |last7=Theze |first7=J |last8=Bonsall |first8=M. B |last9=Bowden |first9=T. A |last10=Rissanen |first10=I |last11=Rocco |first11=I. M |last12=Nogueira |first12=J. S |last13=Maeda |first13=A. Y |last14=Vasami |first14=F. G. d. S |last15=MacEdo |first15=F. L. d. L |last16=Suzuki |first16=A |last17=Rodrigues |first17=S. G |last18=Cruz |first18=A. C. R |last19=Nunes |first19=B. T |last20=Medeiros |first20=D. B. d. A |last21=Rodrigues |first21=D. S. G |last22=Nunes Queiroz |first22=A. L |last23=Silva |first23=E. V. P. d |last24=Henriques |first24=D. F |last25=Travassos Da Rosa |first25=E. S |last26=De Oliveira |first26=C. S |last27=Martins |first27=L. C |last28=Vasconcelos |first28=H. B |last29=Casseb |first29=L. M. N |last30=Simith |first30=D. d. B |displayauthors=29 }}</ref> Zika virus usually has very mild, or no symptoms, so it took almost a year for Brazil to confirm the first case of the disease. By then the outbreak was already widespread.
Factors associated with the rapid spread of Zika virus in Brazil include the non-immune population, high population density, tropical climate and inadequate control of ''Aedes'' mosquitoes in the country.<ref name="AiZhang2016">{{cite journal |doi=10.1038/emi.2016.42 |pmid=26956448 |pmc=4820676 |title=Zika virus outbreak: 'a perfect storm' |journal=Emerging Microbes & Infections |volume=5 |issue=3 |pages=e21 |year=2016 |last1=Ai |first1=Jing-Wen |last2=Zhang |first2=Ying |last3=Zhang |first3=Wenhong }}</ref>

The above average warm temperatures of 2015-2016 caused by a strong El Nino and ongoing anthropogenic climate change created an environment conducive to the spread of the Zika Virus in Brazil[2010]. The 2015 -16 El Nino increased ocean and ground surface temperatures to above average [2010]. January 2016 brought about nine consecutive months with temperatures 1.04&nbsp;°C above the global average.<ref name=r200>Global Climate Report - January 2016. Retrieved March 16, 2018, from https://www.ncdc.noaa.gov/sotc/global/201601</ref> It is important to note, however, that while South America had areas experiencing 2.0&nbsp;°C above average temperatures (for 1981-2010), areas including Argentina, Southern Brazil and Uruguay experienced temperatures 0.5&nbsp;°C below average.<ref name=r200/>

Precipitation is another crucial factor to consider as Eastern Brazil and other areas in southern South America experienced high amounts of precipitation in early 2016.<ref name=r200/> The environmental conditions of increased rainfall and higher average temperatures in the South American region, lead to both a longer mosquito season and a higher mosquito density<ref name=r206>{{cite journal |doi=10.1371/journal.pone.0163863 |pmid=27695107 |pmc=5047650 |title=Climate Change Influences on the Global Potential Distribution of the Mosquito Culex quinquefasciatus, Vector of West Nile Virus and Lymphatic Filariasis |journal=PLOS ONE |volume=11 |issue=10 |pages=e0163863 |year=2016 |last1=Samy |first1=Abdallah M |last2=Elaagip |first2=Arwa H |last3=Kenawy |first3=Mohamed A |last4=Ayres |first4=Constância F. J |last5=Peterson |first5=A. Townsend |last6=Soliman |first6=Doaa E }}</ref> which created an environment in which the Zika carrying Aedes aegypti and Aedes albopictus mosquitoes can thrive. Looking forward, climate models suggest that regions favorable to the Aedes mosquitoes will grow, widening the range of Zika and other mosquito-carried diseases.<ref name=r201>{{cite journal |doi=10.4081/gh.2014.29 |pmid=24893017 |title=Climate change and the potential global distribution of Aedes aegypti: Spatial modelling using geographical information system and CLIMEX |journal=Geospatial Health |volume=8 |issue=2 |pages=405–15 |year=2014 |last1=Khormi |first1=Hassan M |last2=Kumar |first2=Lalit }}</ref> The potential for epidemics will spread inland and into other regions of the world, not just in tropical environments.<ref name=r202>{{cite journal |doi=10.1016/j.ebiom.2016.03.046 |pmid=27322480 |pmc=4909611 |title=Climate Change and Aedes Vectors: 21st Century Projections for Dengue Transmission in Europe |journal=Ebiomedicine |volume=7 |pages=267–277 |year=2016 |last1=Liu-Helmersson |first1=Jing |last2=Quam |first2=Mikkel |last3=Wilder-Smith |first3=Annelies |last4=Stenlund |first4=Hans |last5=Ebi |first5=Kristie |last6=Massad |first6=Eduardo |last7=Rocklöv |first7=Joacim }}</ref>

Confirmed cases have been reported in 40 countries or territories in South America, North America, and the Caribbean,<ref name="PAHOGeographicDistribution">{{cite web | url=http://ais.paho.org/phip/viz/ed_zika_countrymap.asp | title=Geographic distribution of confirmed autochthonous cases of Zika virus (vector-borne transmission) in countries and territories of the Americas, 2015-2016 | publisher=[[Organization:Pan American Health Organization|Pan American Health Organization]] | website=Epidemic Diseases–Zika in the Americas | date=May 26, 2016 | accessdate=May 30, 2016}}</ref> as well as 16 in the western Pacific and one in Africa since the beginning of 2015 (''see table'').

Many countries with no cases of mosquito transmission have reported travel-related Zika cases: people who moved or came home from a Zika-affected region before they showed symptoms (''see table'').

== Transmission ==
[[File:Aedes aegypti.jpg|thumb|Adult ''Aedes aegypti'' mosquito, a vector or carrier of the Zika virus ]]
Zika is a [[Medicine:Mosquito-borne disease|mosquito-borne disease]]. The resurgence of ''[[Biology:Aedes aegypti|Aedes aegypti]]''{{'}}s worldwide distribution over the past 2–3 decades makes it one of the most widely distributed mosquito species.<ref name="ECDC Aedes aegypti">{{cite web |url=http://ecdc.europa.eu/en/healthtopics/vectors/mosquitoes/Pages/aedes-aegypti.aspx |title=Aedes aegypti |publisher=European Centre for Disease Prevention and Control}}</ref> In 2015, ''[[Biology:Aedes albopictus|Aedes albopictus]]'' was present in tropical, subtropical, and temperate regions of the Americas, reaching as far north as the Great Lakes of North America and, internationally, living alongside ''Aedes aegypti'' in some tropical and subtropical regions.<ref name="The global distribution of the arbovirus vectors" />

The ''Aedes aegypti'' mosquito usually bites in the morning and afternoon hours, and can be identified by the white stripes on its legs.<ref name="WHO Zika virus fact sheet">{{cite web |url=http://www.who.int/mediacentre/factsheets/zika/en/ |title=Zika virus fact sheet |publisher=World Health Organization |date=February 2016 |accessdate=February 15, 2016}}</ref> The mosquito species (''Aedes aegypti'', mainly, and ''Aedes albopictus'') that can spread Zika virus can also spread dengue, [[Medicine:Chikungunya|chikungunya]], and [[Medicine:Yellow fever|yellow fever]].<ref name="CDC Help Control Mosquitoes">{{cite web |url=https://www.cdc.gov/zika/pdfs/control_mosquitoes_chikv_denv_zika.pdf |title=Help Control Mosquitoes that Spread Dengue, Chikungunya, and Zika Viruses |publisher=Centers for Disease Control |website=Fact Sheets |date=August 2015}}</ref>

Zika can also be [[Medicine:Sexually transmitted infection|sexually transmitted]] between partners of both genders.<ref>{{Cite news|url=https://www.cdc.gov/zika/hc-providers/clinical-guidance/sexualtransmission.html|title=Clinical Guidance for Healthcare Providers for Prevention of Sexual Transmission of Zika Virus|last=|first=|date=2017-07-21|work=CDC|access-date=2017-10-30|language=en-us}}</ref> Sexual transmission of Zika has been documented in nine countries—Argentina, Canada, Chile, France, Italy, New Zealand, Peru, Portugal, and the United States—during this outbreak.<ref name="CanadaSexTrans">{{cite news |url=http://outbreaknewstoday.com/canada-reports-1st-sexually-transmitted-zika-case-9th-country-to-report-person-to-person-transmission-88047/ |title=Canada reports 1st sexually transmitted Zika case, 9th country to report person-to-person transmission |work=Outbreak News Today |date=April 26, 2016 }}</ref>

Zika is transmitted from pregnant women to the fetus ("[[Biology:Vertical transmission|vertical transmission]]"), and causes microcephaly and other severe brain anomalies in infants born of women infected with the virus.<ref name=RasmussenJamieson2016 /><ref name="WHO SitRep Apr 7, 2016"/>
[[File:Microcephaly-comparison-500px.jpg|thumb|A baby with microcephaly (left) compared to a baby with a typical head size]]

Zika infections in adults can cause [[Medicine:Guillain–Barré syndrome|Guillain–Barré syndrome]].<ref name="WHO SitRep Apr 7, 2016"/>

