Free Email

• Windows Live Hotmail
  Send, receive, and organize email with Hotmail, a free web-based email provider from MSN. Features a personal calendar and customizable contact groups.
  www.hotmail.com
• Gmail
  Web-based free email service from Google that offers spam protection, groups replies into a single conversation, and allows users to search their message archive.
  gmail.google.com
• Yahoo! Mail
  Yahoo! Mail provides free, customizable email, including PhotoMail online picture sharing, spam protection, filtering, and multiple email account management.
  mail.yahoo.com
• Mail.com
  Provides personalized, web-based email. Also offers premium service upgrades.
  www.mail.com
• Mail2Web
  Free web-based email application which allows users to access accounts anywhere.
  www.mail2web.com
• AOL Mail
  Provides free AOL email account. Users can check email and compose new messages online.
  webmail.aol.com
• Mailinator
  Free, receive-only email service to mislead spammers.
  www.mailinator.com
• Lycos Mail
  Provides email, voice mail, and instant messaging services from Lycos.
  mail.lycos.com
• Netaddress
  Provides email accounts.
  www.netaddress.com
• FastMail
  Provides Internet email access as well as the ability to work with third-party email programs.
  www.fastmail.fm
• Walla!
  Provides free web-based email services, includes 3 GB account space.
  www.walla.com
• Postmaster
  European free web-based email service. No configuration hassles, full functionality.
  www.postmaster.co.uk
• ZapZone Network
  Provides a free web-based email solution and service to web sites that want to offer free email to their users.
  www.zzn.com
• Abcde...
  Offers free email accounts with the world's longest alphabetical domain.
  www.abcdefghijklmnopqrstuvwxyzabcdefghijklmnopqrstuvwxyzabcdefghijk.com
• 10 Minute Mail
  Provides sparm-wary users a temporary valid email address that automatically expires after ten minutes.
  www.10minutemail.com
• PookMail.com
  Disposable email account system to avoid giving your personal email address to suspicious web sites.
  www.pookmail.com
• Doramail
  For all doraemon fans.
  www.doramail.com
• dodgeit
  Free, receive-only email service.
  www.dodgeit.com
• ThatWeb
  Offers one-step gateway access to one's different email accounts anywhere.
  www.thatweb.com
• XasaMail
  Offering 2000MB of free storage.
  www.xasamail.com
• MyRealBox
  Email and calendaring services provided by Novell NetMail.
  www.myrealbox.com
• Excite Mail
  Free web-based email.
  mail.excite.com
• Mail2World Personal Services [SPONSOR]
  Free web-based email service with unlimited storage, translation engine, SMS services, spam protection, domain names, and a variety of skins.
  www.mail2world.com
• E-MailAnywhere.com
  Offers a consolidated Web-based e-mail service for business and corporate users.
  www.e-mailanywhere.com
• Caramail
  Free email service by from Lycos France.
  www.caramail.lycos.fr
• FlashMail
  Gives you the ability to receive, read, and send mail from any computer with Internet access.
  www.flashmail.com
• Zenbe
  Email service with integrated Facebook, Twitter, calendar, multiple email accounts management, and other extras.
  www.zenbe.com
• HushMail
  Web-based fully encrypted email system.
  /www.hushmail.com
• NamePlanet
  Gives users the opportunity to use their own names in their email address.
  www.nameplanet.com
• ICQmail
  Free email service, with virus protection, translator, skins, and other features.
  www.icqmail.com
• Juno WebMail
  Juno email is a web-based email service that allows members to check their email on the Web.
  webmail.juno.com
• EarthLink WebMail
  Login page for EarthLink, MindSpring, and OneMain accounts.
  webmail.earthlink.net
• Orgoo
  Web-based application which allows users access to all of their IM accounts, email accounts, SMS, and video chatting in one place.
  www.orgoo.com
• MailandNews.com
  Supporting web, POP3, IMAP4 and phone access. Also has news group access.
  www.mailandnews.com
• Indiatimes Mail
  Indiatimes mail provides free email for users. Includes features like folders, tags, and calendar.
  mail.indiatimes.com
• AventureMail.com
  Offers 2GB of free email storage.
  www.aventuremail.com
