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Zika virus infection and Commonwealth Games 2018 on the Gold Coast, Australia

  • Kazi Mizanur Rahman
    Correspondence
    Corresponding author. Public Health, School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
    Affiliations
    Public Health, School of Medicine, Griffith University, Gold Coast, Queensland, Australia
    Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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  • David Harley
    Affiliations
    Research School of Population Health & the Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, ACT, Australia
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  • David Plummer
    Affiliations
    Public Health, School of Medicine, Griffith University, Gold Coast, Queensland, Australia
    Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Published:December 26, 2016DOI:https://doi.org/10.1016/j.idh.2016.12.001

      Highlights

      • Commonwealth Games on the Gold Coast, Australia in 2018 (GC2018) will bring in visitors, athletes and officials from 71 countries.
      • Zika virus (ZIKV) infected visitors will likely be there and the local transmission of ZIKV during GC2018 will largely depend on the future growth of Aedes mosquito population in the area.
      • Control of Aedes mosquito population, and early detection and containment of any imported cases will be essential for the prevention of local transmission of Zika during GC2018.

      Keywords

      The ongoing outbreak of Zika virus (ZIKV) in Brazil followed introduction of the virus after international mass gatherings including the FIFA Soccer World Cup and an international canoe race, in 2014 [
      • Gautret P.
      • Simon F.
      Dengue, chikungunya and Zika and mass gatherings: what happened in Brazil, 2014.
      ]. However, phylogenetic analysis demonstrates that ZIKV circulated in Brazil from 2013 resulting from a single introduction [
      • Faria N.R.
      • Azevedo Rdo S.
      • Kraemer M.U.
      • Souza R.
      • Cunha M.S.
      • Hill S.C.
      • et al.
      Zika virus in the Americas: early epidemiological and genetic findings.
      ]. The Rio Olympics have been held and the world is waiting to see what impact this may have on the global spread of Zika. Risk assessments had given inconsistent predictions [
      • Attaran A.
      Zika virus and the 2016 Olympic Games.
      ,
      • Lewnard J.A.
      • Gonsalves G.
      • Ko A.I.
      Low risk for International Zika virus spread due to the 2016 Olympics in Brazil.
      ]. In April 2018, the 21st Commonwealth Games will be held on the Gold Coast in Queensland, Australia (Gold Coast 2018 or GC2018) [
      ]. Among the potential health risks associated with the games is ZIKV. We discuss the likelihood of local ZIKV transmission in connection with GC2018 [
      • Department of Health D
      Appendix 7-examples of risk matrices.
      ].
      Zika, a Flavivirus, is primarily transmitted by female Aedes mosquitoes among humans resulting in short-lived (2–7 days), self-limiting illnesses with symptoms including fever, rash, joint pain, muscle pain, headache, and conjunctivitis [
      • Hayes E.B.
      Zika virus outside Africa.
      ,
      • CDC
      Zika virus: symptoms, testing, & treatment.
      ,
      • Simpson D.I.
      Zika virus infection in man.
      ,
      • PHE
      Health protection – guidance: Zika virus.
      ]. It may also be sexually transmitted [
      • Deckard D.T.
      • Chung W.M.
      • Brooks J.T.
      • Smith J.C.
      • Woldai S.
      • Hennessey M.
      • et al.
      Male-to-male sexual transmission of Zika virus – Texas, January 2016.
      ,
      • Venturi G.
      • Zammarchi L.
      • Fortuna C.
      • Remoli M.E.
      • Benedetti E.
      • Fiorentini C.
      • et al.
      An autochthonous case of Zika due to possible sexual transmission, Florence, Italy, 2014.
      ], although importance for transmission is unclear. Most remain asymptomatic [
      • CDC
      Zika virus: symptoms, testing, & treatment.
      ,
      • PHE
      Health protection – guidance: Zika virus.
      ]. However, ZIKV may also cause more serious outcomes, Guillain–Barré syndrome and congenital Zika virus syndrome [
      • Franca G.V.
      • Schuler-Faccini L.
      • Oliveira W.K.
      • Henriques C.M.
      • Carmo E.H.
      • Pedi V.D.
      • et al.
      Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation.
      ,
      • Oehler E.
      • Watrin L.
      • Larre P.
      • Leparc-Goffart I.
      • Lastere S.
      • Valour F.
      • et al.
      Zika virus infection complicated by Guillain-Barre syndrome—case report, French Polynesia, December 2013.
      ]. In February 2016, World Health Organization (WHO) declared a global public health emergency of international concern after an association was suggested between ZIKV infection during pregnancy and microcephaly [
      • Franca G.V.
      • Schuler-Faccini L.
      • Oliveira W.K.
      • Henriques C.M.
      • Carmo E.H.
      • Pedi V.D.
      • et al.
      Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation.
      ,
      • Schuler-Faccini L.
      • Ribeiro E.M.
      • Feitosa I.M.
      • Horovitz D.D.
      • Cavalcanti D.P.
      • Pessoa A.
      • et al.
      Possible association between Zika virus infection and microcephaly – Brazil, 2015.
      ,
      • Cauchemez S.
      • Besnard M.
      • Bompard P.
      • Dub T.
      • Guillemette-Artur P.
      • Eyrolle-Guignot D.
      • et al.
      Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study.
      ,
      • Martines R.B.
      • Bhatnagar J.
      • de Oliveira Ramos A.M.
      • Davi H.P.
      • Iglezias S.D.
      • Kanamura C.T.
      • et al.
      Pathology of congenital Zika syndrome in Brazil: a case series.
      ,
      • Rasmussen S.A.
      • Jamieson D.J.
      • Honein M.A.
      • Petersen L.R.
      Zika virus and birth defects—reviewing the evidence for causality.
      ,
      • WHO
      WHO Director-General summarizes the outcome of the Emergency Committee regarding clusters of microcephaly and Guillain-Barré syndrome.
      ]. Although this declaration has recently been withdrawn, the global threat of Zika virus infection and its consequences still remain [

      WHO. Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus. Available from: http://www.who.int/mediacentre/news/statements/2016/zika-fifth-ec/en/.

