Talk:2015–16 Zika virus epidemic/Archive 2

Archive 1

Archive 2

Vanuatu

In the article it says the outbreak began in April 2015. Vanuatu should be included since a case was reported in April 2015. http://www.abc.net.au/news/2015-04-28/vanuatu-records-first-case-of-rare-zika-virus/6427666 — Preceding unsigned comment added by Rhetoricalnoodle (talk • contribs) 10:54, 5 March 2016 (UTC)

That news article doesn't go into detail about the case. This local newspaper article specifies that the 'cases' were blood samples taken before Cyclone Pam in March 2015 that had been sent to laboratories for testing. The number of samples with Zika has not been specified, and with no other sources providing information on Vanuatu, it is impossible to identify if there has been a proper outbreak of Zika on Vanuatu, how many cases there were, or if the cases are all imported. Alcherin (talk) 14:11, 5 March 2016 (UTC)

Alcherin: Vanuatu, Fiji, New Caledonia (up till the latest report, anyway), and the Solomon Islands have consistently shown up on ECDC's chart as having autochthonous cases within the last nine months but not within the last two months. Since that's still within the article's time frame, I've put Vanuatu back and added Fiji into the non-Americas table. Along with Laos, that makes three countries that we know have autochthonous cases, but for which we have no numbers of cases to report. It may look a little odd to have blanks in the table, but it does convey the information that there are cases there and, IMHO, is okay like that. — Gorthian (talk) 01:45, 6 March 2016 (UTC)

WHO's "Dispelling rumours around Zika and microcephaly"

Already too many sources? This seems the most authoritative one -- from the WHO: Dispelling rumours around Zika and microcephaly. fgnievinski (talk) 01:09, 7 March 2016 (UTC)

Notes on microcephaly link

Here's a draft for a new beginning to this section -- another question is whether we should separate GBS from birth defects into two sections?

Public health officials strongly suspect that Zika infection during pregnancy can cause a number of grave outcomes, including microcephaly and loss of pregnancy.Following the initial Zika outbreak in Northeastern Brazil, physicians observed a very large surge of reports of infants born with microcephaly, with 20 times the number of expected cases.

Proving that Zika causes these effects is difficult and complex for several reasons. For example, the effects on an infant might not be seen until months after the mother’s initial infection, long after the time when Zika is easily detected in the body. In addition, research is also needed to determine the mechanism by which Zika produces these effects.

Since the initial outbreak, studies that use several different methods have found evidence of a link, leading public health officials to conclude that it appears increasingly likely the virus is linked to microcephaly and miscarriage.

I think we've had a spate (almost said 'rash') of new studies, I thought it would make sense to take notes here and then craft an update. . .

• Prospective cohort study of 88 pregnant women presenting with rash, 16 uninfected, 72 with infections confirmed by PCR, 42 of whom underwent ultrasound examination. Fetal abnormalities were detected by Doppler ultrasonography in 12 of the 42 ZIKV-positive women (29%) and in none of the 16 ZIKV-negative women. [1]

As of March 2016, researchers have found a growing body of evidence that Zika fever in pregnant women is associated with intrauterine growth restriction, including abnormal brain development in their fetuses, which may result in miscarriage or microcephaly.

• Lab model study indicates Zika infects neural progenitor cells. [2] Healthday coverage: [3]
• Mainstream media coverage of the prior two studies [4] Chris vLS (talk) 03:37, 8 March 2016 (UTC)
• Case control study on GBS [5]

Chris vLS (talk) 03:52, 8 March 2016 (UTC)

• Coverage of the 5,000 case study, results expected in June. Chris vLS (talk) 03:54, 8 March 2016 (UTC)

References

Zika arrived in Americas in 2013: study

It is primarily the Americas. Read more at: http://www.oneindia.com/international/zika-arrived-americas-2013-study-2051043.html juanTamad (talk) 03:32, 25 March 2016 (UTC)

Zika in Bangladesh

@SheriffIsInTown: I removed the Bangladeshi case because it was from an old sample of blood, drawn in 2014 or 2015. Yes, it's important in that it establishes that Zika has been active in Bangladesh, but it is not part of the current outbreak, which is the subject of this article. Add the information to Zika virus or Zika virus outbreak timeline, but it doesn't belong here. — Gorthian (talk) 17:57, 23 March 2016 (UTC)

