Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
US Public Health Service, Rockville, Maryland, United States of America.
PLoS Negl Trop Dis. 2020 Sep 21;14(9):e0008532. doi: 10.1371/journal.pntd.0008532. eCollection 2020 Sep.
After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease.
Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015-December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20-29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]: -0.22 [95% confidence interval -0.29, -0.14]), eastern longitude (log HR: -1.04 [-1.17, -0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR: -0.30 [-0.32, -0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature (log HR: -0.04 [-0.05, -0.03]). Higher incidence of ZIKV disease was associated with lower mean precipitation, but not socioeconomic factors.
During the ZIKV epidemic in Puerto Rico, 1% of residents were reported to public health authorities and had laboratory evidence of ZIKV disease. Transmission was first detected in urban areas of eastern Puerto Rico, where transmission also peaked earlier. These trends suggest that ZIKV was first introduced to Puerto Rico in the east before disseminating throughout the island.
寨卡病毒（ZIKV）在美洲出现后，波多黎各对虫媒病毒病的实验室监测进行了调整，以纳入寨卡病毒病。
波多黎各卫生部报告的疑似虫媒病毒病病例通过 RT-PCR 和 IgM ELISA 检测是否感染了寨卡、登革热和基孔肯雅热病毒。为了描述确诊寨卡病毒病病例的时空趋势，我们分析了市县级社会人口统计学、气候和空间因素与首次寨卡病毒病病例检出时间和疫情中期之间的关系。在 2015 年 11 月至 2016 年 12 月期间，共报告了 71618 例疑似虫媒病毒病病例，其中 39717 例（55.5%；每 100 名居民中有 1.1 例）经检测对寨卡病毒感染呈阳性。疫情在 2016 年 8 月达到高峰，当周报告的 71.5%的虫媒病毒病病例经检测对寨卡病毒感染呈阳性。20-29 岁人群的寨卡病毒病发病率最高（每 100 名居民中有 1.6 例），大多数（62.3%）病例为女性。最常报告的症状是皮疹（83.0%）、头痛（64.6%）和肌痛（63.3%）。很少有患者住院（1.2%），13 人（<0.1%）死亡。寨卡病毒病病例的早期检出与人口规模增加（对数危险比[HR]：-0.22[95%置信区间-0.29，-0.14]）、东经（对数 HR：-1.04[-1.17，-0.91]）和靠近城市（样条估计自由度[edf]=2.0）有关。疫情中期较早出现与北纬（对数 HR：-0.30[-0.32，-0.29]）、东经（样条 edf=6.5）和较高的月平均温度（对数 HR：-0.04[-0.05，-0.03]）有关。寨卡病毒病发病率较高与较低的月平均降水量有关，但与社会经济因素无关。
在波多黎各的寨卡病毒疫情期间，有 1%的居民向公共卫生部门报告，并经实验室检测证实患有寨卡病毒病。传播首先在波多黎各东部的城市地区被发现，那里的传播也更早达到高峰。这些趋势表明，寨卡病毒首先在波多黎各东部传入，然后传播到该岛各地。
