Volume 100, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Zika virus (ZIKV) had emerged as a global arboviral concern since late 2015. In this study, we describe the results of ZIKV testing in returning Israeli travelers from Zika-endemic countries. We conducted a nation-wide prospective observational study, including all ZIKV tests during January 2016–June 2017. Zika virus infection was defined as confirmed, if diagnosed by polymerase chain reaction (PCR) or serology confirmed by neutralization, and as possible if diagnosed by serology alone. During the study period, 1,188 travelers were tested: 66.7%, 30.5%, 1.6%, and 1.2% had returned from the Americas, Asia, Africa, and Oceania, respectively. Thirty persons were diagnosed with ZIKV. Most travelers tested were women of reproductive age; the gender ratio among infected travelers however was 1.0. During 2016, 19/20 (95%) ZIKV cases were acquired in the Americas; in 2017, however, 6/10 (60%) cases were acquired in Asia. Of 248 symptomatic travelers, 28 (11.3%) were diagnosed with ZIKV infection, whereas only 2/940 (0.2%) of asymptomatic travelers were diagnosed with ZIKV infection Odds ratio = 59.7 (95% confidence interval: 14.1–252.5, < 0.0001). Our findings suggest that although women are more likely to be referred for ZIKV testing, gender does not affect the likelihood of ZIKV infection and that asymptomatic ZIKV infection appears to be rare in travelers. Furthermore, it appears that in 2017, Southeast Asia emerges as the leading source of travel-related ZIKV infection.