SheriffIsInTown, the outbreak in this article is now worldwide, and dates from April 2015. The editors here have been diligent about confirming numbers and dates for each country listed in the tables. I deliberately did not add Bangladesh because there is no definite date for the sample. No source I found gave any date other than 2014–2015. Until the date is confirmed as being April 2015 or later, or there is a fresh case, Bangladesh should not be listed. Again, I invite you to add that information to a more appropriate article.— Gorthian (talk) 20:45, 23 March 2016 (UTC)

The blood sample was taken in 2014: [6] and [7]. — Gorthian (talk) 22:53, 23 March 2016 (UTC)

THIS outbreak has never "become worldwide." The virus was present already in Africa, Asia and Oceania well before the current outbreak. There have been and continue to be cases detected in places like Bangladesh, where the virus has been present for decades, but rarely confirmed because it's a mild disease and assumed to be dengue or chik or something else. This outbreak (the subject of this page) is best described as an outbreak in the Americas. juanTamad (talk) 02:36, 26 March 2016 (UTC)

Yes, it's primarily in the Americas, but Cape Verde is part of it, too, as are several islands in Oceania (American Samoa, the Solomon Islands, Tonga). Because of those countries, I do think of it as worldwide.

The limits (in terms of this article) are fairly arbitrary: exactly what date should we count as the beginning? How about the end? The outbreak is almost over in Cape Verde and seems to be decreasing in some Latin American countries, while in others, the number of cases is increasing. The aftereffects of the outbreak are burgeoning—do we count those as part of the outbreak? So far, we seem to be. (And that seems appropriate to me.)

Who knows where it will show up this summer? It may yet become truly worldwide.— Gorthian (talk) 03:16, 26 March 2016 (UTC)

Should we remove the World Cup from the lede?

There have been conflicting theories about this. Now we have a source that doubts both of those theories. Thoughts? Chris vLS (talk) 04:54, 26 March 2016 (UTC)

"Mostly in South America"

I am not comfortable with this limitation in the lede. It's true if you look at suspected cases. But probably not if you look at number of nations affected. And probably not in terms of square miles. It seems to offer comfort to those outside of South America, but that's not really an appropriate read if you're in Central of Caribbean America. So from a 'due weight' perspective, it just doesn't seem to belong in the very first sentence. Besides, with all the tireless work Gorthian and Alcherin put into the stats, they should look at the table and the map if they want to know where it is!

Ok to delete? Chris vLS (talk) 04:09, 24 March 2016 (UTC)

I agree. "Primarily in the Americas" already sums up the geographical context necessary. Alcherin (talk) 10:03, 24 March 2016 (UTC)

I think it's a leftover from when this was only about the Americas. Deleting it is a good idea.— Gorthian (talk) 16:42, 24 March 2016 (UTC)

Thanks! Done. Chris vLS (talk) 04:55, 26 March 2016 (UTC)

Sexual transmission

In the various Zika articles, we have followed our sources by referring to the sexual transmission as unconfirmed. The CDC in the latest MMWR has assembled enough cases to say simply "Zika virus can be spread during sex by a man infected with Zika to his partners." [8] Time to address this . . . would appreciate input! Chris vLS (talk) 02:58, 29 March 2016 (UTC)

Now that they're looking, they're finding

Vietnam reports first Zika infections, raises alarm juanTamad (talk) 12:25, 5 April 2016 (UTC)

Outbreak or epidemic?

This outbreak certainly meets the definition of an epidemic now (http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html). How about changing the title to reflect that? juanTamad (talk) 16:43, 11 April 2016 (UTC)

What about pandemic, per the same reference? I would say it certainly "has spread over several countries or continents, ...affecting a large number of people." — Gorthian (talk) 16:03, 12 April 2016 (UTC)

I agree. Don't see the term used much, except here (http://www.nejm.org/doi/full/10.1056/NEJMp1600297) and Fauci is certainly an authority. WHO does not use the term that I recall seeing. It does meet the WHO definition of a phase 5 pandemic for influenza (http://www.who.int/csr/disease/swineflu/phase/en/). juanTamad (talk) 17:25, 12 April 2016 (UTC)

WHO seems to confine the word pandemic to influenza; the ECDC confirms the broader sense. — Gorthian (talk) 20:29, 12 April 2016 (UTC)

