An investigation of zika outbreak in Saraburi, September - December 2023
DOI:
https://doi.org/10.59096/wesr.v55i10.1339Keywords:
zika, microcephaly, outbreak, surveillance system, SaraburiAbstract
Background: On October 5, 2023, the Division of Epidemiology received notification from the Office of Disease Prevention and Control 4 Saraburi (ODPC4) regarding 5 cases of congenital Zika syndrome in Saraburi. We investigated to confirm the outbreak, described its epidemiological characteristics, and evaluated the Zika surveillance system at a hospital in Saraburi to recommend control measures.
Methods: We reviewed the situation of fever with rash in Saraburi to identify suspected areas of Zika outbreak and performed active case finding. Suspected cases met one of the following criteria: 1. rash with fever/headache/arthralgia/conjunctivitis 2. Newborn with microcephaly or 3. GBS in Saraburi from September 1 to December 10,2023. Confirmed cases were identified through Zika virus detection via RT–PCR. We interviewed stakeholders of Zika surveillance system. Suspected cases and pregnant women in villages with confirmed cases underwent RT–PCR testing for Zika virus. Larvae survey, and mosquito testing for zika, dengue, and chikungunya viruses were conducted in areas with confirmed cases.
Results: We identified abnormally high cases of fever with rash in 5 villages of 4 districts. The investigation identified 31 confirmed cases: 5 (16%) newborns and 26 (84%) from adults, with a median age (Q1, Q3) of 26 (9.5,35.5) years old. The female–to–male ratio was 1 : 2.4. No severe complications were reported. Cases were spread across 7 districts of Saraburi. Microcephaly was found in 60% among newborns. Genome sequencing revealed the Asian lineage of the Zika virus. Pregnant women showed no Zika infections. The median household index and container index were 10% and 4%, respectively. The existing Zika surveillance system failed to detect the outbreak due to unaccounted for Zika virus cases in patients with fever and rash, unavailability of Zika testing in Saraburi, and discrepancies between the ICD–10 codes used for diagnosis and those for disease surveillance.
Discussion and recommendations: A previously undetected Zika outbreak likely occurred in Saraburi. Most areas exhibited a high mosquito larvae index. Enhancing awareness of diagnosis, strengthening laboratory capacity for Zika testing and aligning ICD–10 codes of the surveillance system with those used for diagnosis are essential. These measures will enhance the efficiency of the surveillance system.
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