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Is Zika a substantial risk for visitors to the Rio de Janeiro Olympic Games?

2016; Elsevier BV; Volume: 388; Issue: 10039 Linguagem: Inglês

10.1016/s0140-6736(16)30842-x

1474-547X

Eduardo Massad, Francisco Antônio Bezerra Coutinho, Annelies Wilder‐Smith,

Travel-related health issues

On May 20, 2016, 150 physicians, bioethicists, and scientists from several countries (including Brazil) posted an open letter suggesting WHO Director-General Margaret Chan exert pressure on Olympics authorities to delay or relocate the Rio de Janeiro Games because of public health concerns over the risk of Zika virus infection for tourists and athletes. The same concern was raised in 2013 about the risk of dengue infection for tourists and athletes intending to travel to Brazil during the 2014 World Cup. At the time we estimated that the individual risk of dengue for visitors would vary from around 6 × 10−5 to around 4 × 10−4,1Massad E Wilder-Smith A Ximenes R et al.Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.Mem Inst Oswaldo Cruz. 2014; 109: 394-397Crossref PubMed Scopus (24) Google Scholar which represented an expected number of infections among tourists between three and 59 cases. The reported number of dengue cases among tourists after the Games was three.2Aguiar M Rocha F Pessanha JEM Mateus L Stollenwerk N Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons?.Sci Rep. 2015; 5: 8462Crossref PubMed Scopus (21) Google Scholar Here we provide a risk estimation for tourists and athletes intending to visit Rio de Janeiro during the summer Olympics in August. Aedes mosquitoes have a strong seasonal pattern with highest abundance in the summer months (from January to February in Rio de Janeiro) and lowest in the winter (from July to August), and Burattini and colleagues3Burattini MN Coutinho FA Lopez LF et al.Potential exposure to Zika virus for foreign tourists during the 2016 Carnival and Olympic Games in Rio de Janeiro, Brazil.Epidemiol Infect. 2016; 144: 1904-1906Crossref PubMed Scopus (25) Google Scholar estimated the individual risk of being bitten by an Aedes egypti mosquito in Rio de Janeiro during the 3 weeks of the Olympic Games at 3·5 × 10−2. The individual risk of dengue infection for tourists in the same period was estimated by Ximenes and colleagues4Ximenes R Amaku M Lopez LF et al.The risk of dengue for non-immune foreign visitors to the 2016 summer olympic games in Rio de Janeiro, Brazil.BMC Infect Dis. 2016; 16: 186Crossref PubMed Scopus (26) Google Scholar to be about 5 × 10−4. Although the actual numbers of Zika virus infection in Brazil are still unknown, it is estimated between 500 000 and 1·5 million cases of infection;5ECDCRapid risk assessment: Zika virus disease epidemic potential association with microcephaly and Guillain–Barré syndrome. European Centre for Disease Prevention and Control, Stockholm2016Google Scholar with these estimates, we calculated the risk of infection in August to be between 9 × 10−6 and 3 × 10−5.6Massad E Tan SH Khan K Wilder-Smith A Estimated Zika virus importations to Europe by travellers from Brazil.Glob Health Action. 2016; 9: 31669PubMed Google Scholar The risk of Zika virus infection is therefore more than 15 times less than that for dengue. Although the risk of Zika virus infection during the time of the Olympic Games is extremely low, we think that pregnant women should avoid visiting any region of the world where Zika virus circulation has been reported, including Rio de Janeiro, a recommendation in line with international and national public health guidelines.7WHOPregnancy management in the context of Zika virus infection. Interim guidance update.http://www.who.int/csr/resources/publications/zika/pregnancy-management/en/Date: May 13, 2016Google Scholar, 8Public Health EnglandZika virus: updated travel advice for pregnant women.https://www.gov.uk/government/news/zika-virus-updated-travel-advice-for-pregnant-womenGoogle Scholar For the open letter see https://www.washingtonpost.com/news/to-your-health/wp-content/uploads/sites/26/2016/05/Zika-Olympics-Open-Letter-to-WHO-current2.pdf?tid=a_inl%22open%20letter For the open letter see https://www.washingtonpost.com/news/to-your-health/wp-content/uploads/sites/26/2016/05/Zika-Olympics-Open-Letter-to-WHO-current2.pdf?tid=a_inl%22open%20letter We declare no competing interests.