== Diagnosis ==
{{main|Medicine:Zika fever}}
[[File:ZIKA.png|alt=Symptoms of Zika virus|thumb|Symptoms of Zika virus<ref name="Understanding Zika">{{cite web |access-date=February 8, 2016 |url=http://understandingzika.org/ |title=Understanding Zika}}</ref>]] Symptoms are similar to other flaviviruses such as dengue fever or the alphavirus that causes chikungunya,<ref name="Musso14">{{cite journal |doi=10.1111/1469-0691.12707 |pmid=24909208 |title=Rapid spread of emerging Zika virus in the Pacific area |journal=Clinical Microbiology and Infection |volume=20 |issue=10 |pages=O595–O596 |year=2014 |last1=Musso |first1=D |last2=Nilles |first2=E.J |last3=Cao-Lormeau |first3=V.-M }}</ref> but are milder in form and usually last two to seven days.<ref name="The emergence of zika virus" /> It is estimated that 80% of cases are asymptomatic.<ref name="Interim Guidelines for Prevention of Sexual Transmission"/> The main clinical symptoms in symptomatic patients are low-grade fever, conjunctivitis, transient joint pain (mainly in the smaller joints of the hands and feet) and [[Medicine:Maculopapular rash|maculopapular rash]] that often starts on the face and then spreads throughout the body.<ref name=Musso14 />

It is difficult to diagnose Zika virus infection based on clinical signs and symptoms alone due to overlaps with other [[Medicine:Arbovirus|arbovirus]]es that are endemic to similar areas.<ref name="Yet Another Arbovirus Threat">{{cite journal |doi=10.1056/NEJMp1600297 |pmid=26761185 |title=Zika Virus in the Americas — Yet Another Arbovirus Threat |journal=New England Journal of Medicine |volume=374 |issue=7 |pages=601–604 |year=2016 |last1=Fauci |first1=Anthony S |last2=Morens |first2=David M }}</ref> The methods currently available to test for Zika antibodies cross-react with dengue antibodies. An [[Biology:Immunoglobulin M|IgM]]-positive result in a dengue or Zika ELISA test can only be considered indicative of a recent flavivirus infection. Plaque-reduction neutralization tests (PRINT) can be performed and may be specific.<ref name="CDC Revised diagnostic testing for Zika">{{cite web |url=https://www.cdc.gov/zika/pdfs/denvchikvzikv-testing-algorithm.pdf |title=Revised diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health Laboratories |publisher=Centers for Disease Control and Prevention |website=Division of Vector-Borne Diseases |date=February 7, 2016}}</ref> The Zika virus can be identified by RT-PCR in acutely ill patients.<ref name="The emergence of zika virus" />

RT-PCR testing of serum and tissue samples can be used to detect the presence of the Zika virus. However, the RT-PCR test with serum is only helpful while the virus is still in the blood which is generally within the first week of the illness. After this period other methods should be used to determine if the virus is still present in the body. A test for IgM antibodies has seen to be effective over longer periods of time, as these antibodies can be present starting 4 days after the beginning of the illness and up to 12 weeks after that. However, it is suggested that a PRINT test be performed following a test for IgM antibodies to help eliminate false positives resulting from other flaviviruses. The PRINT test looks for viral-specific neutralizing antibodies. However, this test can still produce false positive results, for Zika, in individuals who have received immunization for or had previously been exposed to other flaviviruses.<ref>{{cite journal |doi=10.1542/peds.2016-0621 |pmid=27009036 |title=Zika Virus Disease: A CDC Update for Pediatric Health Care Providers |journal=Pediatrics |volume=137 |issue=5 |pages=e20160621 |year=2016 |last1=Karwowski |first1=M. P |last2=Nelson |first2=J. M |last3=Staples |first3=J. E |last4=Fischer |first4=M |last5=Fleming-Dutra |first5=K. E |last6=Villanueva |first6=J |last7=Powers |first7=A. M |last8=Mead |first8=P |last9=Honein |first9=M. A |last10=Moore |first10=C. A |last11=Rasmussen |first11=S. A }}</ref>

== Containment and control ==

=== The Americas ===
Several countries, including Colombia, Ecuador, El Salvador, and Jamaica, advised women to postpone getting pregnant until more was known about the risks.<ref name="Zika virus triggers pregnancy delay calls"/><ref name="Pregnant Irish women warned" /> Plans were announced by the authorities in Rio de Janeiro, Brazil, to try to prevent the spread of the Zika virus during the 2016 Summer Olympics in Rio.<ref name="BBC-2016-01-24a">{{cite news |url=https://www.bbc.com/news/world-latin-america-35394297 |title=Zika: Olympics plans announced by Rio authorities |work=BBC News |date=January 24, 2016}}</ref> The health ministry of Peru installed more than 20,000 ovitraps during the 2015 dengue outbreak. The same ovitraps will be used to monitor a potential Zika outbreak in tropical regions of Peru.<ref name="Northern Peru braces">{{cite news |last=Post |first=Colin |url=http://perureports.com/2016/01/25/northern-peru-braces-for-mosquito-borne-zika-virus/ |title=Northern Peru braces for mosquito-borne Zika virus |work=Peru Reports |date=January 25, 2016}}</ref>

[[File:MICROCEPHALY.png|alt=symptoms of microcephaly|thumb|Symptoms of microcephaly, linked to mothers infected by Zika virus<ref name="Understanding Zika"/>]]
On January 15, 2016, because of the "growing evidence of a link between Zika and microcephaly" the Centers for Disease Prevention and Control (CDC) issued a travel warning advising pregnant women to consider postponing travel to Brazil as well as the following countries and territories where Zika fever had been reported: Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.<ref name="Medscape&nbsp;– CDC Issues Zika Travel Alert">{{cite news |last=Lowes |first=Robert |url=http://www.medscape.com/viewarticle/857389?nlid=97363_3901&src=wnl_newsalrt_160115_MSCPEDIT&uac=28013DZ&impID=957011&faf=1 |title=CDC Issues Zika Travel Alert |work=Medscape Medical News |date=January 15, 2016}}</ref> On January 20, the Ministry of Health of Chile published a health notice.<ref name="Recomendaciones por Dengue Zika Chikungunya">{{cite web |url=http://web.minsal.cl/virus-zika/ |title=Recomendaciones por Dengue Zika Chikungunya |publisher=Chile Ministry of Health |date=January 20, 2016 |language=es |deadurl=yes |archiveurl=https://web.archive.org/web/20160315024332/http://web.minsal.cl/virus-zika/ |archivedate=March 15, 2016 |df=mdy-all }}</ref> On January 22, eight more countries and territories were added to the list of those affected: Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa.<ref name="CDC expands Zika travel advisory">{{cite news |last=Branswell |first=Helen |url=http://www.statnews.com/2016/01/22/zika-travel-advisory-expanded/ |title=CDC expands Zika travel advisory to include more countries |work=Stat News |date=January 22, 2016}}</ref>

On February 1, Costa Rica and Nicaragua were added to the list, bringing the number of countries and territories affected to 28.<ref name="costaricanicaragua1">{{cite news |last1=Mohney |first1=Gillian |title=Latest on Zika Virus: WHO's Recommendations, CDC Advisory Expanded to 28 Countries |url=http://abcnews.go.com/Health/latest-zika-virus-recommendations-cdc-advisory-expanded-28/story?id=36664447 |accessdate=February 28, 2016 |work=ABC News |date=February 2, 2016}}</ref> The agency issued additional guidelines and suggested that women thinking about becoming pregnant consult with their [[Medicine:Physician|physician]]s before traveling.<ref name="CDC Interim Guidelines for Pregnant Women">{{cite journal |doi=10.15585/mmwr.mm6502e1 |pmid=26796813 |title=Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=65 |issue=2 |pages=30–33 |year=2016 |last1=Petersen |first1=Emily E |last2=Staples |first2=J. Erin |last3=Meaney-Delman |first3=Dana |last4=Fischer |first4=Marc |last5=Ellington |first5=Sascha R |last6=Callaghan |first6=William M |last7=Jamieson |first7=Denise J }}</ref> Canada issued a similar travel advisory.<ref name="BBC-2016-01-24a" /><ref name="Government of Canada-2016-02-03a">{{cite web |url=http://travel.gc.ca/travelling/health-safety/travel-health-notices/143?_ga=1.191165994.1052850922.1446055028 |title=Zika virus infection in the Americas |publisher=Government of Canada |date=February 3, 2016}}</ref> Questions have been raised about the readability and effectiveness of the press releases issued by the  WHO/PAHO, CDC, and the ministries of health of affected countries with the average readability of a press release by the WHO measured at 17.1 on the Flesch Kincaid grade level readability test.<ref>{{cite journal |doi=10.1136/bmjgh-2017-000296 |pmid=29082006 |pmc=5656128 |title=Zika pandemic online trends, incidence and health risk communication: A time trend study |journal=BMJ Global Health |volume=2 |issue=3 |pages=e000296 |year=2017 |last1=Adebayo |first1=Gbenga |last2=Neumark |first2=Yehuda |last3=Gesser-Edelsburg |first3=Anat |last4=Abu Ahmad |first4=Wiessam |last5=Levine |first5=Hagai }}</ref>

