Public Health Surveillance & Research, Department of Veterans Affairs, Washington, DC, United States of America.
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America.
PLoS Negl Trop Dis. 2018 May 24;12(5):e0006416. doi: 10.1371/journal.pntd.0006416. eCollection 2018 May.
Zika virus (ZIKV) is an important flavivirus infection. Although ZIKV infection is rarely fatal, risk for severe disease in adults is not well described. Our objective was to describe the spectrum of illness in U.S. Veterans with ZIKV infection.
Case series study including patients with laboratory-confirmed or presumed positive ZIKV infection in all Veterans Health Administration (VHA) medical centers. Adjusted odds ratios of clinical variables associated with hospitalization and neurologic complications was performed.
Of 1,538 patients tested between 12/2015-10/2016 and observed through 3/2017, 736 (48%) were RT-PCR or confirmed IgM positive; 655 (89%) were male, and 683 (93%) from VA Caribbean Healthcare System (VACHCS). Ninety-four (13%) were hospitalized, 91 (12%) in the VACHCS. Nineteen (3%) died after ZIKV infection. Hospitalization was associated with increased Charlson co-morbidity index (adjusted odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), underlying connective tissue disease (OR, 29.5; CI, 3.6-244.7), congestive heart failure (OR, 6; CI, 2-18.5), dementia (OR, 3.6; CI, 1.1-11.2), neurologic symptom presentation (OR, 3.9; CI, 1.7-9.2), leukocytosis (OR, 11.8; CI, 4.5-31), thrombocytopenia (OR, 7.8; CI, 3.3-18.6), acute kidney injury (OR, 28.9; CI, 5.8-145.1), or using glucocorticoids within 30 days of testing (OR, 13.3; CI 1.3-133). Patients presenting with rash were less likely to be hospitalized (OR, 0.29; CI, 0.13-0.66). Risk for neurologic complications increased with hospitalization (OR, 5.9; CI 2.9-12.2), cerebrovascular disease (OR 4.9; CI 1.7-14.4), and dementia (OR 2.8; CI 1.2-6.6).
Older Veterans with multiple comorbidities or presenting with neurologic symptoms were at increased risk for hospitalization and neurological complications after ZIKV infection.
Zika 病毒（ZIKV）是一种重要的黄病毒感染。尽管 ZIKV 感染很少致命，但成年人患严重疾病的风险尚不清楚。我们的目的是描述美国退伍军人中 ZIKV 感染的疾病谱。
包括所有退伍军人健康管理局（VHA）医疗中心中实验室确诊或推定阳性 ZIKV 感染患者的病例系列研究。对与住院和神经并发症相关的临床变量进行调整后的优势比进行了分析。
在 2015 年 12 月至 2016 年 10 月期间，对 1538 名接受检测的患者进行了检测，并在 2017 年 3 月前进行了观察，其中 736 名（48%）为 RT-PCR 或确证 IgM 阳性；655 名（89%）为男性，683 名（93%）来自 VA 加勒比海医疗保健系统（VACHCS）。94 名（13%）住院，91 名（12%）在 VACHCS。19 名（3%）在感染 ZIKV 后死亡。住院与增加的 Charlson 合并症指数（调整后的优势比[OR]1.2；95%置信区间[CI]，1.1-1.3）、潜在的结缔组织疾病（OR，29.5；CI，3.6-244.7）、充血性心力衰竭（OR，6；CI，2-18.5）、痴呆（OR，3.6；CI，1.1-11.2）、神经症状表现（OR，3.9；CI，1.7-9.2）、白细胞增多（OR，11.8；CI，4.5-31）、血小板减少症（OR，7.8；CI，3.3-18.6）、急性肾损伤（OR，28.9；CI，5.8-145.1）或在检测后 30 天内使用糖皮质激素（OR，13.3；CI，1.3-133）相关。出现皮疹的患者住院的可能性较低（OR，0.29；CI，0.13-0.66）。住院（OR，5.9；CI，2.9-12.2）、脑血管疾病（OR，4.9；CI，1.7-14.4）和痴呆（OR，2.8；CI，1.2-6.6）增加了发生神经并发症的风险。
患有多种合并症或出现神经症状的老年退伍军人在感染 ZIKV 后住院和发生神经并发症的风险增加。