• AOL Postmaster.info
  Official AOL Mail FAQs, error message explanations, IP block database, and other resources.
  postmaster.info.aol.com
• ProntoMail
  Free web-based email address and a personal home page.
  www.prontomail.com
• Fuzzmail
  Records users movements as they type to give more life to the written email. Recipients of emails are able to see backspaces, reconsiderations, typos, and the final draft.
  www.fuzzmail.org
• E-OmniNet
  Offers POP3 email, file manager, calendar, bookmarks, and address book.
  eo.yifan.net
• gURLmAIL
  Free web-based email.
  www.gurlmail.com
• MauiMail
  Free email from paradise.
  www.mauimail.com
• Doghouse Mail
  Offers free web-based mail.
  www.thedoghousemail.com
• EmailAccount.com
  Offering free email accounts.
  www.emailaccount.com
• Return Receipt Email
  Free e-mail with a delivery receipt. Send e-mail return receipt requested.
  www.returnreceipt.com
• ASTRAL FreeMail
  Free web-based email service that offers file attaching to the messages, address book, personal folders, and other features. Also in Romanian.
  www.personal.ro
• MeowMail.com
  Online community for well-wired cats and their human valets.
  www.meowmail.com
• MyPersonalEmail.com
  Serving a global community.
  www.MyPersonalEmail.com
• Computermail.net
  Web based email for you and your family.
  www.computermail.net
• Wong Faye Free Email
  Free web-based email with an @wongfaye.com domain.
  www.wongfaye.com
• EmailChoice
  Web based email service.
  www.emailchoice.com
• Every Mail
  Offers multilingual web-based email.
  www.everymail.com
• Byke.com
  Hosts several BMX web sites, and provides free web-based email.
  www.byke.com
• Kaxy [SPONSOR]
  Offers anonymous web browsing and free email as well as e-commerce solutions, software, and a variety of consumer and business resources.
  www.kaxy.com
• Katchup
  Travellers can get a permanent email address and home page to catch up with mates.
  www.katchup.co.nz
• KukaMail.com
  Offers e-mail and personal homepage.
  www.kukamail.com
• Mucho Mail
  Provides free web-based email services with anti-spam facility.
  www.muchomail.com
• ProbeMail
  Send and receive email without a program.
  www.probemail.com
• God Mail
  Offers email service, message boards, chat, online Bible, personals, and more.
  www.godmail.com
• Rediff Mail
  Provides users with a free web-based email services.
  mail.rediff.com/cgi-bin/login.cgi
• 123VN.com
  Email service with English and Vietnamese text features.
  www.123vn.com
• HowlerMonkey
  Offering free email accounts.
  www.howlermonkey.net
• Zapak Mail
  Zapak mail provides free email services including Zapak mail videos and unlimited free space.
  www.zapak.com/zapakmail.z
• Bachelor Girl Mail
  Free @bachelorgirl.zzn.com email addresses.
  bachelorgirl.zzn.com
• Jershie Mail
  Personalized email addresses ending with @jershie.zzn.com.
  jershie.zzn.com
• AAeMail.com
  Provides spam and virus filtering, instant email notification, and multiple log-in pages.
  www.aaemail.com
• WitchesBrew Mail
  Available in multiple languages.
  witchesbrew.zzn.com
• iWon Email
  Offers free email services.
  email.iwon.com
• Expat Mail
  Web-based multi-lingual email designed specially for globetrotting expatriates.
  www.expatmail.net
• Phat.co.nz
  Email accounts with enhanced spam protection, address book, and global accessibility.
  www.phat.co.nz
• Synacor Email
  Web-based email service.
  web.synacor.com
• NZ11
  Send and receive emails worldwide.
  www.nz11.com
• Stoolmail
  Your own stoolmail.zzn.com email address.
  stoolmail.zzn.com
• Merawala Email
  Free service offering several domain choices and pop email services.
  www.merawalaemail.com
• Epenguin Mail
  Offers web-based e-mail.
  www.epenguin.zzn.com
• GalacMail
  Provides free email space, customized signatures, calendars, and more.
  www.galacmail.com
• MikellMail
  Offers free email addresses and web-based service.
  www.mikellmail.zzn.com
• Zappo! Mail
  Offers free web-based email at yourname@zappo.com.
  mail.zappo.com
• Atgratis
  Free email accounts from 7MetaSearch.com.
  www.atgratis.com/index.asp
• Walkerware Popmail
  Allows users to check pop3 email accounts.
  www.popmail.walkerware.ca