On February 5, after the laboratory confirmation of a Zika virus infection in the U.S. in a non-traveler, which was linked to sexual contact with an infected partner, the CDC issued interim guidelines for prevention of sexual transmission of Zika virus for the United States.<ref name="Interim Guidelines for Prevention of Sexual Transmission"/> These guidelines recommend that men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy.<ref name="Interim Guidelines for Prevention of Sexual Transmission"/> The guidelines recommend that pregnant women discuss any possible Zika exposure with their male partners.<ref name="Interim Guidelines for Prevention of Sexual Transmission"/> The guidelines recommend that non-pregnant women and their partners consider taking similar measures.<ref name="Interim Guidelines for Prevention of Sexual Transmission"/>

On February 8, CDC elevated its response efforts to a Level 1 activation, the highest response level at the agency. The CDC then issued a statement on February 23 further encouraging adherence to this guidance after 14 reports of possible sexual transmission of the virus were under investigation.<ref name="cdc1"/><ref name="nyttavernise"/> A bill, Zika Authorization Plan Act of 2016 (H.R. 4562), was introduced in the second session of the United States 114th Congress by Representative Curt Clawson (R-FL) on February 12, 2016,<ref name="congress.gov">https://www.congress.gov/bill/114th-congress/house-bill/4562{{full citation needed|date=September 2018}}</ref><ref>https://www.gpo.gov/fdsys/search/pagedetails.action?packageId=BILLS-114hr4562ih{{full citation needed|date=September 2018}}</ref> aimed at reducing the spread of the virus.<ref name="legislation ">{{Cite news|url=http://www.tennessean.com/story/news/local/2016/02/11/third-zika-case-reported-lee-health-department/80242696/|title=Clawson introduces legislation to stem spread of zika|work=The Tennessean|access-date=2017-03-23|language=en}}</ref>

Paraguay reported its first case of Zika in a pregnant woman on March 11.<ref>{{Cite web|url=http://www.abc.com.py/nacionales/primer-caso-de-zika-en-embarazada-1460904.html|title=Paraguay: primer caso de zika en embarazada|website=ABC.com|date=March 11, 2016}}</ref> On March 18, CDC cautioned men who have been infected with Zika from attempting to conceive children due to probability of virus transfer from man to woman during sexual activity which in turn can affect the fetus, under this caution, men are advised not to try conception until six months after the infection.<ref name="STAT25Mar2016">{{cite news | url=http://www.statnews.com/2016/03/25/zika-new-cdc-recommendations/ | title=Couples exposed to Zika virus are urged to delay pregnancy | work=Stat News | date=March 25, 2016 | last=Branswell | first=Helen}}</ref>

Colombia reported its first cases of microcephaly associated to the Zika virus on April 14.<ref>{{cite web|url=https://www.nytimes.com/2016/04/15/world/americas/colombia-reports-first-cases-of-microcephaly-linked-to-zika-virus.html|title=Colombia Reports First Cases of Microcephaly Linked to Zika Virus|website=New York Times|date=April 15, 2016|author1=Casey, Nicholas|author2=Díaz, María Eugenia}}</ref> The CDC authorized emergency use of a Zika Virus RNA Qualitative test on April 28 to detect Zika virus in the blood of patients who have symptoms of Zika virus infection and live in or have traveled to an area with ongoing Zika virus transmission. This is the first commercial test to detect Zika virus authorized by the United States Food and Drug Administration for emergency use.<ref>{{cite web|title=Zika Virus Response Updates from FDA|url=http://www.fda.gov/EmergencyPreparedness/Counterterrorism/MedicalCountermeasures/MCMIssues/ucm485199.htm#bydate|accessdate=April 29, 2016}}</ref>

On May 6, Major League Baseball announced that a series of games between the Miami Marlins and Pittsburgh Pirates scheduled to be played at the end of the month in [[Place:San Juan, Puerto Rico|San Juan, Puerto Rico]] would be relocated to Marlins Park in Miami, Florida after a number of players on each team voiced concerns regarding the threat of Zika exposure.<ref>{{cite news|last1=Almasy|first1=Steve|title=MLB moves games from Puerto Rico due to Zika concerns|url=http://www.cnn.com/2016/05/06/health/mlb-puerto-rico-zika/|accessdate=June 1, 2016|work=CNN|date=May 6, 2016}}</ref> By mid-August at least 37 people had contracted the virus in neighborhoods near the city of Miami, Florida, though officials estimated that the actual number of infections was much higher due to under-reporting of mild illness.<ref>{{cite web|last1=Doucleff|first1=Michaeleen|title=How Big, Really, Is The Zika Outbreak In Florida?|url=https://www.npr.org/sections/health-shots/2016/08/22/490941346/how-big-really-is-the-zika-outbreak-in-florida|website=NPR|accessdate=August 23, 2016}}</ref> It was determined in June that travelers to Dominican Republic lead New York City in positive Zika tests.<ref>{{cite web|title=Travelers to Dominican Republic Lead New York City in Positive Zika Tests|url=https://www.nytimes.com/2016/06/30/nyregion/dominicans-lead-among-those-testing-positive-for-zika-in-new-york-city.html|website=New York Times|date=June 29, 2016|author=Santora, Mark}}</ref>

The first-affected area in the continental United States, the Wynwood neighborhood of Miami, was declared Zika-free in September, 2016.<ref>[https://www.npr.org/2016/09/19/494619451/miami-neighborhood-declared-zika-free-as-cdc-lifts-warning Miami Neighborhood Declared Zika Free As CDC Lifts Warning]</ref>  After the virus stopped circulating in South Beach, all of Florida was declared Zika-free in December, 2016.<ref>[http://fortune.com/2016/12/12/florida-zika-free-cdc/ Florida Has Officially Been Declared Zika-Free]</ref>  One case of local transmission was reported in Texas up until September, 2017.<ref>[https://www.newyorker.com/tech/elements/is-zika-gone-for-good Is Zika Gone for Good?]</ref> As of 2018, Zika remains endemic in Puerto Rico,<ref>[https://www.nbcnews.com/health/health-news/zika-lyme-drive-big-increase-bug-borne-disease-u-s-n870496 Zika, Lyme drive big increase in bug-borne disease in U.S.]</ref> but the number of cases was reduced from about 8,000 reported per month at the peak in August 2016 to about 10 reported per month in April 2017.<ref>[https://www.usnews.com/news/us/articles/2017-06-05/puerto-rico-declares-zika-outbreak-over-cdc-maintains-travel-warning Puerto Rico Declares Zika Outbreak Over, CDC Maintains Travel Warning]</ref>

