Table 1. Demographic, itinerary, and laboratory characteristics of GeoSentinel Zika patients from Africa, Asia, and the Pacific.
| Country of acquisition | Demographics | Travel Dates | Type of travel and presentation | Diagnosis | Other results | Designation | Comments |
|---|---|---|---|---|---|---|---|
| American Samoa | 26 yo M | Travel: 18 to 25 Jan 2016. Illness onset: 26 Jan 2016 | Business travel. Seen after travel as outpatient in US | ZIKV PCR neg but IgM and PRNT pos from specimen taken 29 Feb 2016 | Dengue IgM equivocal; dengue PCR and PRNT neg | C | Occurred coincident with earliest cases recognized in American Samoa (1st reports emerged in Jan 2016) |
| Cameroon | 58 yo M | Travel: 23 Feb to 23 Mar 2015. Illness onset: 1 April 2015 | Missionary. Seen after travel as inpatient in Belgium | ZIKV IgM pos, ZIKV PRNT >640 from specimen taken on day 7 after illness onset | Dengue serology, NS1 Ag and PCR neg | P | Only reported case of ZIKV in Cameroon since 2010 (also reported in [28]) (incidental retrospective diagnosis while evaluating ZIKV serological diagnostics), but note that probable case only. GeoSentinel index case |
| French Polynesia (city of Papeete) | 32 yo F | Travel: Mid Nov to 5 Dec 2013.Illness onset: 9 Dec 2013 | Tourist. Seen after travel as inpatient in Norway | PCR pos from blood specimen taken on day 4 after illness onset (ZIKV IgM and IgG initially neg, but convalescent serum 1 year later was IgM and IgG pos) | Dengue IgM and NS1 Ag neg | C | 1st reports of French Polynesian outbreak occurred in Oct/Nov 2013, so not a sentinel event but occurred very early in the outbreak (reported in [29] and [30], ProMED Archive number 20140303.2309965) |
| French Polynesia | 65 yo M | Travel: 27 Dec 2013 to 12 Jan 2014. Illness onset: 7 Jan 2014 | Tourist. Seen after travel as outpatient in US | ZIKV IgM (and IgG) and ZIKV PRNT pos from specimen taken on day 7 after illness onset | Dengue IgM also pos but dengue PRNT neg | P | Case coincided with early reports of local outbreak (Nov 2013). Imported into US (likely included in [31]), but note that probable case only |
| French Polynesia | 55 yo M | Travel: 26 Dec 2013 to 7 Jan 2014. Illness onset: 12 Jan 2014 | Traveling in military. Seen after travel as outpatient in France | ZIKV IgM and IgG pos from specimen taken on day 16 after illness onset | Dengue serology, NS1 Ag and PCR neg | P | Case coincided with early reports of local outbreak reports (Nov 2013), but note probable case only |
| French Polynesia | 40 yo M | Travel: 16 Oct to 3 Nov 2016. Asymptomatic (screened as wife wanting to conceive). Clinic visit date: 7 Dec 2016 | Tourist. Seen after travel as outpatient in France | Zika IgM pos (ELISA) and PRNT pos on blood specimen taken 7 Dec 2016, but PCR from blood and semen neg | Dengue serology not done | P | French Polynesia not considered as having ongoing ZIKV activity in late 2016, but note that probable case only |
| Indonesia (Jakarta) | 52 yo F | 14 to 25 May 2012. Illness onset 25 May 2012 | Tourist. Seen after travel as outpatient in Australia | PCR pos for flavivirus from blood on specimen taken on day 4 after illness onset sequencing identified ZIKV | Dengue IgM and IgG low pos, NS1 Ag neg, dengue PCR neg | C | Had been reports of positive serosurveys for ZIKV in 1970s and 1980s, but this case (reported in [32]) was the 1st proven case from Indonesia. GeoSentinel index case |
