Zika virus infection in the Veterans Health Administration (VHA), 2015-2016

BackgroundZika virus (ZIKV) is an important flavivirus infection. Although ZIKV infection is rarely fatal, risk for severe disease in adults is not well described. Our objective was to describe the spectrum of illness in U.S. Veterans with ZIKV infection.MethodologyCase series study including patients with laboratory-confirmed or presumed positive ZIKV infection in all Veterans Health Administration (VHA) medical centers. Adjusted odds ratios of clinical variables associated with hospitalization and neurologic complications was performed.Principal findingsOf 1,538 patients tested between 12/2015-10/2016 and observed through 3/2017, 736 (48%) were RT-PCR or confirmed IgM positive; 655 (89%) were male, and 683 (93%) from VA Caribbean Healthcare System (VACHCS). Ninety-four (13%) were hospitalized, 91 (12%) in the VACHCS. Nineteen (3%) died after ZIKV infection. Hospitalization was associated with increased Charlson co-morbidity index (adjusted odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1–1.3), underlying connective tissue disease (OR, 29.5; CI, 3.6–244.7), congestive heart failure (OR, 6; CI, 2–18.5), dementia (OR, 3.6; CI, 1.1–11.2), neurologic symptom presentation (OR, 3.9; CI, 1.7–9.2), leukocytosis (OR, 11.8; CI, 4.5–31), thrombocytopenia (OR, 7.8; CI, 3.3–18.6), acute kidney injury (OR, 28.9; CI, 5.8–145.1), or using glucocorticoids within 30 days of testing (OR, 13.3; CI 1.3–133). Patients presenting with rash were less likely to be hospitalized (OR, 0.29; CI, 0.13–0.66). Risk for neurologic complications increased with hospitalization (OR, 5.9; CI 2.9–12.2), cerebrovascular disease (OR 4.9; CI 1.7–14.4), and dementia (OR 2.8; CI 1.2–6.6).ConclusionOlder Veterans with multiple comorbidities or presenting with neurologic symptoms were at increased risk for hospitalization and neurological complications after ZIKV infection.背景：寨卡病毒（Zika virus, ZIKV）是一种重要的黄病毒感染性疾病。尽管寨卡病毒感染极少致命，但成人重症疾病的风险尚未得到充分阐明。本研究旨在描述美国退伍军人感染寨卡病毒后的疾病谱特征。 方法学：本研究为病例系列研究，纳入美国退伍军人事务部（Veterans Health Administration, VHA）所有医学中心内经实验室确诊或疑似寨卡病毒检测阳性的患者。针对与住院治疗及神经系统并发症相关的临床变量，我们开展了校正比值比分析。 主要研究结果：在2015年12月至2016年10月期间接受检测、并随访至2017年3月的1538例患者中，736例（48%）经逆转录聚合酶链式反应（RT-PCR）或免疫球蛋白M（IgM）检测确诊为寨卡病毒感染；其中655例（89%）为男性，683例（93%）来自退伍军人加勒比医疗系统（VA Caribbean Healthcare System, VACHCS）。94例（13%）患者住院治疗，其中91例（12%）来自该医疗系统。19例（3%）患者在感染寨卡病毒后死亡。 住院治疗与更高的查尔森合并症指数（校正比值比[OR] 1.2；95%置信区间[CI] 1.1~1.3）、基础性结缔组织病（OR 29.5；CI 3.6~244.7）、充血性心力衰竭（OR 6；CI 2~18.5）、痴呆（OR 3.6；CI 1.1~11.2）、以神经系统症状起病（OR 3.9；CI 1.7~9.2）、白细胞增多症（OR 11.8；CI 4.5~31）、血小板减少症（OR 7.8；CI 3.3~18.6）、急性肾损伤（OR 28.9；CI 5.8~145.1），以及检测前30天内使用糖皮质激素（OR 13.3；CI 1.3~133）显著相关。而以皮疹为首发症状的患者住院风险更低（OR 0.29；CI 0.13~0.66）。 神经系统并发症的发生风险与住院治疗（OR 5.9；CI 2.9~12.2）、脑血管疾病（OR 4.9；CI 1.7~14.4）及痴呆（OR 2.8；CI 1.2~6.6）呈正相关。 结论：合并多种基础疾病或起病时表现为神经系统症状的老年退伍军人，在感染寨卡病毒后出现住院治疗需求及神经系统并发症的风险显著升高。