=== Asia ===
Following the spread of Zika infection into Southeast Asia in June 2016, [[Place:Singapore|Singapore]], Thailand and Vietnam become the most heavily affected.<ref name="hundreds confirmed cases"/><ref>{{cite web|url=https://www.bbc.com/news/world-asia-37548723|title=Zika virus: The outbreak in Asia|publisher=BBC News|date=October 11, 2016|accessdate=October 21, 2016}}</ref> Singapore has planned to release an army of mosquitoes that contain the ''[[Biology:Wolbachia|Wolbachia]]'' bacteria to fight the Aedes aegypti mosquito population.<ref>{{cite web|url=http://m.thenational.ae/world/southeast-asia/in-fight-against-zika-singapore-releases-more-mosquitoes|title=In fight against Zika, Singapore releases more mosquitoes|author=Tan, Joanna|publisher=The National (UAE)|date=October 16, 2016|accessdate=October 21, 2016}}</ref> The Association of Southeast Asian Nations (ASEAN) members have increased information sharing and joint research on the virus.<ref>{{cite web|url=http://asean.org/asean-health-ministers-respond-to-zika-virus/|title=ASEAN Health Ministers respond to Zika virus|publisher=[[Organization:ASEAN|ASEAN]]|date=September 20, 2016|accessdate=October 21, 2016}}</ref><ref>{{cite web|url=http://m.todayonline.com/world/asia/asean-pledges-boost-data-sharing-zika|title=Asean pledges to boost data-sharing on Zika|website=Bangkok Post|publisher=Today Online|date=September 24, 2016|accessdate=October 21, 2016}}</ref> On September 30, Thailand confirmed that two babies has born with microcephaly.<ref>{{cite web|url=http://www.aljazeera.com/news/2016/09/zika-virus-thai-babies-diagnosed-microcephaly-160930152653089.html|title=Zika virus: Thailand babies diagnosed with microcephaly|publisher=Al Jazeera|date=October 1, 2016|accessdate=November 1, 2016}}</ref> Prior to the case, Thailand has allowed abortion for pregnant women that have been affected by birth defects.<ref>{{cite web|url=http://health.economictimes.indiatimes.com/news/diagnostics/abortion-legal-in-thai-birth-defect-cases-linked-to-zika-officials-say/54714732|title=Abortion legal in Thai birth defect cases linked to Zika, officials say|author=Amy Sawitta Lefevre|website=Reuters|publisher=ETHealthworld|date=October 6, 2016|accessdate=October 21, 2016}}</ref> Malaysia is still undecided on the issue,<ref>{{cite web|url=https://asiancorrespondent.com/2016/09/malaysia-govt-muslim-clerics-split-abortion-zika-cases/|title=Malaysia: Govt, Muslim clerics split over abortion in Zika cases|publisher=Asian Correspondent|date=September 1, 2016|accessdate=October 21, 2016}}</ref> with doctors there letting the mother make the decision whether or not to abort.<ref>{{cite web|url=http://www.nst.com.my/news/2016/10/177315/let-mother-decide|title=Let the mother decide|author=Soorian, A.|publisher=New Straits Times|date=October 1, 2016|accessdate=October 21, 2016}}</ref> Rentokil, a Malaysian pest company, has designed an Integrated Mosquito Management (IMM) program to curb the spread of Aedes mosquito.<ref>{{cite web|url=http://m.digitaljournal.com/pr/3096400|title=Rentokil Malaysia Battling Rising Dengue and Zika Cases with Integrated Mosquito Management Programme|publisher=Digital Journal|accessdate=October 21, 2016}}</ref> On October 17, Zika was declared as endemic in Vietnam by the country Health Ministry due to the number of local cases.<ref name="endemic Vietnam">{{cite news |url=http://tuoitrenews.vn/society/37590/zika-disease-becomes-endemic-in-vietnam-health-official |title=Zika disease becomes endemic in Vietnam: health official |publisher=Tuổi Trẻ |date=October 17, 2016 }}</ref> Vietnam confirmed that one baby has born with microcephaly on October 31.<ref>{{cite web|url=http://vietnamnews.vn/society/345333/vn-confirms-first-zika-tied-birth-defect-case.html|title=VN confirms first Zika-tied birth defect case|website=Vietnam News Agency|publisher=Việt Nam News|date=October 31, 2016|accessdate=November 1, 2016}}</ref> Following the rise of local Zika infection cases in the {{wipe|Philippines}}, the virus have also been declared as endemic by the country Health Department.<ref>{{cite web|url=http://www.rappler.com/nation/148215-zika-virus-endemic-philippines|title=DOH: Zika virus endemic in PH|author=Jee Y. Geronimo|publisher=Rappler|date=October 4, 2016|accessdate=November 21, 2016}}</ref> The government of the republic hosting the “One Philippines against Zika” national summit on October 28 with church in the country has joint fight to curb the spread of the virus by issuing a pastoral guidance to help raise awareness about the mosquito-borne disease among local communities.<ref>{{cite web|url=http://www.doh.gov.ph/node/7552|title=DOH continues campaign against Zika as 3 new confirmed cases emerge|publisher=Department of Health (Philippines)|accessdate=November 1, 2016}}</ref><ref>{{cite web|url=http://reliefweb.int/report/world/zika-virus-microcephaly-and-guillain-barr-syndrome-situation-report-27-october-2016|title=Zika virus, Microcephaly and Guillain-Barré syndrome Situation Report, 27 October 2016|publisher=ReliefWeb|date=October 27, 2016|accessdate=November 1, 2016}}</ref><ref>{{cite web|url=http://en.radiovaticana.va/news/2016/10/29/church_in_philippines_joins_fight_against_zika/1268660|title=Church in Philippines joins fight against Zika|publisher=Vatican Radio|date=October 29, 2016|accessdate=November 1, 2016}}</ref> Taiwan has also seen an increase of infection, most of the cases are believed to be imported from other countries.<ref>{{cite web|url=https://www.cdc.gov.tw/english/info.aspx?treeid=BC2D4E89B154059B&nowtreeid=EE0A2987CFBA3222&tid=B457AF423C41CBDB|title=As CECC for Zika Virus confirms 13th imported Zika case, travelers returning from Zika-affected areas advised to take precautions against mosquito bites, follow "1+6 Principle" and seek immediate medical attention when symptoms develop|publisher=Centers for Disease Control (Taiwan)|date=October 17, 2016|accessdate=October 21, 2016}}</ref> On October 27, Myanmar reported its first imported case on a pregnant foreign woman.<ref name="Myanmar"/>

=== International ===
[[File:Dengue Votuporanga.jpg|thumb|Agent for endemic diseases of the city of Votuporanga, São Paulo, Brazil]]
Governments or health agencies such as those of Australia,<ref name="Health Department information">{{cite news |url=http://www.health.gov.au/internet/main/publishing.nsf/content/ohp-zika-health-practitioners.htm |title=Zika virus – information for clinicians and public health practitioners |work=Australian Health Department | accessdate=October 21, 2016 |location=Australia}}</ref> Canada,<ref name="Canada travel alert">{{cite news |url=https://travel.gc.ca/travelling/health-safety/travel-health-notices/152 |title=Zika virus infection: Global Update |work=Government of Canada |accessdate=October 21, 2016 |location=Canada}}</ref> China,<ref name="China travel alert">{{cite news |url=http://news.xinhuanet.com/english/2016-09/07/c_135669994.htm |title=China alerts travellers against Zika |work=Xinhua News Agency |date=September 7, 2016 |author=Huaxia |location=China}}</ref> Hong Kong,<ref name="Hong Kong travel warning">{{cite news |url=http://m.scmp.com/news/hong-kong/health-environment/article/2013029/hong-kong-issues-travel-warning-singapore-zika |title=Hong Kong issues travel warning for Singapore on Zika virus fears |work=South China Morning Post |date=September 7, 2016 |author1=Chiu, Peace |author2=Elizabeth, Cheung |location=Hong Kong}}</ref> Indonesia,<ref name="Indo advisory on Zika virus">{{cite news |url=http://www.channelnewsasia.com/news/asiapacific/indonesia-mulls-travel-advisory-for-singapore-over-zika-outbreak/3089376.html |title=Indonesia mulls 'travel advisory' for Singapore over Zika outbreak |author=Vatvani, Chandni |work=Channel NewsAsia |date=August 31, 2016 |location=Jakarta}}</ref> Ireland,<ref name="Pregnant Irish women warned">{{cite news |url=http://www.rte.ie/news/2016/0122/762119-el-salvador-zika-virus/ |title=Pregnant Irish women warned over Zika virus in central and South America |work=RTÉ News |date=January 22, 2016}}</ref> Japan,<ref name="Japan to step up screening for Zika virus">{{cite news |url=http://www.japantimes.co.jp/news/2016/02/02/national/science-health/japan-require-doctors-report-zika-fever-cases/#.VrCOx9J96t9 |title=Japan to step up screening for Zika virus |work=The Japan Times |date=February 2, 2016 |agency=Kyodo, Associated Press}}</ref> Malaysia,<ref name="Health Ministry issues travel advisory">{{cite news |url=http://www.thestar.com.my/news/nation/2016/02/03/zika-health-ministry-issues-travel-advisory/ |title=Zika virus: Health Ministry issues travel advisory |work=The Star |date=February 3, 2016 |author=Anis, Mazwin Nik |location=Malaysia}}</ref> New Zealand,<ref name="3News-NZ-2016-01-22a">{{cite web |url=http://www.3news.co.nz/nznews/zika-virus-prompts-travel-warning-for-kiwis-2016012416 |title=Zika virus prompts travel warning for Kiwis |website=3News |date=January 24, 2016 |author=Burton, Nina |location=New Zealand |access-date=January 24, 2016 |archive-url=https://web.archive.org/web/20160125091028/http://www.3news.co.nz/nznews/zika-virus-prompts-travel-warning-for-kiwis-2016012416 |archive-date=January 25, 2016 |dead-url=yes |df=mdy-all }}</ref> Philippines,<ref name="DOH cautions public on Zika virus">{{cite news |url=http://www.sunstar.com.ph/manila/local-news/2016/01/31/doh-cautions-public-zika-virus-454679 |title=DOH cautions public on Zika virus |work=Sun Star |date=January 31, 2016 |location=Manila}}</ref> Singapore,<ref name="Singapore Zika precautions">{{cite web|url=http://www.prischew.com/sports/running/singapores-zika-outbreak-precautions-for-runners-comments-by-running-doctor-derek-li/ |title=Singapore's ZIKA outbreak & precautions for runners: Comments by Running Doctor Derek Li |author=Priscilla |website=PrisChew Dot Com |date=September 3, 2016}}</ref> South Korea,<ref name="skoreameeting">{{cite news |url=http://english.yonhapnews.co.kr/news/2016/02/02/0200000000AEN20160202002400320.html |title=S. Korea holds emergency meeting on Zika virus threat |work=Yonhap News Agency |date=February 2, 2016}}</ref> Taiwan,<ref name="Taiwan travel alert">{{cite web|url=https://www.cdc.gov.tw/english/info.aspx?treeid=BC2D4E89B154059B&nowtreeid=EE0A2987CFBA3222&tid=B457AF423C41CBDB|title=As first imported case of Zika virus infection identified in Taiwan, Taiwan CDC to list Zika virus infection as Category II Notifiable Infectious Disease and raises travel notice level for Central and South America and six countries in Southeast Asia|publisher=Centers for Disease Control (Taiwan)|date=January 19, 2016|accessdate=October 21, 2016}}</ref> the United Kingdom,<ref name="Zika virus: Advice for those planning to travel">{{cite news |url=http://www.itv.com/news/2016-01-22/zika-virus-advice-for-those-planning-to-travel-to-outbreak-area/ |title=Zika virus: Advice for those planning to travel to outbreak areas |work=ITV News |date=January 22, 2016}}</ref> United States<ref name="CDC issues Zika travel notice Asean">{{cite news |url=https://www.washingtonpost.com/news/to-your-health/wp/2016/09/29/cdc-issues-zika-travel-notice-for-11-southeast-asian-countries/ |title=CDC issues Zika travel notice for 11 Southeast Asian countries |author=H. Sun, Lena|work=The Washington Post |date=September 29, 2016}}</ref> as well the European Union<ref name="BBC-2016-01-24a"/> issued travel warnings. The warnings are predicted to have an effect on the tourism industry in affected countries.<ref name="BBC&nbsp;– Tourist industry on edge">{{cite news |url=https://www.bbc.com/news/business-35472864 |title=Tourist industry on edge as Zika virus spreads |work=BBC News |date=February 3, 2016}}</ref><ref name="AP&nbsp;– Zika affects plans">{{cite news |last=Harpaz |first=Beth J. |url=http://bigstory.ap.org/article/45f6dfa46b984f329a7fc5c6569481ac/zika-affects-plans-destination-weddings-babymoons |title=Zika affects plans for destination weddings, babymoons |work=Associated Press |publisher=Associated Press |date=February 3, 2016}}</ref><ref name="Zika virus discourages many Americans">{{cite news |last=Dastin |first=Jeffrey |url=https://www.reuters.com/article/us-health-zika-poll-exclusive-idUSKCN0VG0L8 |title=Zika virus discourages many Americans from Latin America travel |work=Reuters |date=February 8, 2016}}</ref>