      ]. As of 30 November 2016, seventy-five countries and territories have reported local transmission of ZIKV since 2007, including 69 countries from 2015 onwards []. Twenty-eight countries or territories reported microcephaly or other central nervous system malformations that can possibly be related to ZIKV infections including Brazil alone reporting more than 2000 cases.
      Zika has not been transmitted in Australia []. During 2016 to 02 December, 55 confirmed ZIKV cases have been reported in Australia, around half from Queensland. Infections were acquired from 21 countries with Pacific island nations contributing a substantial proportion. Fifty three countries are members of the Commonwealth [], and approximately 6500 athletes and officials from 71 countries are expected to travel to the Gold Coast to attend the Games [
      ]. There will be 690,000 visitors and 1.5 million people attending the ticketed events []. ZIKV transmissions have so far occurred in several Commonwealth countries including a few from the Caribbean and Americas, South Africa from Africa, Bangladesh and Maldives from South Asia, a few countries from South-East Asia, and island nations of the Pacific [
      • CDC
      All countries and territories with active Zika virus transmission: as of 11 August, 2016.
      ,
      • WHO
      Countries, territories and areas showing the distribution of Zika virus.
      ]. There is, therefore, a considerable likelihood some will arrive viraemic with ZIKV. The ZIKV remains in the blood on an average for 10 days, in urine for 12 days or more, and in semen for over 60 days [
      • Lessler J.
      • Chaisson L.H.
      • Kucirka L.M.
      • Bi Q.
      • Grantz K.
      • Salje H.
      • et al.
      Assessing the global threat from Zika virus.
      ].
      The primary vector of the virus, Aedes mosquito, is currently present in Australia. Aedes aegypti is common in the Northern and Fart North coastal areas of Queensland [
      • Kearney M.
      • Porter W.P.
      • Williams C.
      • Ritchie S.
      • Hoffmann A.A.
      Integrating biophysical models and evolutionary theory to predict climatic impacts on species' ranges: the dengue mosquito Aedes aegypti in Australia.
      ,
      • Webb C.
      • Doggett S.
      • Russell R.
      A guide to mosquitoes of Australia.
      ]. It also occurred in South East Queensland in the past [
      • Kearney M.
      • Porter W.P.
      • Williams C.
      • Ritchie S.
      • Hoffmann A.A.
      Integrating biophysical models and evolutionary theory to predict climatic impacts on species' ranges: the dengue mosquito Aedes aegypti in Australia.
      ,

      City of Gold Coast: mosquitoes fact sheet. Available from: http://www.goldcoast.qld.gov.au/documents/bf/Mosquitoes_fact_sheet.pdf.

      ]. Larval surveys of container habitats are the traditional methods of identifying the abundance of this vector in its immature forms [
      • Focks D.A.
      A review of entomological sampling methods and indicators for dengue vectors.
      ]. But surveillance of adult mosquitoes using traps and aspirators provide more direct evidence on the disease transmission risk. The risk of occurrence of locally acquired dengue cases is increased in the country during April, following the summer wet season [
      • Viennet E.
      • Ritchie S.A.
      • Faddy H.M.
      • Williams C.R.
      • Harley D.
      Epidemiology of dengue in a high-income country: a case study in Queensland, Australia.
      ]. By analogy with dengue, the risk of vector transmission of ZIKV is likely to be increased around April when GC2018 will take place.
      The likelihood of local transmission of ZIKV on the Gold Coast will largely depend on the future growth of Aedes mosquito population in the area and whether it goes over the transmission threshold [
      • Focks D.A.
      • Brenner R.J.
      • Hayes J.
      • Daniels E.
      Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts.
      ]. Sexual transmission can also play a significant role in disease transmission, especially in the absence of sufficient vector density. Internal travel by attendees might trigger an epidemic in Northern and Far North Queensland. Thus control of Aedes mosquito population by targeting them directly or indirectly [
      • Bowman L.R.
      • Donegan S.
      • McCall P.J.
      Is dengue vector control deficient in effectiveness or evidence?: Systematic review and meta-analysis.
      ], effective use of condom in preventing sexual transmission, and early detection and containment of any imported cases will be essential for the prevention of local transmission of Zika during Commonwealth Games 2018.

      Authorship statement

      Kazi Rahman conceived the idea and prepared the first draft. David Harley and David Plummer reviewed the draft, and made edits and comments. Kazi Rahman finalized the writing for submission.

      Conflict of interest

      The authors declare no conflict of interest in relation to this work.

      Funding

      This work received funding from Griffith University School of Medicine, Gold Coast, Queensland, Australia through the start-up research funding (MED1009) mechanism for Kazi Rahman.

      Provenance and peer review

      Not commissioned; externally peer reviewed.

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