Read More

Original Lyrics Indonesia Raya

Created by: W.R. Suresh / Wage Rudolf Supratman

Indonesia tanah airku

Tanah tumpah darahku

Disanalah aku berdiri

Jadi pandu ibuku

Indonesia kebangsaanku

Bangsa dan Tanah Airku

Marilah kita berseru

Indonesia bersatu

Hiduplah tanahku

Hiduplah negriku

Bangsaku Rakyatku semuanya

Bangunlah jiwanya

Bangunlah badannya

Untuk Indonesia Raya

Indonesia Raya

Merdeka Merdeka

Tanahku negriku yang kucinta

Indonesia Raya

Merdeka Merdeka

Hiduplah Indonesia Raya

Indonesia Tanah yang mulia

Tanah kita yang kaya

Di sanalah aku berdiri Untuk slama-lamanya

Indonesia Tanah pusaka Pusaka Kita semuanya

Marilah kita mendoa Indonesia bahagia

Suburlah Tanahnya Suburlah jiwanya

Bangsanya Rakyatnya semuanya

Sadarlah hatinya Sadarlah budinya

Untuk Indonesia Raya

Indonesia Raya

Merdeka Merdeka

Tanahku negriku yang kucinta

Indonesia Raya

Merdeka Merdeka

Hiduplah Indonesia Raya

Indonesia Tanah yang suci Tanah kita yang sakti

Disanalah aku berdiri 'njaga ibu sejati

Indonesia! Tanah berseri Tanah yang aku sayangi

Marilah kita berjanji Indonesia abadi

Slamatlah Rakyatnya Slamatlah putranya

Pulaunya lautnya semuanya

Majulah Negrinya Majulah Pandunya

Untuk Indonesia Raya

Indonesia Raya

Merdeka Merdeka

Tanahku negriku yang kucinta

Indonesia Raya

Merdeka Merdeka

Hiduplah Indonesia Raya

Indonesia Raya

Merdeka Merdeka

Tanahku negriku yang kucinta

Indonesia Raya

Merdeka Merdeka

Hiduplah Indonesia Raya

Read More

MMWR: Local Transmission Of Zika Virus In Puerto Rico

Credi MMWR

#11,008


The CDC has published, late this afternoon, an extensive MMWR review of local acquisition of the Zika virus in the U.S. Territory of Puerto Rico - to date involving 30 individuals - including one pregnant woman.


The review, charts, and map are far too large to excerpt here effectively, so I'll simply direct my readers to follow the link. I have excerpted the summary.

Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016
 
FEBRUARY 12, 2016
On December 31, 2015, the Puerto Rico Department of Health reported the first locally acquired case of Zika virus disease in a jurisdiction of the United States in a patient from southeastern Puerto Rico. Zika virus is expected to continue to spread throughout the territory, and the 3.5 million residents of Puerto Rico, including approximately 43,000 pregnant women per year, are at risk for Zika virus infection.

Early Release / February 12, 2016 / 65(6);1–6

• PDF [529 KB]

Dana L. Thomas, MD^1,2; Tyler M. Sharp, PhD³; Jomil Torres, MS¹; Paige A. Armstrong, MD⁴; Jorge Munoz-Jordan, PhD³; Kyle R. Ryff, MPH¹; Alma Martinez-Quiñones, MPH⁵; José Arias-Berríos, MD⁶; Marrielle Mayshack^1,7; Glenn J. Garayalde, MD⁸; Sonia Saavedra, MD, PhD⁸; Carlos A. Luciano, MD⁶; Miguel Valencia-Prado⁵; Steve Waterman, MD³; Brenda Rivera-García, DVM¹

Summary

 

What is already known about this topic?Zika virus emerged in the Region of the Americas in mid-2015, and since then, outbreaks have occurred in multiple South American and Caribbean countries and territories. Zika virus infection appears to be related with increased risk for fetal microcephaly and Guillain-Barré syndrome.
 