To prevent the transmission of the Zika virus, WHO recommends using [[Chemistry:Insect repellent|insect repellent]], wearing long-sleeved clothes to cover the body, and using screens and [[Biology:Mosquito net|mosquito net]]s to exclude flying insects from dwellings or sleeping areas. It is also vital to eliminate any standing water near homes to minimize breeding areas for mosquitoes. Authorities can treat larger water containers with recommended [[Biology:Larvicide|larvicide]]s.<ref name="WHO Zika virus fact sheet" /><ref name="WHOPES-recommended compounds">{{cite web |url=http://www.who.int/whopes/Mosquito_Larvicides_25_Oct_2013.pdf |title=WHOPES-recommended compounds and formulations for control of mosquito larvae |publisher=World Health Organization |date=October 25, 2013 |access-date=February 15, 2016 |archive-url=https://web.archive.org/web/20151203180043/http://www.who.int/whopes/Mosquito_Larvicides_25_Oct_2013.pdf |archive-date=December 3, 2015 |dead-url=yes |df=mdy-all }}</ref> Furthermore, the Centers for Disease Control and Prevention (CDC) recommends that containers holding water near homes either be sealed or scrubbed once per week, because mosquito eggs can stick to them.<ref name="CDC Help Control Mosquitoes" />

On February 1, 2016, WHO declared the cluster of microcephaly cases and other neurological disorders a Public Health Emergency of International Concern,<ref name="WHO Summarizes Emergency Committee"/> which may reduce the number of visitors to the Rio Olympics in 2016.<ref name="Pro-MED-mail&nbsp;– WHO Declares Public Health Emergency">{{cite web |url=http://www.promedmail.org/post/3985366 |title=WHO Declares Public Health Emergency of International Concern |publisher=International Society for Infectious Diseases |website=Pro-MED-mail |date=February 1, 2016}}</ref> The designation has been applied in the past to the Ebola outbreak in 2014, the outbreak of [[Medicine:Poliomyelitis|polio]] in Syria in 2013, and the 2009 flu pandemic.<ref name="An Emergency Meeting on the Zika Virus">{{cite news |last=Calamur |first=Krishnadev |url=https://www.theatlantic.com/international/archive/2016/02/zika-virus/458682/ |title=An Emergency Meeting on the Zika Virus |work=The Atlantic |date=February 1, 2016}}</ref> South Korea held an emergency meeting in response to the WHO declaration on February 2, 2016.<ref name="skoreameeting"/> A second meeting of the WHO-convened emergency committee, held on March 8, 2016, reaffirmed the situation's status as a Public Health Emergency of International Concern. The committee reported that evidence was increasing for a causal relationship between Zika virus and microcephaly and other neurological conditions, and called for continued research, aggressive mosquito control, and improved surveillance and communication of risks to the public. The report stated that pregnant women should be advised not to travel to affected areas, and should use safe sex practices if their partners lived in or travelled to affected areas throughout their pregnancy.<ref name=WHO_8_March_2016>{{cite web |url=http://www.who.int/mediacentre/news/statements/2016/2nd-emergency-committee-zika/en/ |title=WHO statement on the 2nd meeting of IHR Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations |publisher=WHO |date=March 8, 2016 |accessdate=March 8, 2016 }}</ref> On March 9, 2016, WHO announced that research should prioritise prevention and diagnosis, not treatment, and in particular non-live vaccines suitable for pregnant women and those of childbearing age, novel mosquito control measures, and diagnostic tests that can detect dengue and chikungunya as well as Zika.<ref>{{cite web |url=http://www.who.int/mediacentre/news/notes/2016/research-development-zika/en/ |title=WHO and experts prioritize vaccines, diagnostics and innovative vector control tools for Zika R&D |publisher=WHO |date=March 9, 2016 |accessdate=March 13, 2016 }}</ref>

=== Responses ===
[[File:Exército Brasileiro no combate ao mosquito Aedes (24626830366).jpg|thumb|right|The Brazilian Army has sent more than 200,000 troops to go "house to house" in the campaign against Zika-carrying mosquitoes.]]
[[File:Mutirão de combate ao mosquito Aedes Aegypti no Grupamento de Fuzileiros Navais de Brasília (24063648524).jpg|thumb|Brazilian Army soldier analyzes the water from a cistern.]]

In January 2016, it was announced that, in response to the Zika virus outbreak, Brazil's National Biosafety Committee approved the releases of more genetically modified ''Aedes aegypti'' mosquitoes throughout their country.<ref name="How mosquitoes with ‘self-destruct’ genes" /> Previously, in July 2015, [[Company:Oxitec|Oxitec]] had published results of a test in the Juazeiro region of Brazil, of so-called "self-limiting" mosquitoes, to fight dengue, chikungunya, and Zika viruses. They concluded that mosquito populations were reduced by over 90% in the test region.<ref name="How mosquitoes with ‘self-destruct’ genes">{{cite news |last=Kim |first=Meeri |url=https://www.washingtonpost.com/news/to-your-health/wp/2016/01/29/heres-how-gm-mosquitos-with-self-destruct-genes-could-save-us-from-zika-virus/ |title=How mosquitoes with 'self-destruct' genes could save us from Zika virus |work=The Washington Post |date=January 29, 2016}}</ref><ref name="Oxitec mosquito works to control Aedes">{{cite web |url=http://www.oxitec.com/press-release-oxitec-mosquito-works-to-control-aedes-aegypti-in-dengue-hotspo/ |title=Oxitec mosquito works to control Aedes aegypti in dengue hotspot |publisher=Oxitec |website=Press release |date=July 2, 2015}}</ref><ref name="OlsonCarvalho2015">{{cite journal |doi=10.1371/journal.pntd.0003864 |pmid=26135160 |pmc=4489809 |title=Suppression of a Field Population of Aedes aegypti in Brazil by Sustained Release of Transgenic Male Mosquitoes |journal=PLOS Neglected Tropical Diseases |volume=9 |issue=7 |pages=e0003864 |year=2015 |last1=Carvalho |first1=Danilo O |last2=McKemey |first2=Andrew R |last3=Garziera |first3=Luiza |last4=Lacroix |first4=Renaud |last5=Donnelly |first5=Christl A |last6=Alphey |first6=Luke |last7=Malavasi |first7=Aldo |last8=Capurro |first8=Margareth L }}</ref> Male genetically modified mosquitoes mate with females in the wild and transmit a self-limiting gene that causes the resulting offspring to die before reaching adulthood and thus diminishes the local mosquito population.<ref name="How mosquitoes with ‘self-destruct’ genes" /><ref name="OlsonCarvalho2015" /> In January 2016 the technique was being used to try to combat the [[Medicine:Zika virus|Zika virus]] in the town of Piracicaba, São Paulo.<ref name="NYT">{{cite news|last1=Pollack|first1=Andrew|title=New Weapon to Fight Zika: The Mosquito|url=https://www.nytimes.com/2016/01/31/business/new-weapon-to-fight-zika-the-mosquito.html?_r=0|accessdate=March 16, 2016|publisher=New York Times|date=January 30, 2016}}</ref>

On February 1, 2016, the WHO declared the current Zika virus outbreak an international public health emergency,<ref name="WHO Summarizes Emergency Committee" /><ref name="NYT&nbsp;– W.H.O. Declares Zika Virus">{{cite news |url=https://www.nytimes.com/2016/02/02/health/zika-virus-world-health-organization.html |title=W.H.O. Declares Zika Virus an International Health Emergency |work={{wipe|The New York Times}} |date=February 1, 2016 |last1=Tavernise |first1=Sabrina |last2=McNeil, Jr. |first2=Donald G.}}</ref> and the Brazilian President released a decree that increased local and federal pest control agents' access to private property required by mobilization actions for the prevention and elimination of ''Aedes'' mosquito outbreaks in the country.<ref name="Decree No. 8662">{{cite web |url=https://planalto.gov.br/ccivil_03/_ato2015-2018/2016/decreto/d8662.htm |title=Decreto Nº 8.662 |publisher=Palácio do Planalto, Presidência da República |date=February 1, 2016 |accessdate=February 4, 2016 |language=pt |trans-title=Decree No. 8662 |deadurl=yes |archiveurl=https://web.archive.org/web/20160302044801/https://www.planalto.gov.br/ccivil_03/_ato2015-2018/2016/decreto/d8662.htm |archivedate=March 2, 2016 |df=mdy-all }}</ref>

