In October 2013, there was an outbreak of

Zika fever Zika fever, also known as Zika virus disease or simply Zika, is an infectious disease caused by the Zika virus. Most cases have no symptoms, but when present they are usually mild and can resemble dengue fever. Symptoms may include fever, conju ...

French Polynesia French Polynesia ( ; ; ) is an overseas collectivity of France and its sole #Governance, overseas country. It comprises 121 geographically dispersed islands and atolls stretching over more than in the Pacific Ocean, South Pacific Ocean. The t ...

, the first outbreak of several Zika outbreaks across

Oceania Oceania ( , ) is a region, geographical region including Australasia, Melanesia, Micronesia, and Polynesia. Outside of the English-speaking world, Oceania is generally considered a continent, while Mainland Australia is regarded as its co ...

. With 8,723 cases reported, it was the largest outbreak of Zika fever before the outbreak in the Americas that began in April 2015. An earlier outbreak occurred on Yap Island in the

Federated States of Micronesia The Federated States of Micronesia (, abbreviated FSM), or simply Micronesia, is an island country in Micronesia, a region of Oceania. The federation encompasses the majority of the Caroline Islands (excluding Palau) and consists of four Admin ...

in 2007, but it is thought that the 2013–2014 outbreak involved an independent introduction of the Zika virus from

Southeast Asia Southeast Asia is the geographical United Nations geoscheme for Asia#South-eastern Asia, southeastern region of Asia, consisting of the regions that are situated south of China, east of the Indian subcontinent, and northwest of the Mainland Au ...

. Investigators suggested that the outbreaks of mosquito-borne diseases in the

Pacific The Pacific Ocean is the largest and deepest of Earth's five oceanic divisions. It extends from the Arctic Ocean in the north to the Southern Ocean, or, depending on the definition, to Antarctica in the south, and is bounded by the cont ...

from 2012 to 2014 were "the early stages of a wave that will continue for several years", particularly because of their vulnerability to

infectious diseases infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

stemming from isolation and immunologically naive populations.

Epidemiology

French Polynesia

The first Zika outbreak started in French Polynesia in October 2013, with cases reported in the

Society A society () is a group of individuals involved in persistent social interaction or a large social group sharing the same spatial or social territory, typically subject to the same political authority and dominant cultural expectations. ...

Marquesas The Marquesas Islands ( ; or ' or ' ; Marquesan: ' ( North Marquesan) and ' ( South Marquesan), both meaning "the land of men") are a group of volcanic islands in French Polynesia, an overseas collectivity of France in the southern Pacific ...

and

Tuamotu Islands The Tuamotu Archipelago or the Tuamotu Islands (, officially ) are a French Polynesian chain of just under 80 islands and atolls in the southern Pacific Ocean. They constitute the largest chain of atolls in the world, extending (from northwest to ...

Tahiti Tahiti (; Tahitian language, Tahitian , ; ) is the largest island of the Windward Islands (Society Islands), Windward group of the Society Islands in French Polynesia, an overseas collectivity of France. It is located in the central part of t ...

, Mo'orea, Raiatea, Tahaa,

Bora Bora Bora Bora (French language, French: ''Bora-Bora''; Tahitian language, Tahitian: ''Pora Pora'') is an island group in the Leeward Islands (Society Islands), Leeward Islands in the Pacific Ocean, South Pacific. The Leeward Islands comprise the we ...

Nuku Hiva Nuku Hiva (sometimes spelled Nukahiva or Nukuhiva) is the largest of the Marquesas Islands in French Polynesia, an overseas country of France in the Pacific Ocean. It was formerly also known as ''Île Marchand'' and ''Madison Island''. Herman M ...

and Arutua. The outbreak ran concurrently with an outbreak of

dengue fever Dengue fever is a mosquito-borne disease caused by dengue virus, prevalent in tropical and subtropical areas. Asymptomatic infections are uncommon, mild cases happen frequently; if symptoms appear, they typically begin 3 to 14 days after i ...

