First Female-to-Male Zika Transmission, Second Zika-Related Death Recorded in U.S.

• Two people have now died in the U.S. from complications of Zika infection.
• The first case of female-to-male transmission has been detected by the Centers for Disease Control and Prevention (CDC).
• More than 1300 cases of Zika infection have been detected in the U.S.
• The CDC elevated its response efforts to a Level 1 activation, the highest response level at the agency.
• The World Health Organization declared a Public Health Emergency of International Concern.
• The virus is now widespread in nearly 50 countries throughout South America and the Caribbean and continues to spread rapidly in the Americas, according to the World Health Organization (WHO).

Talk of a diminishing threat from the Zika virus may well be premature. This more than 50-year-old virus is reaching new heights of transmissibility and lethality. The first case of female-to-male transmission has been detected by the Centers for Disease Control and prevention in New York City, and 2 Americans have died after contracting the disease, the first in Puerto Rico and the second in Utah. Importantly, still no mosquito borne cases of Zika infection have been reported within the continental U.S. The virus is carried by the Aedes aegypti, or "Yellow Fever," mosquito (Figure).

“At least seven children have been born with birth defects and five pregnancy losses related to Zika in the United States. The lifetime cost of care is estimated to be $10 million for each sick child,” according to an article published recently in The New York Times.

Because many people who are infected with Zika show no symptoms, the number of actual infections may be much higher than has been detected by the CDC and state health officials.

Types of Zika infections and complications reported in the continental U.S. and U.S. territories, according to the CDC:

Two Deaths

“Utah health officials said Friday that the death of an elderly patient at the end of June was related to the Zika virus, the first Zika-related death in the continental United States. The unidentified resident of Salt Lake County had traveled to an undisclosed destination where the virus is circulating,” according to CNN.com.

Utah

Utah health officials have confirmed that the death of an elderly patient at the end of June was related to the Zika virus. The unidentified resident of Salt Lake County had traveled to an are where the virus is common.

While the cause of death has not been determined, Utah officials noted that person had an underlying medical condition and tested positive for Zika. “We know it contributed to [the death], but we don't know that it was the sole cause [of death],” Dagmar Vitek, MD, told CNN. Dr. Vitek is the medical director for the Salt Lake County Department of Health. “It may not be possible to determine how the Zika infection contributed to the death,” he noted in a press release said. Zika infection was not confirmed until after the individual had died.

Puerto Rico

In February, a 70-year-old Puerto Rican man died from complications of the Zika virus, the CDC and the Puerto Rico Department of Health announced recently. This is the first time in the United States or territories that Zika infection contributed to a death, the CDC said, according to a separate report from CNN.com. report. 

The man lived in the San Juan metropolitan area, contracted Zika infection, and was treated for symptoms that lasted less than a week, said Lieutenant Commander Tyler M. Sharp, PhD in a CDC press release. Dr. Sharp is an epidemiologist at the CDC Dengue Branch in San Juan, Puerto Rico.

“A few days after his recovery, he returned to the hospital with signs of a bleeding disorder and was diagnosed with immune thrombocytopenic purpura [ITP],” Dr. Sharp said. This individual did have some underlying health conditions, but they were not life-threatening and not likely to have led to his death.”

This is the ninth known case of bleeding associated with the Zika virus. “There have been four cases in French Polynesia, one case from Suriname and three cases in Colombia that were all diagnosed with ITP,” Dr. Sharp explained. The individuals in French Polynesia and Suriname survived; those in Colombia did not.

“We do not know if there are risk factors in the person infected with Zika that would make them more susceptible to developing ITP,” Sharp said. “Bleeding typically begins in the mouth and from the gums, and progresses with easy bruising and petechiae.”

Dr. Sharp noted that the relationship between bleeding and Zika might be similar to that which occurs between Zika and Guillain-Barré syndrome. “To the best of our understanding, the ITP happens after the Zika illness resolves,” he said. “Then the antibodies begin to cross-react with other cells in the body. In Guillain-Barré, they attack nerves. In ITP, the antibodies attack platelets.”

The CDC said they have tested over 6,000 specimens since Puerto Rico became the first U.S. jurisdiction to report local transmission of the Zika virus; 683 showed evidence of current or recent infection. Nine of those cases, or 1 percent, also showed signs of low blood platelets

First Female-to Male Zika Transmission

The first case of female-to-male sexual transmission of the Zika virus has been reported in New York City, according to the CDC and an article in The New York Times.

“The first case of female-to-male sexual transmission of the Zika virus has been documented in New York City, raising the prospect that the disease could spread more widely beyond the countries where it is already endemic and largely transmitted by mosquitoes,” wrote Marc Santora in The Times.

According to The New York Times and the CDC, researchers found that a man in his 20s living in New York City, who had not traveled outside the U.S. during the year before his illness, contracted the virus after one instance of vaginal intercourse, in which he did not wear a condom. His partner was a woman, also in her 20s, who had recently returned from a country where Zika infection is widespread.

The woman, who was not pregnant at the time of intercourse, had sex with the man on the day she returned to New York. The woman reported to New York City health officials having headache and abdominal cramping while in the airport before returning to the city. The next day she developed a number of symptoms associated with Zika, including fever, fatigue, a maculopapular rash, myalgia, arthralgia, back pain, swelling of the extremities, and numbness and tingling in her hands and feet. She also reported that her period, which began that day, was heavier than usual.

On day 3 she visited her primary care physician and gave blood and urine specimens. Zika virus RNA was detected in both serum and urine by real-time reverse transcription–polymerase chain reaction (rRT-PCR) performed at the New York City Department of Health and Mental Hygiene (DOHMH) Public Health Laboratory using a test based on an assay developed at CDC.

Seven days after sexual intercourse (day 6), the woman’s partner developed fever, a maculopapular rash, joint pain, and conjunctivitis. On day 9, 3 days after the onset of his symptoms, the man sought care from the same primary care provider who had diagnosed Zika virus infection in his female partner.

The physician suspected sexual transmission of Zika virus and contacted DOHMH to seek testing for the male partner. Urine and serum specimens were collected from the man. Zika virus RNA was detected in urine but not serum by rRT-PCR testing at the DOHMH Public Health Laboratory. Zika virus IgM antibodies were not detectable by the CDC Zika MAC-ELISA assay performed at the New York State Department of Health Wadsworth Center. The CDC Arbovirus Disease Branch confirmed all rRT-PCR results for urine and serum specimens from both partners.