| Kiribati (South Tarawa) | 29 yo F | Travel: Mid -Jan 2015 to 23 April 2015. Illness onset: 25 April 2016 | Missionary. Seen after travel as outpatient in New Zealand | PCR pos on blood from specimen taken on day 5 after illness onset | Dengue PCR neg | C | 1st reported case of ZIKV ever to be reported from Kiribati. GeoSentinel index case |
| Maldives | 34 yo M | Travel: 3 to 13 June 2016. Illness onset: 16 June 2016 | Tourist. Seen after travel as outpatient in Germany | ZIKV PCR pos from blood specimens taken 22 June, 14 July and 26 July and from urine specimen taken 22 July 2016; ZIKV IgM and IgG also pos (IIFAT) | Dengue IgM and PCR neg | C | There are 2 earlier reports of exportation in travelers (June 2015 and Feb 2016) but 1st reports of locally acquired infection occurred in June 2016, so this case imported into Germany coincident with earliest cases recognized in Maldives [30, 33] ProMED Archive Number 20161001.4529740) |
| Micronesia (Kosrae) | 24 yo F | Travel: 1 to 19 Sep 2016. Patient was asymptomatic but presented on return from travel (20 Sep 2016) as was 18 weeks pregnant. Normal obstetric US at 36 weeks (January 2017), declined amniocentesis, gave birth to healthy-appearing baby. | Migrant born in Micronesia, living in the USA, who travelled to Micronesia as a VFR, and was seen after travel as an outpatient in US | ZIKV PCR pos) and IgM pos on blood specimen taken 20 Sep 2016 | Dengue IgM and PCR neg | C | Initial reports of outbreak in Kosrae in Jan 2016, with ongoing outbreak activity since (approximately 20 cases per month from Sep to Oct 2016) |
| Palau | 36 yo F | Travel: 26 Sep to 7 Oct 2016. Illness onset: 6 Oct 2016 | Tourist. Seen after travel as outpatient in Netherlands | ZIKV IgM and IgG pos on blood specimens taken on day 8 after illness onset, and ZIKV PCR neg on urine | Dengue serology (IgM and IgG) and NS1 Ag neg | P | The first report from Palau of a locally acquired case was on 7 Nov 2016. Symptom onset of this case was one month prior, but diagnosis made coincident with earliest cases recognized in Palau. Note that probable case only |
| Philippines | 20 yo M | Travel: Jan 2014 to 20 Dec 2014. Illness onset: 1 Dec 2014 | Missionary. Seen after travel as outpatient in Germany | ZIKV IgM pos 1: 160, ZIKV IgG pos 1: 20480 (IIFT) from blood taken 3 weeks after illness onset | Dengue IgM pos 1: 160, dengue IgG 1:1280. Dengue tests neg when tested in the Philippines during acute illness | C | Positive serosurveys for ZIKV in 1950s in Philippines, and 1st locally acquired case was reported in 2012, but this was 1st case known to have been acquired from Philippines since 2012 (S2 Table). GeoSentinel index case |
| Singapore | 43 yo M | Travel: 9 Aug to >3 Sep 2016. Illness onset: 1 Sep 2016 | Tourist from China. Seen during travel while in Singapore as inpatient | ZIKV PCR pos on blood and urine on day 2 after illness onset | Dengue IgM and NS1 Ag neg | C | 5 GeoSentinel cases between 28 Aug and 5 Sep 2016 (4 in migrant workers), coinciding with early peak of outbreak |
| Singapore—locally acquired | 25 yo M | Illness onset: 30 Aug 2016 | Migrant worker from Bangladesh. Inpatient in Singapore | ZIKV PCR pos on blood and urine on day 3 after illness onset | Dengue IgM and NS1 Ag neg | C | |