. In December 2013, an American traveler to Mo'orea was diagnosed with Zika virus infection in

New York New York most commonly refers to: * New York (state), a state in the northeastern United States * New York City, the most populous city in the United States, located in the state of New York New York may also refer to: Places United Kingdom * ...

after an 11-day history of symptoms, becoming the first American tourist to be diagnosed with Zika. A Japanese tourist returning to

Japan Japan is an island country in East Asia. Located in the Pacific Ocean off the northeast coast of the Asia, Asian mainland, it is bordered on the west by the Sea of Japan and extends from the Sea of Okhotsk in the north to the East China Sea ...

was also diagnosed with Zika virus infection by the National Institute of Infectious Diseases after visiting Bora Bora, becoming the first imported case of Zika fever in Japan. By February 2014, it was estimated that more than 29,000 people with Zika-like symptoms had sought medical care, roughly 11.5% of the population, with 8,503 suspected cases. Of 746 samples tested at the in Tahiti by 7 February, 396 (53.1%) were confirmed as containing the Zika virus by

RT-PCR Reverse transcription polymerase chain reaction (RT-PCR) is a laboratory technique combining reverse transcription of RNA into DNA (in this context called complementary DNA or cDNA) and amplification of specific DNA targets using polymerase chain ...

. Two further cases of Zika virus infection were imported into Japan, and on 25 February, the Norwegian Institute of Public Health reported that a traveler returning to

Norway Norway, officially the Kingdom of Norway, is a Nordic countries, Nordic country located on the Scandinavian Peninsula in Northern Europe. The remote Arctic island of Jan Mayen and the archipelago of Svalbard also form part of the Kingdom of ...

from Tahiti was confirmed to have a Zika virus infection. By March 2014, the outbreak was declining in the majority of the islands, and by October the outbreak had abated. A total of 8,723 suspected cases of Zika virus infection were reported, as well as more than 30,000 estimated clinical visits and medical consultations due to concerns about Zika. The true number of Zika cases was estimated at more than 30,000.

New Caledonia

Zika spread westwards from French Polynesia to

New Caledonia New Caledonia ( ; ) is a group of islands in the southwest Pacific Ocean, southwest of Vanuatu and east of Australia. Located from Metropolitan France, it forms a Overseas France#Sui generis collectivity, ''sui generis'' collectivity of t ...

, where imported cases from French Polynesia were reported from November 2013 onwards. The first indigenous case was confirmed in January 2014 by the

Pasteur Institute The Pasteur Institute (, ) is a French non-profit private foundation dedicated to the study of biology, micro-organisms, diseases, and vaccines. It is named after Louis Pasteur, who invented pasteurization and vaccines for anthrax and rabies. Th ...

. On 10 February, there were 64 reported cases of Zika in the communities of Greater

Nouméa Nouméa () is the capital and largest city of the French Sui generis collectivity, special collectivity of New Caledonia and is also the largest Francophone city in Oceania. It is situated on a peninsula in the south of New Caledonia's main i ...

, Dumbéa, and

Ouvéa Ouvéa () or Uvea is a commune in the Loyalty Islands Province of New Caledonia, an overseas territory of France in the Pacific Ocean. The settlement of Fayaoué , on Ouvéa Island, is the administrative centre of the commune. Geography Ouv ...

, of which 30 were imported from French Polynesia. By 26 February 2014, there were 140 confirmed cases of Zika in New Caledonia, including 32 imported cases. The outbreak peaked in April, and by 17 September, the number of confirmed cases had gone up to 1,400, of which 35 were imported. During the same time period, there were also outbreaks of chikungunya fever and dengue fever.

Cook Islands

In February 2014, an outbreak of Zika was reported in the

Cook Islands The Cook Islands is an island country in Polynesia, part of Oceania in the South Pacific Ocean. It consists of 15 islands whose total land area is approximately . The Cook Islands' Exclusive Economic Zone (EEZ) covers of ocean. Avarua is its ...

, to the southwest of French Polynesia. In March, an

Australian Australian(s) may refer to: Australia * Australia, a country * Australians, citizens of the Commonwealth of Australia ** European Australians ** Anglo-Celtic Australians, Australians descended principally from British colonists ** Aboriginal Aus ...

woman was diagnosed with a Zika virus infection by

Queensland Health Queensland Health is the public health system in Queensland, Australia, comprising sixteen statutory Hospital and Health Services (HHS), the Department of Health and Queensland Ambulance Service. Each HHS provides health services to its local ...

following a recent trip to the Cook Islands, becoming the second reported case of Zika diagnosed in

Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...

. Nearly 40 other cases of Zika virus infection were imported into

New Zealand New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...

. By 29 May, the outbreak had ended, with 50 confirmed and 932 suspected cases of Zika virus infection.

Easter Island

By March 2014, there were one confirmed and 40 suspected cases of Zika virus infection on

Easter Island Easter Island (, ; , ) is an island and special territory of Chile in the southeastern Pacific Ocean, at the southeasternmost point of the Polynesian Triangle in Oceania. The island is renowned for its nearly 1,000 extant monumental statues, ...