Some experts have proposed combatting the spread of the Zika virus by breeding and releasing mosquitoes that have either been genetically modified to prevent them from transmitting pathogens or that have been infected with the ''[[Biology:Wolbachia|Wolbachia]]'' bacterium, thought to inhibit the spread of viruses.<ref name="GlobeNews">{{cite news | first1=Kate | last1=Kelland | url=https://www.theglobeandmail.com/news/world/who-backs-trials-of-genetically-modified-mosquitoes-to-fight-zika/article29297605/ | title=WHO backs trials of genetically modified mosquitoes to fight Zika | work=The Globe and Mail | date=March 18, 2016 | accessdate=March 19, 2016 | deadurl=yes | archiveurl=https://web.archive.org/web/20160318223119/http://www.theglobeandmail.com/news/world/who-backs-trials-of-genetically-modified-mosquitoes-to-fight-zika/article29297605/ | archivedate=March 18, 2016 | df=mdy-all }}</ref><ref name="The Best Weapon for Fighting Zika">{{cite news |url=https://www.bloomberg.com/news/articles/2016-02-04/as-zika-virus-goes-global-scientists-breed-infected-mosquitoes |title=The Best Weapon for Fighting Zika? More Mosquitoes |work={{wipe|Bloomberg News}} |date=February 4, 2016 |author=Jason Gale}}</ref> Another proposed technique consists of using radiation to [[Biology:Sterile insect technique|sterilize male larvae]] so that when they mate, they produce no progeny.<ref name="UN Readies Nuclear Solution">{{cite news |url=https://www.bloomberg.com/news/articles/2016-02-12/un-readies-nuclear-weapons-to-destroy-the-zika-virus |title=UN Readies Nuclear Solution to Destroy the Zika Virus |work=Bloomberg Business |date=February 12, 2016 |last=Tirone |first=Jonathan}}</ref> Male mosquitoes do not bite or spread disease.<ref name="Mosquito Biology">{{cite web |url=http://www.mimosq.org/mosquitobiology/mosquitobiology.htm |archive-url=https://web.archive.org/web/20130330125526/http://www.mimosq.org/mosquitobiology/mosquitobiology.htm |dead-url=yes |archive-date=March 30, 2013 |title=Mosquito Biology |publisher=Michigan Mosquito Control Association |accessdate=February 23, 2016 }}</ref>

In February, the Brazilian federal government mobilized 60% of the country's Armed Forces, or about 220,000 soldiers, to warn and educate the populations of 350 municipalities on how to reduce mosquito breeding grounds.<ref name="Brasil destina 60% das suas Forças Armadas">{{cite news |last=Martín |first=María |url=http://brasil.elpais.com/brasil/2016/02/13/politica/1455383958_196275.html?id_externo_rsoc=FB_CM |title=Brasil destina 60% das suas Forças Armadas na luta contra um mosquito |language=pt |trans-title=Brazil deploys 60% of its armed forces in the fight against mosquitoes |work=El Pais |location=Río de Janeiro |date=February 13, 2016}}</ref>

A joint statement on the sharing of data and results on the Zika outbreak in the Americas and future public health emergencies was issued on February 10, 2016, by a group of more than 30 global health bodies.<ref name="Data sharing in public health emergencies">{{cite news |url=http://www.wellcome.ac.uk/About-us/Policy/Spotlight-issues/Data-sharing/Public-health-emergencies/index.htm |title=Data sharing in public health emergencies |work=Wellcome Trust Blog |date=February 10, 2016 |accessdate=February 21, 2016}}</ref> The statement reinforces a similar consensus statement issued by WHO in September 2015.<ref name="WHO&nbsp;– Developing global norms for sharing data">{{cite web |url=http://www.who.int/medicines/ebola-treatment/blueprint_phe_data-share-results/en/ |title=Developing global norms for sharing data and results during public health emergencies |publisher=World Health Organization |date=September 2015 |accessdate=February 21, 2016}}</ref> The statement calls for free access to all data as rapidly and widely as possible.<ref name="Sharing data during Zika">{{cite web |url=http://blog.wellcome.ac.uk/2016/02/10/sharing-data-during-zika-and-other-global-health-emergencies/ |title=Sharing data during Zika and other global health emergencies |website=Wellcome Trust Blog |date=February 10, 2016 |accessdate=February 21, 2016}}</ref>

In February 2016, [[Company:Google|Google]] announced that they were donating $1 million via UNICEF to fight the spread of the Zika virus and offering professional personnel to help to determine where it will hit next.<ref name="Google donates $1M to help fight Zika virus spread">{{cite news |url=http://www.baltimoresun.com/health/ct-google-zika-virus-20160303-story.html |title=Google donates $1M to help fight Zika virus spread |work=The Baltimore Sun |date=March 3, 2016}}</ref>

== Prevention and treatment ==
While there are no known cures for Zika, there have been recent developments in Zika vaccination. Three vaccine designs are showing high confidence levels of protection against the Zika virus. Scientists have conducted tests on the rhesus monkey, and human trials began in late 2016.<ref>{{cite web|last1=Hamzelou|first1=Jessica|title=Zika vaccine trials begin – but fears remain over virus's impact|url=https://www.newscientist.com/article/2104167-zika-vaccine-trials-begin-but-fears-remain-over-viruss-impact/|website=New Scientist|accessdate=12 October 2016}}</ref>

This preventative treatment is promising, but it will take years before it is available for widespread usage.<ref>{{cite web|last1=Bednarczyk|first1=Robert|title=Why a Zika vaccine is a long way off|url=http://theconversation.com/why-a-zika-vaccine-is-a-long-way-off-63804|website=the conversation|accessdate=12 October 2016}}</ref>

The three approaches to the vaccine include an inactive Zika virus test and the other two involve replicas of the virus's genetic code. During these vaccination tests, complete protection against the virus was deemed possible with none being linked to major side-effects.

British experts are clear that any of the vaccines would take considerable time to develop. Dr Ed Wright, a senior lecturer and virologist at the University of Westminster, said: "All of the vaccines currently under development are many years away from being licensed and available for widespread public use." Jonathan Ball, professor of molecular virology at the University of Nottingham, said: "We knew that these vaccines worked in mice and now the researchers have shown that they also protect non-human primates from Zika virus infection." "The next step will be to see if these vaccines are safe and the scientists hope to start early trials in humans to address this."<ref name="ZikaEarlyPromise">{{cite news|access-date=August 8, 2016|url=https://www.bbc.com/news/health-36975088|title=Zika vaccines show early promise |work=BBC News|date=August 4, 2016}}</ref>

Kineta, a Seattle-based biotech company, is actively working on treatments and has received an undisclosed amount of funding from National Institute of Allergy and Infectious Disease, one of the National Institutes of Health, to carry on the research. Kineta CEO Dr Shawn Iadonato said in a statement. "We are eager to expand testing of our broad spectrum antivirals in Zika virus as they have shown compelling efficacy across other flaviviruses such as Dengue and West Nile and have the potential for long-term development."<ref name = "KinetaZikaFunding">{{cite news|access-date=August 8, 2016|url=http://www.bizjournals.com/seattle/blog/health-care-inc/2016/08/kineta-awarded-funding-to-test-zika-treatment.html|title=Kineta awarded funding to test Zika treatment |work=Puget Sound Business Journal | date= August 5, 2016}}</ref>

As of July 26, 2016, Inovio Pharmaceuticals, Inc. dosed the first subject in its multi-center phase I trial to evaluate Inovio's Zika DNA vaccine (GLS-5700). In addition to the previously announced US FDA approval for the conduct of the study, Health Canada’s Health Products and Food Branch has also approved this study, which will be conducted at clinical sites in Miami, Philadelphia, and Quebec City. The phase I, open-label, dose-ranging study of 40 healthy adult volunteers is evaluating the safety, tolerability and immunogenicity of GLS-5700 administered with the CELLECTRA®-3P device, Inovio's proprietary intradermal DNA delivery device. In preclinical testing, this synthetic vaccine induced robust antibody and T cell responses – the immune responses necessary to fight viral infections – in small and large animal models.<ref name = "InovioTrials">{{cite news | access-date=August 8, 2016|url=https://globenewswire.com/news-release/2016/07/26/858976/0/en/Inovio-Pharmaceuticals-Doses-First-Subject-in-Zika-Vaccine-Clinical-Trial.html|title=Inovio Pharmaceuticals Doses First Subject in Zika Vaccine Clinical Trial |work=Inovio Pharmaceuticals | date=July 26, 2016}}</ref>

== Challenges to US response ==
In May 2017, the [[Engineering:Government Accountability Office|Government Accountability Office]] published a report, "Emerging Infectious Diseases: Actions Needed to Address the Challenges of Responding to Zika Virus Disease Outbreak", to correspond with an associated House subcommittee hearing. The GAO said that even though scientific breakthroughs have increased in recent years, the United States remains unprepared to handle a Zika virus outbreak.<ref name=":0">{{Cite news|url=https://homelandprepnews.com/featured/22565-challenges-hobble-u-s-public-health-response-zika-virus/|title=Challenges hobble U.S. public health response to Zika virus|last=Riley|first=Kim|date=2017-05-24|work=Homeland Preparedness News|access-date=2017-09-12|language=en-US}}</ref>