I haven't heard the term used in the case of Zika, although the CDC definition seems to fit. Would certainly be safe to go with epidemic, using the CDC definitions. For other diseases, being truly worldwide seems to be a requirement (influenza, cholera, HIV). This is an interesting definition of outbreak, but I think it's incorrect: https://www.youtube.com/watch?v=CUl87kYHT3I juanTamad (talk) 00:32, 13 April 2016 (UTC)

Two and a half months ago, Fauci explicitly defined this as a pandemic. However, you're right, it's not commonly used yet, except in the sense that we're "on the verge" of a pandemic.[9][10][11][12][13]

I've seen that definition you linked to before, but I don't remember where. Changing the article name from "outbreak" to "epidemic" (at the least) seems clearly warranted at this stage. But it would be good to get more than just two opinions. Do we need to do a full RFC, or would it be enough to just ping some of the other editors active on this article?— Gorthian (talk) 22:19, 13 April 2016 (UTC)

I think it should be pandemic. It is already in Asia and Oceania as well. Rhetoricalnoodle (talk) 07:56, 16 April 2016 (UTC)

Renaming the article

It's definitely time to call this an epidemic. Although it certainly seems to fit the definition of a pandemic, sources seem reluctant to use that word. (See discussion above.) So I've been thinking about what the name of this article should be.

I propose the name be changed to 2015–16 Zika virus epidemic.

Any objections or other ideas? I'll probably move the article in a few days, depending on the discussion. — Gorthian (talk) 17:13, 6 May 2016 (UTC)

I will take that resounding silence to be a YES. — Gorthian (talk) 20:40, 12 May 2016 (UTC)

 Done (is there an echo in here?) — Gorthian (talk) 21:04, 12 May 2016 (UTC)

References' display

I'm wondering why inline references #20 through 74 do not show in the article body, but only in the list at the end. BatteryIncluded (talk) 01:44, 9 August 2016 (UTC)

They're in the collapsed tables at the beginning of the "Epidemiology" section. — Gorthian (talk) 01:52, 9 August 2016 (UTC)

Gotcha. Thanks. BatteryIncluded (talk) 02:22, 9 August 2016 (UTC)

Puerto Rico numbers

@98.204.236.60: There were two problems that I'm glad you addressed in your edits here and here. One was that in a previous update, I had made a typo, accidentally adding a extra "4" in front of the real number of 5,582, so that it read 45,582(!). The second was the number of suspected cases, which had been in a previous report from PAHO (9 June 2016); they got rid of that number later, and I meant to remove it from the table, but hadn't yet.

However, the CDC is not the only source for numbers in these tables. In the Americas, most of the numbers come from PAHO (the citation is next to the title of the table; right now it's #19). They do not always agree with the CDC about Puerto Rico; sometimes it seems that the CDC is playing catch-up with them. And both the CDC and PAHO report one Zika-related death in Puerto Rico. Some of the numbers come from the ECDC, for the European territories in the Americas. When a number is from a different source than PAHO, there's a citation next to it.

I appreciate your attention to detail. But in the future, would you bring your concerns to the talk page? We all make mistakes, and there may be other reasons for the way the data is presented. — Gorthian (talk) 03:21, 10 August 2016 (UTC)

Moved from User talk:Gorthian § Zika Cases in Puerto Rico

Thank you for correcting the data for Zika case in Puerto Rico. However, the total number of cases cited on Wikipedia (7,296) is incorrect.

CDC reports the total number of cases as 5,548.

PAHO reports the total number of cases as 5,572.

Kind regards,

Kevin — Preceding unsigned comment added by Kevshe (talk • contribs) 00:12, 11 August 2016 (UTC)

Kevin, I suspect you may be looking at outdated data. The numbers used for the table are from PAHO, as of August 5. The numbers are updated every Thursday or Friday.