. The Zika virus was suspected to have been carried to the island by a tourist from French Polynesia during the annual Tapati festival, held between January and February.

Chile Chile, officially the Republic of Chile, is a country in western South America. It is the southernmost country in the world and the closest to Antarctica, stretching along a narrow strip of land between the Andes, Andes Mountains and the Paci ...

an health authorities decided against issuing a health alert, saying that the outbreak had been contained and was under control, and advised travelers to take precautions against mosquito bites. By the end of the year, 173 cases of Zika had been reported, but all of the cases were described as "mild". On 24 September 2014, a Belgian woman flying to Easter Island from Tahiti was diagnosed with Zika virus infection after having previously received

ambulatory care Ambulatory care or outpatient care is Health care, medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technolog ...

in Tahiti, and was taken to Hanga Roa Hospital for evaluation.

LAN Airlines LATAM Airlines Chile, formerly known as LAN Chile and LAN Airlines, is a Chilean multinational airline based in Santiago and one of the founding companies of the LATAM Airlines Group, the largest airline holding company in Latin America. Its m ...

undertook operations to ensure other people on the woman's flight were not infected, and local health authorities stated that Zika was not a risk for people on the island.

Transmission

Zika is a

mosquito-borne disease Mosquito-borne diseases or mosquito-borne illnesses are diseases caused by bacteria, viruses or parasites transmitted by mosquitoes. Nearly 700 million people contract mosquito-borne illnesses each year, resulting in more than a million death ...

. Four aedine species of

mosquito Mosquitoes, the Culicidae, are a Family (biology), family of small Diptera, flies consisting of 3,600 species. The word ''mosquito'' (formed by ''Musca (fly), mosca'' and diminutive ''-ito'') is Spanish and Portuguese for ''little fly''. Mos ...

are found in the

, including ''

Aedes aegypti ''Aedes aegypti'' ( or from Greek 'hateful' and from Latin, meaning 'of Egypt'), sometimes called the Egyptian mosquito, dengue mosquito or yellow fever mosquito, is a mosquito that spreads diseases like dengue fever, yellow fever, malar ...

'', widespread across the South Pacific, and ''

Aedes polynesiensis ''Aedes polynesiensis'', the Polynesian tiger mosquito, is only found in the Oceania, South Pacific on the islands of Austral Islands, Cook Islands, Ellice Islands, Fiji, Fiji Islands, Hoorn Islands, Marquesas Islands, Pitcairn Island, Samoa Isla ...

'', found between

Fiji Fiji, officially the Republic of Fiji, is an island country in Melanesia, part of Oceania in the South Pacific Ocean. It lies about north-northeast of New Zealand. Fiji consists of an archipelago of more than 330 islands—of which about ...

and French Polynesia. ''Aedes aegypti'' has previous been identified as a wild

vector Vector most often refers to: * Euclidean vector, a quantity with a magnitude and a direction * Disease vector, an agent that carries and transmits an infectious pathogen into another living organism Vector may also refer to: Mathematics a ...

of the Zika virus, and preliminary results from the Institut Louis-Malardé have supported the main role of ''Aedes aegypti'' and probable role of ''Aedes polynesiensis'' in spreading the Zika virus. People infected with the Zika virus traveling to other Pacific islands could transmit the disease to local mosquitoes that bit them. The infected mosquitoes could then go on to spread Zika among the local mosquito population, and thence cause outbreaks of Zika among local people. A study conducted between November 2013 and February 2014 in French Polynesia found that 2.8% of blood donors tested positive for the Zika virus, of which 3% were asymptomatic at the time of blood donation. 11 of the infected donors studied subsequently reported symptoms of Zika virus infection within 10 days. This indicated a potential risk of transmission of the Zika virus through

blood transfusion Blood transfusion is the process of transferring blood products into a person's Circulatory system, circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used ...

s, but there are no confirmed cases of this occurring.

Nucleic acid test A nucleic acid test (NAT) is a technique used to detect a particular nucleic acid sequence and thus usually to detect and identify a particular species or subspecies of organism, often a virus or bacterium that acts as a pathogen in blood, tissu ...

ing of blood donors was implemented in French Polynesia from 13 January 2014 onwards to prevent unintended transmission of the Zika virus.