What is added by this report?The first locally acquired case of Zika virus disease in Puerto Rico was identified in early December 2015. During the subsequent months, 29 additional laboratory-confirmed cases have been detected, including in one pregnant woman and in a man with Guillain-Barré syndrome.

What are the implications for public health practice?Clinicians in Puerto Rico and other clinicians evaluating patients with recent travel to Puerto Rico should report all cases of suspected Zika virus disease to public health authorities. Residents of and visitors to Puerto Rico should strictly follow steps to avoid mosquito bites including using air conditioning or window and door screens when indoors, wearing long sleeves and pants, using permethrin-treated clothing and gear, and using insect repellents. When used according to the product label, Environmental Protection Agency-registered insect repellents are safe for pregnant women.

---

Read More

Brazil MOH: Epi Week 5 Microcephaly report

#11,007


The weekly reporting on microcephaly cases from Brazil's MOH started out being posted  on Tuesdays last December, shifted to Wednesdays in January, while this week's report has run the latest to date - appearing on Friday.

With the removal of both confirmed and discarded cases from the Total Under Investigation each week, the numbers tend to bounce around.  But this week's report adds 296 new cases to the investigation, leaving 3862 cases under investigation.

Out of 1,227 cases that have been investigated, 462 (37.6%) have been confirmed as microcephaly or other CNS disorders. A state-by-state listing of cases can be found at the link below.

Ministry of Health investigates 3,852 suspected cases of microcephaly in the country

New report shows that 462 cases have been confirmed to microcephaly or other disorders of the central nervous system, 41 with respect to the Zika virus. Notified, they were discarded 765
 
The Ministry of Health and the states investigating 3,852 suspected cases of microcephaly across the country. The new report released on Friday (12) points out, too, that 462 cases have had microcephaly confirmation and / or other disorders of the central nervous system, and 41 with respect to the Zika virus. This week 24 new cases were confirmed, compared with the previous week.

Other 765 cases reported were discarded because they had normal exams, or submit microcefalias and / or changes in the central nervous system by an infectious causes. In all, 5,079 suspected cases of microcephaly have been recorded since the start of the investigation in October 22, 2015 until February 6, 2016. Of this total, 62.5% of cases (3,174) were reported in 2015 and 37.5% ( 1,905) in the year 2016.

The state of Pernambuco remains with the largest number of confirmed cases in relation to the Zika virus (33), followed by Rio Grande do Norte (4), Paraíba (2) and Ceará and Pará with one case each. Amapá and Amazonas are the only states of the federation which has no record of suspected cases of microcephaly.

In total, 91 deaths were reported by microcephaly and / or alteration of the central nervous system after birth (stillbirth) or during pregnancy (miscarriage). Of these, 24 were investigated and confirmed for microcephaly and / or alteration of the central nervous system, of which eight were discarded. Another 59 are still under investigation.

It should be noted that the Ministry of Health is investigating all cases of microcephaly and other disorders of the central nervous system, informed by the states and the possible relationship with the Zika virus and other congenital infections. Microcephaly can be caused by various infectious agents beyond Zika, such as syphilis, toxoplasmosis, Other Infectious Agents, Rubella, Cytomegalovirus and Herpes Viral.

According to the report, the 462 confirmed cases were reported in 175 municipalities in 13 states: Alagoas, Bahia, Ceará, Espírito Santo, Goiás, Mato Grosso do Sul, Pará, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, Rio de Janeiro and Rio Grande do Sul. the Northeast region has the largest number of confirmed cases and Pernambuco continues with the highest number of confirmed cases (167), followed by the states of Bahia (101), Rio Grande do Norte (70), Paraíba (54), Piauí (29) and Alagoas (21).