(I assume you were editing from the IP address above before you registered? Welcome! Please be sure to sign your messages by typing four tildes: ~~~~. And discussion about an article needs to be at the article's talk page; that's why I moved this here.) — Gorthian (talk) 00:45, 11 August 2016 (UTC)

Date format

Note that most if not all North and South American sources use the m-d-y format, ie. August 16, 2016. That includes Brazilian newspapers, such as Rio Times and Merco Press. The article should use that format. --Light show (talk) 23:54, 19 August 2016 (UTC)

Section about abortion laws is biased

They "leave women with no recourse once they are pregnant"? Is Wikipedia really going to take a stand in favor of changing the laws? Let's come up with something more neutral for that!!! — Preceding unsigned comment added by 129.59.122.51 (talk) 16:14, 21 April 2016 (UTC)

 Done I agree. That sentence was impossible to support. I deleted it. --Lucianobello (talk) 15:55, 21 August 2016 (UTC)

The U.S. caught the hot potato

Officials report more Zika viruses confirmed in the U.S., and thousands more undetected. 2605:6001:E484:1000:1C77:AF4A:761B:D56A (talk) 05:39, 19 August 2016 (UTC)

 Done Updated. --Lucianobello (talk) 16:42, 21 August 2016 (UTC)

Requested move 1 September 2016

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: not moved. (non-admin closure) Regards, Krishna Chaitanya Velaga (talk • mail) 13:52, 7 September 2016 (UTC)

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2015–16 Zika virus epidemic → 2015–16 Zika virus pandemic – Now that it has reached Singapore it is not confined to a single region anymore. Shhhhwwww!! (talk) 07:53, 1 September 2016 (UTC)

It's a pandemic when reliable sources call it a pandemic - is that the consensus among reliable sources now? If so, please point to those sources. In addition, "epidemic" is not incorrect when referring to a pandemic, since the latter is a subset of the former - so this is not a major priority. — soupvector (talk) 04:17, 2 September 2016 (UTC)

• Oppose. I cannot find any reliable sources calling it a pandemic. soupvector, I think you have it backwards. "Epidemic" is a subset of "pandemic". — Gorthian (talk) 00:38, 4 September 2016 (UTC)

  Perhaps you should review these terms. Let's do it like an exam question: epidemic is to pandemic as rectangle is to square. All pandemic are epidemics, whereas only the most extensive epidemics are pandemics; thus, pandemics are a subset of epidemics. — soupvector (talk) 03:48, 4 September 2016 (UTC)

• Oppose. While there are reliable sources that have been calling it a pandemic, the article doesn't yet include any citations for that change. See: May 23rd, Jan. 28th, March 1, Jan. 13. --Light show (talk) 01:55, 4 September 2016 (UTC)

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Clarification of "death" in table section

Is death is only specifically for those who died because of Zika fever? How about if the infected person died because of other illness that worsens his/her condition like in this case? Should this be include on the list? Molecule Extraction (talk) 17:26, 14 September 2016 (UTC)

For adults, Zika itself is not usually fatal. Most of the deaths have been because of Guillain–Barré syndrome triggered by Zika. One or two others have been because of other nervous-system disorders thought to be triggered by the virus. (IIRC, the first man who died in Puerto Rico was one of those.) edited to add: No, he had a rare autoimmune reaction seemingly triggered by the Zika. Its similarity to GBS was in its being an autoimmune response. — Gorthian (talk) 20:06, 14 September 2016 (UTC)

I have been trying to stick to what reliable sources report; for the table in this article, reliable sources have been mostly PAHO, CDC, ECDC, and various government health departments. For a while, I added deaths reported by reliable media (such as [14] and [15]) but, after months went by and they were not reported by the health agencies, I stopped including them. The health agencies themselves obviously struggle with which cases to include, and have gone a mostly conservative route, in which they seem to report only deaths with a confirmed previous Zika infection.

In the case you linked to above (which happened about 10 days ago), they were clear in the article that he did not die because of Zika, but because of his underlying heart condition. I look at it this way: it most likely didn't matter that the infection he got was Zika; probably any infectious disease would have put enough stress on his system for his heart to fail. It could have been a cold or the flu. So, no, cases like that aren't included here. — Gorthian (talk) 19:41, 14 September 2016 (UTC)

Thanks for the clarification, now I understand. At first, I thought most of the adult fatal cases are caused by the fever (like in the case of dengue fever). I agree with you, some of the links seems not been updated yet for any cases in September. So, I think I will stick to every countries news site (for example for me in the Southeast Asian region) as they keep a record for every cases that happens in their countries too. :) Molecule Extraction (talk) 09:57, 15 September 2016 (UTC)