| Singapore—locally acquired | 33 yo F | Illness onset: 2 Sep 2016 | Migrant worker from Malaysia. Inpatient in Singapore | ZIKV PCR pos (in house assay) on blood and urine on day 3 after illness onset | Dengue IgM and NS1 Ag neg | C | |
| Presumed acquisition in Singapore | 30 yo M | Travel: Visited Malaysia (Ipoh) from 23 to 25 Aug 2016. Illness onset: 27 Aug 2016 | Migrant worker from Malaysia. Inpatient in Singapore | ZIKV PCR pos on blood and urine on day 1 after illness onset | Dengue IgM and NS1 Ag neg | C | Presumed to have been acquired in Singapore, although by late Aug/early Sep 2016 cases were being reported from Malaysia, which is notable given travel to Malaysia late Aug 2016 [30] (ProMED Archive number 20160908.4475100) |
| Singapore—locally acquired | 49 yo M | Illness onset: 24 Aug 2016 | Migrant worker from Malaysia. Inpatient in Singapore | ZIKV PCR pos on blood and urine on day 5 after illness onset | Dengue IgM and NS1 Ag neg | C | |
| Thailand | 63 yo F | Travel: 20 Jan to 5 Feb 2013. Illness onset: 11 Feb 2013 | Tourist. Seen after travel as outpatient in Canada | PCR pos from blood and urine specimen taken on days 1 and 4 after illness onset. ZIKV IgM equivocal, and PRNT pos 15 March (CDC) | Dengue IgM pos but PCR neg | C | Were positive serosurveys from Thailand prior to 2012, but this case (reported in [34]) emerged prior to recent reports of autochthonous transmission (also reported in [30], ProMED Archive Number 20130529.1744108). GeoSentinel index case. Subsequent retrospective recognition of sporadic cases (3 locally acquired cases from March 2012, 2 sporadic cases reported in 2013 and 2 cases in 2014 [S2 Table]) |
| Thailand (Koh Samui) | 41 yo M | Travel: 25 to 31 July 2014. Illness onset: 2 Aug 2014 | Tourist. Seen after travel as outpatient in Japan | ZIKV PCR pos from blood specimen taken on day 2 after illness onset, and from urine taken on day 5; ZIKV IgM also pos (day 5 and day 11 after illness onset) | Dengue IgM pos, NS1 Ag neg | C | 2nd GeoSentinel case exported from Thailand (reported in [30, 35], ProMED Archive Number 20140823.2716731). Occurred concurrent with early emerging reports of local ZIKV in Thailand |
| Thailand | 25 yo F | Travel: 1 to 31 August 2014. Illness onset: 26 Aug 2014 | Tourist. Seen after travel as outpatient in Germany | ZIKV IgM neg but IgG pos > 1:20840 from specimen taken on day 8 after illness onset | Dengue IgM neg, dengue IgG pos 1: 80, and NS1 Ag neg | C | Case not previously reported |
| Thailand | 37 yo M | Travel: 31 July to 18 Aug 2016. Illness onset: unknown. Clinic visit date 23 Aug 2016 | Tourist. Seen after travel as outpatient in Italy | ZIKV IgM and IgG neg on 23 Aug and 9 Sep 2016, but PCR pos from urine specimen taken 23 Aug 2016 | No dengue serology available | C | Case occurred during known low-level circulation of ZIKV in Thailand. Note that PCR was pos despite neg serology for ZIKV |
| Thailand | 51 yo F | Travel: 5 July to 28 July 2016. Illness onset: 30 Jul. Clinic visit date 9 Aug 2016 | Tourist. Seen after travel as outpatient in Spain | ZIKV IgG pos on day 10 after illness onset and on 8 Sep 2016 | Dengue IgM neg and PCR neg | C | Case occurred during known low-level circulation of ZIKV in Thailand |