So far, they are with indigenous circulation of Zika virus 22 units of the federation. They are: Goiás, Minas Gerais, Federal District, Mato Grosso do Sul, Roraima, Amazonas, Pará, Rondônia, Mato Grosso, Tocantins, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraiba, Pernambuco, Alagoas, Bahia, Espírito Santo , Rio de Janeiro, Sao Paulo and Parana. 

(Continue . . . )

Read More

WHO Update : Yellow Fever Outbreak In Angola

#11,006


Over the past couple of days there have been media reports of another arbovirus outbreak in west central Africa (see Yellow fever outbreak kills 37 in Angola) vectored by the same mosquito as the Zika (and Dengue & CHKV) virus.

Yellow fever is currently a threat to 900 million inhabitants of Africa and parts of South America where it remains endemic and occasionally epidemic.

First the WHO update on the Angola outbreak, and then I'll return with a bit more on the subject.

Yellow Fever – Angola

12 February 2016 - On 21 January 2016, the National IHR Focal Point of Angola notified WHO of an outbreak of yellow fever. 

The first cases were identified in the district of Viana (Luanda province) on 5 December 2015. Yellow fever infection was initially confirmed in three patients by polymerase chain reaction at the Zoonosis and Emerging Disease Laboratory of the National Institute for Communicable Diseases in Johannesburg, South Africa and at the Pasteur Institute in Dakar, Senegal. 

As of 8 February, a total of 164 suspected cases and 37 deaths had been reported in Angola. The majority of cases (n=138) had been reported in the province of Luanda. Other affected provinces include Cabinda, Cuanza Sul, Huambo, Huila and Uige. Suspected cases are undergoing laboratory testing in order to rule out other aetiologies and cross reactions with yellow fever.

Public health response

The national task force has been activated to control the outbreak. Health authorities in Angola are implementing a number of control and response activities, including coordination, clinical case management, enhanced surveillance, laboratory testing, social mobilization and vector control. Epidemiological and entomological investigations are ongoing in the main affected areas. On 3 February, the first round of immunization campaign started in Luanda. 

WHO has deployed three experts to provide operational support. In addition to financial support, technical directives and guidelines have been shared with country officials to improve the quality of the response.

On 2 February, an immunization campaign was launched in Luanda. The campaign will initially cover a target population of 1,578,085 in Viana.

WHO risk assessment

In the affected districts of Luanda, there is a high density of Aedes Aegypti, the primary vector of yellow fever; consequently, the risk of spread to unaffected districts is high. This risk is further exacerbated by the high proportion of susceptible individuals, as the only protected groups are the citizens with international vaccination cards and those children that have been vaccinated against yellow fever since 2008. WHO continues to monitor the epidemiological situation and conduct risk assessment. WHO does not recommend any travel or trade restriction to Angola based on the current information available.

Background

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. Up to 50% of severely affected persons without treatment will die from yellow fever. There are an estimated 130,000 cases of yellow fever reported yearly, causing 44,000 deaths worldwide each year, with 90% occurring in Africa. There is no specific treatment for yellow fever. Treatment is symptomatic, aimed at reducing the symptoms for the comfort of the patient. Vaccination is the most important preventive measure against yellow fever. Since the second half of 2015, yellow fever virus circulation has been reported in Mali and Ghana.

While Yellow Fever has been successfully eradicated from North America and Europe for decades, the mosquito vectors that transmit the virus are still present in some regions.

And just as with Dengue, Chikungunya, Malaria,  and most recently Zika, the potential for limited re-introduction of Yellow Fever is not nil.  

A 2010 Eurosurveillance Journal devoted an entire issue to The Threat Of Vector Borne Diseases, including making the case for the reintroduction of  Yellow fever and dengue: a threat to Europe? by P Reiter (excerpt below).

Yellow fever and dengue: a threat to Europe?

P Reiter ()¹

---

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalisation of vectors and vector-borne diseases. The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced.  The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

---

(SNIP)

The history of dengue and yellow fever in Europe is evidence that conditions are already suitable for transmission. The establishment of Ae. albopictus has made this possible, and the possibility will increase as the species expands northwards, or if Ae. aegypti is re-established.