Laos

@Molecule Extraction: I reverted your edit removing Laos from the autochthonous-cases table because there was a report in March from WHO of at least one case there. The table reports cumulative totals from approximately April 2015 on, so unless the original source corrects a number, the numbers can only grow or stay the same. In this case, an exact number was not reported, so the fields were left blank. Right now, WHO classifies Laos as "Category 3: Countries with evidence of local mosquito-borne Zika infections in or before 2015, but without documentation of cases in 2016, or outbreak terminated". Since they had reported cases in Laos in March 2016, I would assume that the small outbreak has terminated. I know your source says differently, but the WHO is a more reliable sources for our purposes here. I will do a more thorough search for any statements WHO has made about Laos to see if this can be clarified. — Gorthian (talk) 16:45, 1 October 2016 (UTC)

@Gorthian: Thanks for notifying. Honestly, I feel a bit weird for the empty section because there is no numbers in any local and import cases. :) Molecule Extraction (talk) 01:13, 2 October 2016 (UTC)

@Molecule Extraction: I know, it bothers me, too. I found WHO's original statement about Laos, and an internal document from July that says "Lao People’s Democratic Republic has reported autochthonous transmission from blood samples collected from 2012 to 2015. Awaiting further confirmation of report date." That would mean that there have been no cases reported in 2016, but possibly in 2015. Then I found a brief outline in PROmed Mail about it (under the heading "Asia") that makes it clearer why no case counts are given: they were analyzing old samples taken for dengue, and it sounds as if they statistically combined the results. All of which makes me think that you were probably right, and Laos should be removed from the table. Though the CDC just put out a travel advisory for Laos, among other countries, Zika is known to be endemic there. Presumably there is a higher rate of immunity because of that, which may make an outbreak less likely. I think I'll self-revert my edit; we can put Laos back if there are reports of cases there. Thanks for making me look more closely at this! — Gorthian (talk) 01:40, 2 October 2016 (UTC)

References

Singapore strains not from the Americas

FYI: Seems the strains in Singapore are not from the Americas. They were strains existing since the spread from Africa in the 1960s. Zika cases in other parts of SE Asia occurred before 2015 (Thailand in 2012 for example), and probably microcephaly related births. Mostly unnoticed until the 2015/16 outbreak in the Americas. These reports are from September; I don't see where this has been added to the article. The same may be true for all the Asian occurrences of the disease, maybe even the Pacific. I don't know if the phylogenetic/strain studies have been done for Zika cases in Asia and other post-2015/16 outbreak occurrences yet, but should be researched. Seems to be mostly an assumption that these cases/small outbreaks came from the Americas outbreak, representing global spread from the Americas. JuanTamad (talk) 17:15, 7 December 2016 (UTC)

https://asiancorrespondent.com/2016/09/singapore-zika-virus-outbreak-not-imported-south-america/

http://www.channelnewsasia.com/news/singapore/zika-strain-in-singapore-similar-to-ones-in-se-asia-since-1960s/3110910.html

Case numbers

I believe that it is more important to show the actual number of active cases of Zika rather than just displaying the total number of Zika cases that have been confirmed since the epidemic started.

Some of the data doesn't not make sense. For example, the table shows that Martinique has only 12 confirmed cases of Zika, but has 36,680 suspected cases of Zika. Puerto Rico has 34,070 confirmed cases of Zika, but no suspected cases. If a case of Zika is suspected it can't remain this way indefinitely.

What travelers need to know is what is my risk of contracting Zika? If during the past 12 months 34,070 cases of Zika have been confirmed on the island of Puerto Rico, how many active cases of Zika does the island actually have.

Zika infection is not permanent and once the infection is cleared the person can no longer spread the disease.

Therefore, people need to know not only the total number of Zika cases over a given period, but more importantly the current total number of active Zika infections.

Kevshe (talk) 14:44, 22 December 2016 (UTC)

@Kevshe: Even the health authorities have trouble tracking the number of Zika cases in their areas; it's far beyond the purview of Wikipedia to do so. Travelers should not be coming to Wikipedia to find out the latest information: Wikipedia is not a newspaper. Every number in the table is referenced to a source that gives more details, often a health agency. The numbers are not consistent with one another because every agency or region has a different methodology for gathering information. The table is a best-effort compilation of what the sources say. — Gorthian (talk) 18:48, 22 December 2016 (UTC)

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