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  1. WHO. Zika Virus, Microcephaly and Guillain-Barré Syndrome Situation Report 20 January 2017. Available at: http://apps.who.int/iris/bitstream/10665/253604/1/zikasitrep20Jan17-eng.pdf?ua=1. Accessed January 28, 2017.
  2. PAHO, 2017. Zika Cumulative Cases. Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=12390&Itemid=42090&lang=en. Accessed January 28, 2017.
  3. Foy BD, Kobylinski KC, Chilson Foy JL, Blitvich BJ, Travassos da Rosa A, Haddow AD, Lanciotti RS, Tesh RB, , 2011. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 17: 880882. [Google Scholar]
  4. Meltzer E, 2016. Zika virus disease in traveler returning from Vietnam to Israel. Emerg Infect Dis 22: 15211522. [Google Scholar]
  5. Lanciotti RS, Kosoy OL, Laven JJ, Velez JO, Lambert AJ, Johnson AJ, Stanfield SM, Duffy MR, , 2008. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 14: 12321529. [Google Scholar]
  6. Abbasi I, Cunio R, Warburg A, , 2009. Identification of blood meals imbibed by Phlebotomine sand flies using cytochrome b PCR and reverse line blotting. Vector Borne Zoonotic Dis 9: 7986. [Google Scholar]
  7. Lustig Y, Mendelson E, Paran N, Melamed S, Schwartz E, , 2016. Detection of Zika virus RNA in whole blood of imported Zika virus disease cases up to 2 months after symptom onset, Israel, December 2015 to April 2016. Euro Surveill 21: pii=30269. [Google Scholar]
  8. Huzly D, Hanselmann I, Schmidt-Chanasit J, Panning M, , 2016. High specificity of a novel Zika virus ELISA in European patients after exposure to different flaviviruses. Euro Surveill 21: pii=30203. [Google Scholar]
  9. Steinhagen K, 2016. Serodiagnosis of Zika virus (ZIKV) infections by a novel NS1-based ELISA devoid of cross-reactivity with dengue virus antibodies: a multicohort study of assay performance, 2015 to 2016. Euro Surveill 21: pii=30426. [Google Scholar]
  10. Lustig Y, Zelena H, Venturi G, Van Esbroeck M, Rothe C, Perret C, Koren R, Katz-Likvornik S, Mendelson E, Schwartz E, , 2017. Sensitivity and kinetics of an NS1-based Zika virus enzyme-linked immunosorbent assay in Zika virus-infected travelers from Israel, the Czech Republic, Italy, Belgium, Germany, and Chile. J Clin Microbiol 55: 18941901. [Google Scholar]
  11. Ynetnews, 2018. Major Increase in Israeli Tourism to Thailand (Hebrew). Available at: https://www.ynet.co.il/articles/0, 7340,L-4999047,00.html. Accessed March 11, 2018.
  12. @globesnews, 2018. 161,000 Israelis Entered Thailand in 2016 (Hebrew). Available at: https://www.globes.co.il/news/article.aspx?fbdid=1001172287. Accessed March 11, 2018.
  13. Meltzer E, Leshem E, Lustig Y, Gottesman G, Schwartz E, , 2016. The clinical spectrum of Zika virus in returning travelers. Am J Med 129: 11261130. [Google Scholar]
  14. Adams L, , 2016. Update: ongoing Zika virus transmission—Puerto Rico, November 1, 2015–July 7, 2016. MMWR Morb Mortal Wkly Rep 65: 774779. [Google Scholar]
  15. Ellison DW, 2016. Complete genome sequences of Zika virus strains isolated from the blood of patients in Thailand in 2014 and the Philippines in 2012. Genome Announc 4: e00359-16. [Google Scholar]
  16. Chu DT, Ngoc VTN, Tao Y, , 2017. Zika virus infection in Vietnam: current epidemic, strain origin, spreading risk, and perspective. Eur J Clin Microbiol Infect Dis 36: 20412042. [Google Scholar]
  17. Escutia G, McDonald E, Rodriguez-Lainz A, Healy J, , 2018. Demographic and travel characteristics of travel-associated Zika virus infection case-patients in san Diego county, California (January 1, 2016–March 31, 2017). J Community Health 43: 566569. [Google Scholar]
  18. Duffy MR, 2009. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 360: 25362543. [Google Scholar]
  19. Lozier M, 2016. Incidence of Zika virus disease by age and sex–Puerto Rico, November 1, 2015–October 20, 2016. MMWR Morb Mortal Wkly Rep 65: 12191223. [Google Scholar]
  20. Carteaux G, 2016. Zika virus associated with meningoencephalitis. N Engl J Med 374: 15951596. [Google Scholar]
  21. Beattie J, 2018. Zika virus–associated Guillain-Barré syndrome in a returning US traveler. Infect Dis Clin Prac 2018 Jul 26 (Epub ahead of print).
  22. Meaney-Delman D, , 2016. Zika virus infection among US pregnant travelers—August 2015–February 2016. MMWR Morb Mortal Wkly Rep 65: 211214. [Google Scholar]
  23. Meltzer E, Heyman Z, Bin H, Schwartz E, , 2012. Capillary leakage in travelers with dengue infection: implications for pathogenesis. Am J Trop Med Hyg 86: 536539. [Google Scholar]
  24. Ratnam I, Leder K, Black J, Torresi J, , 2013. Dengue fever and international travel. J Travel Med 20: 384393. [Google Scholar]
  25. Haby MM, Pinart M, Elias V, Reveiz L, , 2018. Prevalence of asymptomatic Zika virus infection: a systematic review. Bull World Health Organ 96: 402413D. [Google Scholar]
  26. Freour T, Mirallie S, Hubert B, Splingart C, Barriere P, Maquart M, Leparc-Goffart I, , 2016. Sexual transmission of Zika virus in an entirely asymptomatic couple returning from a Zika epidemic area, France, April 2016. Euro Surveill 21: pii=30254. [Google Scholar]
  27. Septfons A, 2016. Travel-associated and autochthonous Zika virus infection in mainland France, 1 January to 15 July 2016. Euro Surveill 21: pii=30285. [Google Scholar]
  28. Bogoch II 2016. Anticipating the international spread of Zika virus from Brazil. Lancet 387: 335336. [Google Scholar]
  29. Gallian P, Cabié A, Richard P, Paturel L, Charrel RN, Pastorino B, Leparc-Goffart I, Tiberghien P, de Lamballerie X, , 2017. Zika virus in asymptomatic blood donors in Martinique. Blood 129: 263266. [Google Scholar]
  30. Leshem E, Bin H, Shalom U, Perkin M, Schwartz E, , 2012. Risk for emergence of dengue and chikungunya virus in Israel. Emerg Infect Dis 18: 345. [Google Scholar]
  31. Venturi G, 2017. Detection of a chikungunya outbreak in central Italy, August to September 2017. Euro Surveill 22: pii=17-00646. [Google Scholar]
  32. Angelini R, 2007. An outbreak of chikungunya fever in the province of Ravenna, Italy. Euro Surveill 12: E070906.1. [Google Scholar]

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  • Received : 03 May 2018
  • Accepted : 27 Aug 2018
  • Published online : 12 Nov 2018

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