And in 2013 Peter Hotez - Dean of the National School of Tropical Medicine at Baylor College of Medicine - and Kristy Murray, an associate professor of pediatrics at Baylor College of Medicine who studys mosquito-borne diseases, penned a PLoS Blog entitled.  

Could Yellow Fever Return to the United States? 

Posted December 5, 2013 by Peter Hotez and Kristy Murray in General, Neglected Diseases

 

Peter Hotez and Kristy Murray from Baylor College of Medicine highlight the potential for yellow fever to return to the southern cities of the United States

Spolier alert, it could.


A reminder, that when it comes to re-emerging infectious diseases - even in areas that for decades have been immune - one should never say `never'.

Read More

WHO Update: Guillain-Barre Syndrome (GBS) In Columbia & Venezuela

Credit CDC

#11,005

On Monday, in Guillain-Barre syndrome: The Other Zika Concern, we looked at growing  evidence that Zika virus infection might - in rare instances -  provoke an autoimmune disease called Guillain-Barre Syndrome that can present with muscle weakness and even paralysis.

I wrote about the first sign that Zika might be capable of such a thing nearly two years ago in Zika, Dengue & Unusual Rates Of Guillain Barre Syndrome In French Polynesia. In March 2014 the journal Eurosurveillance carried a Rapid Communications describing the first case and reporting a 20-fold increase in GBS during their Zika outbreak.

While a handful of cases of GBS have been linked to Dengue and Chikungunya, neither have been viewed as a strong risk factor. But once again we seem to be seeing an increase in Guillain-Barre Syndrome in countries (Brazil, El Salvador, Columbia, and Venezuela) where the Zika virus is currently circulating. 


While a Zika-GBS link has yet to be fully established, the evidence seems to grow stronger with each passing day.  This update on recent surges in GBS in South America comes from the World Health Organization.

Guillain-Barré syndrome – Colombia and Venezuela

Disease Outbreak News
12 February 2016 

Between 30 January and 2 February 2016, the National IHR Focal Points of Colombia and Venezuela informed PAHO/WHO of increases in the number of Guillain-Barre Syndrome (GBS) cases recorded at the national level.

Colombia

From epidemiological week (EW) 51 of 2015 to EW 3 of 2016, 86 GBS cases were reported. On average, Colombia registers 242 GBS cases per year or approximately 19 cases per month or 5 cases per week. The 86 GBS cases reported in those 5 weeks is three times higher than the averaged expected cases of the 6 previous years.

Initial reports indicated that all the 86 reported GBS cases presented with symptoms compatible with a Zika virus infection. Of the 58 cases for which information is available, 57% were male and 94.8% were 18 years old or older.

Venezuela

From 1 January to 31 January 2016, 252 GBS cases with a spatiotemporal association to Zika virus were reported. While cases were recorded in the majority of the federal territories of the country, 66 were detected in the state of Zulia, mainly in the Maracaibo municipality.

Preliminary analysis of the GBS cases in the state of Zulia indicates that the 66 cases originated from six municipalities. Of the 66 cases, 30% were 45 to 54 years old and 29% were 65 years or older; 61% were male and 39% were female. A clinical history consistent with Zika virus infection was observed in the days prior to onset of neurological symptoms in 76% of the GBS cases in the state of Zulia. Associated comorbidities were present in 65% of the cases. Patients were treated with plasmapheresis and/or immunoglobulin. In some cases, according to medical indication, both treatments were used following the treatment protocol established by the Ministry of Popular Power for Health.

Zika virus infection was confirmed by polymerase chain reaction in three GBS cases, including a fatal case with no comorbidities. A total of three cases presenting with other neurological disorders were also biologically confirmed. 

Between late November to 28 January 2016, 192 cases of Zika virus infection were laboratory confirmed through reverse transcription polymerase chain reaction. Of the 192 cases, 110 (57%) are from the state of Zulia.

WHO risk assessment

Zika virus infection has been laboratory confirmed in only three of the reported GBS cases from Venezuela, while the infection has not been detected in any of the GBS cases from Colombia. Although the cause of the rise in GBS cases has not yet been established, similar increases have been observed in other countries, notably El Salvador and Brazil (see DONs published on 21 January and 8 February 2016, respectively). Further investigations are needed to identify the potential role of previous infections known to be associated, or potentially associated, with GBS.