Timothy Persons, head scientist at the GAO, listed areas of limited research that damage the United States’ ability to effectively respond to a Zika outbreak, including an accurate record of the number of cases in the United States, components associated with transmission from mothers to children (especially regarding pregnancy), risk of transmission through bodily fluid as related to the potential for [[Medicine:Transmission|sexual transmission]] of the virus, impact of prior exposure to Zika and other [[Medicine:Arbovirus|arbovirus]]es, and both short-term and long-term outcomes. Recent outbreaks have been connected to an alarming a spike in [[Medicine:Microcephaly|microcephaly]], a birth defect that inhibits the proper development of a baby’s brain, and [[Medicine:Guillain–Barré syndrome|Guillain-Barré syndrome]], which causes paralysis.<ref name=":0" />

Other challenges include the lack of a safe and effective vaccine, a complicated diagnostic process, and faltering support for research funding in the federal government. Dr. Anthony Fauci, director of the [[Organization:National Institute of Allergy and Infectious Diseases|National Institute of Allergy and Infectious Diseases]] (NIAID), said "There aren’t any federally licensed vaccines or specific therapeutics currently available to prevent or treat Zika." Zika is often difficult to distinguish from other illnesses that are spread by mosquitoes, like [[Medicine:Dengue fever|dengue]], [[Medicine:West Nile fever|West Nile]], and [[Medicine:Chikungunya|chikungunya]], among others. President Trump’s budget proposal for 2018 proposed stripping $800 billion from Medicaid over ten years. Democratic Representative Frank Pallone of New Jersey said that this decision "endangers our ability to manage public health emergencies like Zika."<ref name=":0" />

== Controversies ==
Some efforts to contain the spread of Zika virus have been controversial. Oxitec, the company behind the "self-limiting" mosquitoes, which pass on a fatal gene to their offspring, released in Brazil, has faced criticism from environmental groups, who fear that releasing a new mosquito strain into the wild will damage the ecosystem. In the short term, the concern is that a drop in the mosquito population could affect the populations of other species. Supporters claim that the environmental impact of the "self-limiting" mosquitoes will be minimal, since only one species of mosquito is being targeted and the genetically-modified mosquitoes are still safe for predators to eat. Oxitec Product Development Manager Derric Nimmo likened the process to "going in with a scalpel and taking away ''Aedes aegypti'', leaving everything untouched."<ref name="washingtonpostSelfDestruct">{{cite news | access-date=March 20, 2016 | url=https://www.washingtonpost.com/news/to-your-health/wp/2016/01/29/heres-how-gm-mosquitos-with-self-destruct-genes-could-save-us-from-zika-virus/ | title=How mosquitoes with 'self-destruct' genes could save us from Zika virus | work=The Washington Post | date=January 29, 2016 | last=Kim | first=Meeri | issn=0190-8286}}</ref> Since ''Aedes aegypti'' is an imported [[Earth:Invasive species|invasive species]] in Brazil, some experts expect that its eradication will have little impact on the environment. However, other environmentalists emphasize that the long-term consequences of eliminating an entire species cannot be predicted.<ref name="cbsSupportGrows">{{cite news | access-date=March 20, 2016 | url=http://www.cbsnews.com/news/genetically-modified-mosquitoes-zika-virus-fight/ | title=Support grows for genetically modified mosquitoes in Zika fight | work=CBS News | date=February 16, 2016}}</ref>

Government recommendations that women delay pregnancy have also proven to be controversial. [[Philosophy:Human rights|Human]] and reproductive rights groups have deemed the recommendations irresponsible and difficult to follow, since women alone are tasked with avoiding pregnancy despite having little control to do so.<ref name="timeAvoidPregnancy">{{cite news | access-date=March 20, 2016 | url=http://time.com/4197318/zika-virus-latin-america-avoid-pregnancy/ | title=Governments: Avoid Pregnancy Because of Zika. But How? | work=Time | date=January 29, 2016 | last=Alter | first=Charlotte}}</ref> A 2012 study suggests that 56% of pregnancies in Latin America and the Caribbean are unplanned (compared to an average unplanned pregnancy rate of 40% worldwide).<ref name="Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends">{{cite journal |doi=10.1111/j.1728-4465.2014.00393.x |pmid=25207494 |pmc=4727534 |title=Intended and Unintended Pregnancies Worldwide in 2012 and Recent Trends |journal=Studies in Family Planning |volume=45 |issue=3 |pages=301–314 |year=2014 |last1=Sedgh |first1=Gilda |last2=Singh |first2=Susheela |last3=Hussain |first3=Rubina }}</ref> Access to contraceptives might be limited in regions where the [[Organization:Catholic Church|Roman Catholic Church]] is predominant, such as in El Salvador.<ref name="washingtonpostElSalvador">{{cite news | access-date=March 20, 2016 | url=https://www.washingtonpost.com/world/the_americas/as-zika-virus-spreads-el-salvador-asks-women-not-to-get-pregnant-until-2018/2016/01/22/1dc2dadc-c11f-11e5-98c8-7fab78677d51_story.html | title=As Zika virus spreads, El Salvador asks women not to get pregnant until 2018 | work=The Washington Post | date=January 22, 2016 | last=Partlow | first=Joshua | issn=0190-8286}}</ref> Anti-[[Medicine:Abortion|abortion]] laws in much of the region leave women with no recourse once they become pregnant. Aside from three countries where abortion is widely available (French Guiana, Guyana, and Uruguay) and three countries where abortion is allowed in cases of fetal malformation (Colombia, Mexico, and Panama), most of the region only permits abortion in the cases of [[Medicine:Rape|rape]], [[Social:Incest|incest]], or danger to the mother's health. In El Salvador, abortion is illegal under all circumstances.<ref name="timeAvoidPregnancy" />

On February 5, 2016, the UN High Commissioner for Human Rights urged Latin American governments to consider repealing their policies regarding contraception and abortion, emphasizing that "upholding human rights is essential to an effective public health response."<ref name="Upholding women’s human rights">{{cite news | access-date=March 20, 2016 | url=http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=17014&LangID=EN | title=Upholding women's human rights essential to Zika response&nbsp;— Zeid | publisher=United Nations | work=News and Events | date=February 5, 2016}}</ref> On February 16, 2016, the Vatican condemned the UN for its call to action, deeming it "an illegitimate response" to the Zika crisis and emphasizing that "a diagnosis of microcephaly in a child should not warrant a death sentence."<ref name="zenitHolySee">{{cite news | access-date=March 20, 2016 | url=https://zenit.org/articles/holy-see-on-zika-virus-international-community-should-exercise-due-diligence-but-not-panic/ | title=Holy See on Zika Virus: International Community Should Exercise Due Diligence, But Not Panic | work=Zenit | date=February 17, 2016}}</ref>

On February 18, 2016, after a trip to Latin America, Pope Francis stated that "avoiding pregnancy is not an absolute evil" in cases such as the Zika virus outbreak. His comments sparked speculation that the use of contraception may be morally permissible in the prevention of the Zika virus.<ref name="washingtonpostPope">{{cite news | access-date=March 20, 2016 | url=https://www.washingtonpost.com/news/acts-of-faith/wp/2016/02/17/mexico-confirms-zika-virus-cases-in-pregnant-women-as-pope-francis-exits-the-country/ | title=Pope Francis suggests contraception could be permissible in Zika fight | work=The Washington Post | date=February 17, 2016 | last=Bailey | first=Sarah Pulliam | last2=Boorstein | first2=Michelle | issn=0190-8286}}</ref>

== Scientific communication and concerns ==
The 2015-2016 Zika virus outbreak became an important topic on many social media sites, especially on Twitter. An analysis of Twitter posts on February 2, 2016 showed that 50 tweets per minute were posted about Zika, many of which contained the hashtags #salud, which means health in Spanish as well as #who, which served as a reference to the World Health Organization.<ref name=":02">{{Cite news|url=https://www.reuters.com/article/us-health-zika-socialmedia/zika-virus-a-trending-topic-on-social-media-platforms-idUSKCN0VC2I0|title=Zika virus a trending topic on social media platforms|date= 2016-02-03|work=Reuters|accessdate=2017-12-09}}</ref>

The epidemic also caused a rise in tweets from college students upset that their spring break trips and study abroad plans had been changed or cancelled due to the virus’ spread.<ref name=":02" />