| Thailand | 54 yo F | Travel: 5 July to 28 July 2016. Clinic visit date 9 Aug 2016 | Tourist. Seen after travel as outpatient in Spain | Zika IgM and and IgG pos 9 Aug and 8 Sep 2016 | Dengue IgM pos and PCR neg | P | Case occurred during known low-level circulation of ZIKV in Thailand. Probable case only |
| Timor Leste | 29 yo M | Travel: 14 to 28 Apr 2016 (brief stop-overs in Bali, Indonesia and in Singapore). Illness onset: 8 May 2016 | TouristSeen after travel as outpatient in Germany. (Note: patient presented on 26 June, 2 months after the acute illness when feeling well) | ZIKV IgM pos (IIFT and confirmatory ELISA weakly pos 1.01 [neg <0.8]). ZIKV IgG pos (IIFT pos and confirmatory ELISA pos 1.12 [neg <0.8]) from blood specimen taken 26 June 2016 | Dengue IgM and NS1 Ag neg, dengue IgG pos (1:10240) | P | This is the only report of ZIKV from Timor Leste, imported into Germany, but note that probable case only. Probable GeoSentinel index case |
| Tonga (Nakolo) | 66 yo M | Travel: 18 Feb to 3 March 2016. Illness onset: 2 March 2016 | VFR. Seen after travel as outpatient in US | ZIKV PCR neg but IgM and confirmatory PRNT pos, titre >20480 on blood specimen taken on day 5 after illness onset | Dengue PCR neg, IgM pos but confirmatory PRNT neg (titre 320) | C | 1st cases reported Jan 2016 and 1st exported case in a traveler to Europe reported 10–16 Jan, so these 2 cases imported (husband and wife) occurred relatively early during the local outbreak |
| Tonga (Nakolo) | 60 yo F | Travel: 18 Feb to 3 March 2016. Illness onset: 2 March 2016 | VFR. Seen after travel as outpatient in US (wife of patient above) | ZIKV PCR neg but IgM and confirmatory PRNT pos, titre 2460 on blood specimen taken on day 5 after illness onset | Dengue PCR neg, IgM pos but confirmatory PRNT neg (titre <20) | C | As above |
| Vietnam (Ho Chi Minh City) | 61 yo M | Travel: 10 to 23 Dec 2015. Illness onset: 25 Dec 2015 | Tourist. Seen after travel as outpatient in Israel | ZIKV IgM and IgG (and ZIKV PCR were pos on blood taken on day 10 after illness onset | Dengue capture IgM, dengue IgG indirect and NS1Ag were neg | C | Case (reported in [30, 36], ProMED Archive number 20160317.4102468) was 1st report of ZIKV from Vietnam since 1954. GeoSentinel index case |
| Vietnam | 49 yo F | Travel: German woman living in Vietnam, traveled to Singapore Aug 16 to 18, and Aug 21 to 22 2016, and then traveled to Japan on 8 Sep and presented on 9 Sep 2016. Illness onset: 6 Sep 2016 | Business travel. Seen during travel as an outpatient in Japan | ZIKV PCR pos on urine specimen taken on day 6 after illness onset (neg results from blood on days 3 and 6 after illness onset), , ZIKV IgM pos | Dengue IgM and NS1 Ag neg | C | Case reported in [30] (ProMED Archive number 20160915.4491053) |
| Vietnam | 37 yo F | Illness onset: 19 Dec 2016 | Expatriate living in Ho Chi Minh City. Seen as an outpatient in Vietnam | ZIKV PCR (positive on urine on day 1 after illness onset | Dengue IgM and NS1 Ag neg | C | Case occurred during known low-level circulation of ZIKV in Vietnam |
Note: no traveller reported any neurological complications. F: female; M: male; yo: year old; ZIKV: Zika virus; pos: positive; neg: negative; PCR: polymerase chain reaction, PRNT: plaque reduction neutralization test; ELISA: enzyme-linked immunosorbent assay; IIFT: indirect immunofluorescence test; C: confirmed, P: probable. Designation of C versus P adapted from [2, 24] (See S1 Table); VFR: visiting friends and relatives