WHO recommends Member States affected or susceptible to Zika virus outbreaks to:

• monitor the incidence and trends of neurological disorders, especially GBS, to identify variations against their expected baseline values;
• develop and implement sufficient patient management protocols to manage the additional burden on health care facilities generated by a sudden increase in patients with Guillain-Barre Syndrome;
• raise awareness among health care workers and establish and/or strengthen links between public health services and clinicians in the public and private sectors.

(Continue . . .)

Read More

EID Journal: Zika Virus Detection in Semen

Credit CDC PHIL

#11,004


Although there was only one case on record at the time (from 2008 see Probable Non–Vector-borne Transmission of Zika Virus, Colorado, USA), in late January the UK PHE Warned On Potential Sexual Transmission Of Zika strongly recommending that:

Sexual transmission of Zika virus has been recorded in a limited number of cases, and the risk of sexual transmission of Zika virus is thought to be very low. However, if a female partner is at risk of getting pregnant, or is already pregnant, condom use is advised for a male traveller :

• for 28 days after his return from a Zika transmission area if he had no symptoms of unexplained fever and rash
  
• for 6 months following recovery if a clinical illness compatible with Zika virus infection or laboratory confirmed Zika virus infection was reported

Less than a week later, a second case was confirmed (see Dallas, Texas: DCHHS Confirms Locally Acquired Sexually Transmitted Zika Infection), and soon other public health agencies were issuing similar advice.

Today we may know what prompted the UK's initial strong recommendations. 

A letter, published ahead of print today in the CDC's EID journal, describes the detection of ZIKV by rRT-PCR in a 68 year old man's semen by the UK's PHE in 2014, more than 2 months after the onset of his illness.


While live virus was not cultured from the sample, it suggests that sexual transmission may be possible weeks or even months after initial infection.  Not unlike what we've seen (albeit, very rarely) with Ebola.


While the persistence of ZIKV in semen for weeks or months increases the risks of sexual transmission, the mosquito-vector remains the primary way the virus is transmitted to humans.

Volume 22, Number 5—May 2016

Letter

Detection of Zika Virus in Semen

Atkinson B, Hearn P, Afrough B, Lumley S, Carter D, Aarons EJ, et al.

To the Editor: As an increasing number of autochthonous Zika virus (ZIKV) infections are reported from several South America countries (1), we read with interest the report from Musso et al. on the potential sexual transmission of ZIKV (2). We report additional evidence for this potential route of transmission after identification of an imported case of ZIKV infection into the United Kingdom.

After an outbreak alert for ZIKV in French Polynesia, active ZIKV screening was implemented at Public Health England (Porton Down, United Kingdom). In 2014, a 68-year-old man had onset of fever, marked lethargy, and an erythematous rash 1 week after returning from the Cook Islands. Serum samples taken 3 days into the febrile illness tested negative for dengue and chikungunya viruses by real-time reverse transcription PCR (rRT-PCR). Test results for dengue virus IgM and chikungunya virus IgM also were negative; a test result for dengue virus IgG was indeterminate.

An rRT-PCR test result for ZIKV (3) was positive and indicated a crossing threshold value of 35 cycles. This low viral load, commonly observed even in the acute phase of disease (3), meant that attempts to obtain sequence data were unsuccessful. 

Convalescent-phase serum, urine, and semen samples were requested; only semen was positive for ZIKV by rRT-PCR, , at 27 and 62 days after onset of febrile illness. These results demonstrated stronger signals than those obtained in tests of the original serum sample, with crossing threshold values of 29 and 33 cycles, respectively. ZIKV-specific plaque reduction neutralization test results were positive on convalescent-phase serum samples.

Although we did not culture infectious virus from semen, our data may indicate prolonged presence of virus in semen, which in turn could indicate a prolonged potential for sexual transmission of this flavivirus. Moreover, these findings could inform decisions regarding what control methods are implemented and which specimen types are best suited for diagnostic detection.

Read More