Many studies have been conducted on the connections and impact of social media mentions of Zika. One analysis found that the primary topics discussed on Twitter before the peak of the outbreak regarding Zika included Zika’s impact, reactions to Zika, pregnancy and microcephaly, transmission routes of Zika, and case reports.<ref name=":1">{{cite journal |doi=10.1177/0894439317721985 |title=Crisis Communications in the Age of Social Media |journal=Social Science Computer Review |volume=36 |issue=5 |pages=523–541 |year=2017 |last1=Hagen |first1=Loni |last2=Keller |first2=Thomas |last3=Neely |first3=Stephen |last4=Depaula |first4=Nic |last5=Robert-Cooperman |first5=Claudia }}</ref> During the summer of 2016 when Zika was spreading at a much faster rate, this social media analysis determined that the major topics on Twitter regarding Zika had become concerns about the spread of Zika, criticism of Congress, news about Zika, and scientific information about Zika.<ref name=":1" /> The same study also found that tweets from reputable institutions and people holding scientific credentials demonstrated the ability of Twitter as a source to spread information quickly on the internet.<ref name=":1" /> Another study found that the Centers for Disease Control and Prevention as well as the general public showed similar concerns about Zika. The CDC’s posts on Twitter during the outbreak focused on symptoms and education for Zika.<ref name=":2">{{cite journal |doi=10.1016/j.ajic.2016.08.019 |pmid=27751615 |title=Zika live Twitter chat |journal=American Journal of Infection Control |volume=44 |issue=12 |pages=1756–1757 |year=2016 |last1=Joob |first1=Beuy |last2=Wiwanitkit |first2=Viroj }}</ref> However, the public had more of a tendency to focus concern on the consequences of Zika on women and infants, such as microcephaly.<ref name=":2" />

While there was concern for children on social media, this concern was lacking in countries largely impacted by Zika virus, such as Brazil. In Brazil, struggling mothers of infants with microcephaly caused by Zika have used support systems on social media on the cellphone chat app called [[Software:WhatsApp|Whatsapp]] or on [[Company:Facebook|Facebook]] pages that can help connect mothers in need of supplies and money to donors.<ref>{{Cite news|url=https://www.washingtonpost.com/news/world/wp/2016/03/09/brazilmothers/|title=Poor Brazilian mothers join hands, turn to social media amid microcephaly crisis|last=Phillips|first=Dom|date=2016-03-09|work=Washington Post|access-date=2017-12-09|language=en-US|issn=0190-8286}}</ref>

The heavy traditional news and social media coverage of the virus spreading did cause concern over lack of reliability. Research has found that between May and June 2016, four out of five social media posts about Zika provided accurate information, but inaccurate posts were much more popular. This led many researchers to worry about the quality of information being spread and shared on social media.<ref name=":6">{{Cite news|url=https://www.nbcnews.com/storyline/zika-virus-outbreak/study-finds-people-wrong-stuff-social-media-better-n677356|title=If you're reading this, you might not like it. Because it's accurate.|work=NBC News|access-date=2017-12-09|language=en}}</ref> Google Trends showed that Zika did not become a trending topic for the media until January 2016.<ref name=":3">{{Cite news|url=https://www.forbes.com/sites/kalevleetaru/2016/02/14/the-zika-virus-and-how-algorithms-and-media-effects-impact-our-understanding-of-global-issues/#7e2d40dc766b|title=The Zika Virus And How Algorithms And Media Effects Impact Our Understanding Of Global Issues|last=Leetaru|first=Kalev|work=Forbes|access-date=2017-12-09|language=en}}</ref> A study done found that 81 percent of the most popular posts on Facebook about Zika did contain truthful information, but posts spreading false information were far more popular.<ref name=":6" /> Initial media reports on Zika in the United States focused on reassuring viewers and readers that Zika was not a threat in the United States.<ref name=":3" /> Studies have found that real-time social media updates are desirable methods for communication during the emergence of infectious diseases. However, misinformation is common and data control in the cyber world has become a growing necessity.<ref name=":2" />

Many people criticized the lack of governmental response from the U.S. Government in the wake of the crisis.<ref>{{Cite news|url=https://theconversation.com/us-response-to-zika-fragmented-and-uneven-64039|title=US response to Zika: Fragmented and uneven|last=Greer|first=Scott L.|work=The Conversation|access-date=2017-12-09|language=en}}</ref> The United States was criticized for a lack of preparedness in terms of an ability to contain a virus outbreak in the United States. The Obama Administration requested an emergency supplemental appropriation of $1.86 billion for both domestic and international response to the crisis.<ref name=":4">{{cite journal |first1=Alexandra |last1=Phelan |first2=Lawrence O. |last2=Gostin |date=April 28, 2016 |title=On Zika Preparedness And Response, The US Gets A Failing Grade |journal=Health Affairs |url=https://www.healthaffairs.org/do/10.1377/hblog20160428.054662/full/ |doi=10.1377/hblog20160428.054662 |doi-broken-date=2018-09-23 }}</ref> In response to this request, Congress redirected $589 million from funds previously dedicated to Ebola instead of allocating new funds.<ref name=":4" /> Another criticism regarding Zika funding had to do with the fact that Congress members still took vacation in July 2016 before allocating any of the funds requested in February 2016.<ref>{{Cite news|url=https://www.vox.com/2016/9/8/12830642/congress-response-zika-public-health|title=We’re screwed on outbreaks like Zika as long as we have to rely on Congress for money|work=Vox|access-date=2017-12-09}}</ref>

In August 2016, the Centers for Disease Control and Prevention reported that they had spent $194 million of the initial $222 million allocation to fight Zika virus.<ref>{{Cite news|url=https://www.nytimes.com/2016/08/31/health/us-funding-for-fighting-zika-virus-is-nearly-spent-cdc-says.html|title=U.S. Funding for Fighting Zika Virus Is Nearly Spent, C.D.C. Says|last=Tavernise|first=Sabrina|date=2016-08-30|work=The New York Times|access-date=2017-12-09|language=en-US|issn=0362-4331}}</ref> Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases said that the NIAID was running out of funds, which would substantially slow down the development of vaccines.<ref>{{Cite news|url=https://www.usatoday.com/story/opinion/2016/09/05/zika-congress-funding-vaccine-niaid-fauci-mosquitos-sexual-transmission-babies-outbreak/89889250/|title=Q&A: Zika vaccine waits on Congress|work=USA TODAY|access-date=2017-12-09|language=en}}</ref> Although the government faced criticism for not responding strongly enough to the Zika outbreak, the government eventually provided funding of $1.1 billion for Zika in October 2016. It took congress nearly seven months to agree to this allocation, which left many prevention and education projects without funding for a substantial amount of time.<ref>{{Cite news|url=https://www.npr.org/sections/health-shots/2016/09/28/495806979/congress-ends-spat-over-zika-funding-approves-1-1-billion|title=Congress Ends Spat, Agrees To Fund $1.1 Billion To Combat Zika|work=NPR.org|access-date=2017-12-09|language=en}}</ref> Senate Democrats urged Republicans to approve the full amount of funding more quickly rather than waiting for major transmission of Zika virus to begin in the United States.<ref>{{Cite news|url=https://www.nytimes.com/2016/06/09/us/politics/zika-congress-mitch-mcconnell.html|title=Congress Will Work on $1.1 Billion Measure to Fight Zika, McConnell Says|last=Herszenhorn|first=David M.|date=2016-06-08|work=The New York Times|access-date=2017-12-09|language=en-US|issn=0362-4331}}</ref>

In 2017, public health experts are still concerned about the failure of the Zika response in the United States.<ref name=":5">{{Cite news|url=https://www.nytimes.com/2017/01/16/health/zika-virus-response.html|title=How the Response to Zika Failed Millions|last=Jr|first=Donald G. McNeil|date=2017|work=The New York Times|access-date=2017-12-09|language=en-US|issn=0362-4331}}</ref> Many officials failed to provide information about Zika’s sexual transmission. New York City subway systems had posters about mosquitos while all local cases reported had been picked up elsewhere or transmitted sexually.<ref name=":5" /> Many experts believe that the United States lacked severely in providing the public with information to prevent sexual transmission of the virus.<ref name=":5" />

== See also ==
* Zika virus outbreak timeline
* Health crisis

== References ==
{{reflist|30em}}

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== External links ==
* [http://www.paho.org/hq/index.php?option=com_content&view=article&id=11585%3Azika-virus-infection&catid=8424%3Acontents&Itemid=41688&lang=en Zika virus infection] at the Pan American Health Organization
* [https://www.cdc.gov/zika/index.html Zika Virus] at the US Centers for Disease Control and Prevention
* [http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/zika-outbreak/Pages/zika-outbreak.aspx Zika outbreak in the Americas and the Pacific] at the European Centre for Disease Prevention and Control
* [https://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html? Short Answers to Hard Questions] (New York Times)
* [https://www.google.com/maps/d/viewer?mid=zJ3nlsAyCEd0.kZRxkOKHmQAY Risk map for the spread of Zika to 100 cities worldwide] (UNSW Australia)
* [https://www.washingtonpost.com/graphics/national/us-zika-cases/ All the reported cases of Zika in the United States] (Washington Post)
* [https://www.fas.org/sgp/crs/misc/R44460.pdf Zika Response Funding: In Brief] [[Social:Congressional Research Service|Congressional Research Service]]
* [http://bureau.maps.arcgis.com/apps/MapJournal/index.html?appid=9e9ca7c6957f4616a05a4331f99a0c22 Zika virus 1947 to 2016&nbsp;– interactive maps] (esri UK)
* [http://news.trust.org/item/20160610203744-li7a1 Official Map of Zika-transmitting Mosquitoes in the US]

{{DEFAULTSORT:Zika virus epidemic, 2015-16}}
[[Category:Epidemiology]]

{{Sourceattribution|2015–16 Zika virus epidemic|1}}