On behalf of Bram Goorhuis, Site director for AMC Amsterdam, we are forwarding an alert about continued Zika virus (ZIKV) circulation in Thailand, which AMC submitted to ProMED-mail. From January 1st, 2023, to date, 4 cases of Zika acquired in Thailand were entered in the GeoSentinel database (with clinic visit dates in March (n=2), August (n=1), and November (n=1)), and one in a traveler returning from Singapore and Thailand. Ongoing endemic transmission in Thailand in 2022 was also highlighted in a recent publication by Timothy Seers et al. Zika virus infection in European travellers returning from Thailand in 2022: A GeoSentinel case series. Trop Med Int Health. 2023 Jul;28(7):576-579. doi: 10.1111/tmi.13900. Epub 2023 Jun 3. PMID: 37269191
While evidence to suggest that the pathogenic potential for Asian lineages circulating in Southeast Asia to cause congenital ZIKV syndrome is scarce, raising awareness among travelers of child-bearing age when travelling to Thailand is warranted.
The ProMED-mail report from Amsterdam:
On December 1st, 2023, a 33-year-old woman presented to AMC Amsterdam with acute symptomatic Zika virus infection after a 2-week trip to Thailand.
The symptoms started on 27 Nov 2023 with a headache, sub febrile temperature, and a jetlag feeling. From 30 Nov 2023 she also complained of a generalized rash which had started predominantly in the face, and had spread to the trunk and limbs, combined with a light muscle ache.
At presentation, she complained of a headache, muscle ache, generalized rash, and tender lymph nodes. On examination, she had a facial rash, plus a generalized rash including trunk and limbs. She was afebrile. She had palpable painful lymph nodes in the cervical region. Blood tests showed a lymphocytopenia but normal liver tests, ESR and thrombocytes. Both Zika virus RT-PCR from blood and urine sample were positive. Serology showed a positive dengue virus IgG, but IgM and RT PCR (blood, urine) were both negative, suggesting a previous dengue infection. Zika virus serology was not performed. Other recent infections such as chikungunya, COVID-19, influenza, respiratory syncytial virus, Epstein-Barr virus, cytomegalovirus, measles and parvovirus were excluded via serology or RT-PCR.
Our patient had visited Thailand mid-November and had travelled to Koh Samui, where she had stayed most of her trip. She had returned to The Netherlands on the 26th of November. She was frequently bitten by mosquitoes throughout her holiday. The patient recovered fully and without sequelae.
Relevance:
This case is very similar to the recent reported cases of two tourists returning from Thailand with acute symptomatic Zika virus infection presenting in a hospital in Germany (Promed mail post: (Promed Post – ProMED-mail (promedmail.org)) and emphasizes the importance to raise awareness among travelers of child-bearing age when travelling to Thailand, especially Koh Samui.
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On behalf of Bram Goorhuis, Site director for AMC Amsterdam, we are forwarding an alert about continued Zika virus (ZIKV) circulation in Thailand, which AMC submitted to ProMED-mail. From January 1st, 2023, to date, 4 cases of Zika acquired in Thailand were entered in the GeoSentinel database (with clinic visit dates in March (n=2), August (n=1), and November (n=1)), and one in a traveler returning from Singapore and Thailand. Ongoing endemic transmission in Thailand in 2022 was also highlighted in a recent publication by Timothy Seers et al. Zika virus infection in European travellers returning from Thailand in 2022: A GeoSentinel case series. Trop Med Int Health. 2023 Jul;28(7):576-579. doi: 10.1111/tmi.13900. Epub 2023 Jun 3. PMID: 37269191
While evidence to suggest that the pathogenic potential for Asian lineages circulating in Southeast Asia to cause congenital ZIKV syndrome is scarce, raising awareness among travelers of child-bearing age when travelling to Thailand is warranted.
The ProMED-mail report from Amsterdam:
On December 1st, 2023, a 33-year-old woman presented to AMC Amsterdam with acute symptomatic Zika virus infection after a 2-week trip to Thailand.
The symptoms started on 27 Nov 2023 with a headache, sub febrile temperature, and a jetlag feeling. From 30 Nov 2023 she also complained of a generalized rash which had started predominantly in the face, and had spread to the trunk and limbs, combined with a light muscle ache.
At presentation, she complained of a headache, muscle ache, generalized rash, and tender lymph nodes. On examination, she had a facial rash, plus a generalized rash including trunk and limbs. She was afebrile. She had palpable painful lymph nodes in the cervical region. Blood tests showed a lymphocytopenia but normal liver tests, ESR and thrombocytes. Both Zika virus RT-PCR from blood and urine sample were positive. Serology showed a positive dengue virus IgG, but IgM and RT PCR (blood, urine) were both negative, suggesting a previous dengue infection. Zika virus serology was not performed. Other recent infections such as chikungunya, COVID-19, influenza, respiratory syncytial virus, Epstein-Barr virus, cytomegalovirus, measles and parvovirus were excluded via serology or RT-PCR.
Our patient had visited Thailand mid-November and had travelled to Koh Samui, where she had stayed most of her trip. She had returned to The Netherlands on the 26th of November. She was frequently bitten by mosquitoes throughout her holiday. The patient recovered fully and without sequelae.
Relevance:
This case is very similar to the recent reported cases of two tourists returning from Thailand with acute symptomatic Zika virus infection presenting in a hospital in Germany (Promed mail post: (Promed Post – ProMED-mail (promedmail.org)) and emphasizes the importance to raise awareness among travelers of child-bearing age when travelling to Thailand, especially Koh Samui.