Possible links to neurological syndromes, infant microcephaly and other disorders

A concurrent increase in neurological syndromes and

autoimmune In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an " autoimmune disease" ...

complications was first reported in early 2014. Of the 8,723 cases of Zika reported in French Polynesia, complications related to neurological signs of infection were noted in 74 people, including

Guillain–Barré syndrome Guillain–Barré syndrome (GBS) is a rapid-onset Paralysis, muscle weakness caused by the immune system damaging the peripheral nervous system. Typically, both sides of the body are involved, and the initial symptoms are changes in sensation ...

(GBS) in 42 people, as well as

encephalitis Encephalitis is inflammation of the Human brain, brain. The severity can be variable with symptoms including reduction or alteration in consciousness, aphasia, headache, fever, confusion, a stiff neck, and vomiting. Complications may include se ...

meningoencephalitis Meningoencephalitis (; from ; ; and the medical suffix ''-itis'', "inflammation"), also known as herpes meningoencephalitis, is a medical condition that simultaneously resembles both meningitis, which is an infection or inflammation of the mening ...

paraesthesia Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or chronic and has many possible underlying causes. Paresthesia is usually painless and can oc ...

, facial paralysis or

myelitis Myelitis is inflammation of the spinal cord which can disrupt the normal responses from the brain to the rest of the body, and from the rest of the body to the brain. Inflammation in the spinal cord can cause the myelin and axon to be damaged re ...

in 25. However, there was only one laboratory confirmation of Zika virus infection using RT-PCR in patients with GBS. Among the initial 38 cases of GBS found in suspected Zika cases, 73% were male and infected individuals were aged between 27 and 70. This was highly unusual, as prior to the Zika outbreak there had only been 21 cases of GBS in French Polynesia between 2009 and 2012. 18 people newly diagnosed with GBS were admitted to the local rehabilitation centre, putting heavy strain on the limited

intensive care Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes p ...

resources available. On 24 November 2015, health authorities in French Polynesia reported that there had been an unusual increase in the number of cases of

central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...

malformations in fetuses and infants during 2014–2015, coinciding with the outbreak of Zika on the islands. These malformations included 12 with fetal cerebral malformations or polymalformative syndromes, which includes

microcephaly Microcephaly (from Neo-Latin ''microcephalia'', from Ancient Greek μικρός ''mikrós'' "small" and κεφαλή ''kephalé'' "head") is a medical condition involving a smaller-than-normal head. Microcephaly may be present at birth or it m ...

, and another five with

brainstem The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is conti ...

dysfunction and absence of

swallowing Swallowing, also called deglutition or inglutition in scientific and medical contexts, is a physical process of an animal's digestive tract (e.g. that of a human body) that allows for an ingested substance (typically food) to pass from the mou ...

, much greater than the annual average of one case. None of the

pregnant Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

women involved had

medical signs Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

of Zika virus infection, but four who were tested gave positive results in IgG

serology Serology is the scientific study of Serum (blood), serum and other body fluids. In practice, the term usually refers to the medical diagnosis, diagnostic identification of Antibody, antibodies in the serum. Such antibodies are typically formed in r ...

assay An assay is an investigative (analytic) procedure in laboratory medicine, mining, pharmacology, environmental biology and molecular biology for qualitatively assessing or quantitatively measuring the presence, amount, or functional activity ...

s for

flavivirus ''Flavivirus'', renamed ''Orthoflavivirus'' in 2023, is a genus of positive-strand RNA viruses in the family ''Flaviviridae''. The genus includes the West Nile virus, dengue virus, tick-borne encephalitis virus, yellow fever virus, Zika viru ...

es, suggesting an

asymptomatic Asymptomatic (or clinically silent) is an adjective categorising the medical conditions (i.e., injuries or diseases) that patients carry but without experiencing their symptoms, despite an explicit diagnosis (e.g., a positive medical test). P ...

Zika virus infection during pregnancy. French Polynesian health authorities

hypothesis A hypothesis (: hypotheses) is a proposed explanation for a phenomenon. A scientific hypothesis must be based on observations and make a testable and reproducible prediction about reality, in a process beginning with an educated guess o ...

e that these abnormalities are associated with Zika if pregnant women are infected during the first or second trimester of pregnancy. Dr. Didier Musso, an

infectious disease An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

specialist at the Institut Louis-Malardé, said that there was "very high suspicion" of a link between microcephaly and the Zika virus outbreak in French Polynesia, but added that further research was still needed. The two cases of Zika virus infection imported into Japan from French Polynesia in February 2014 showed signs of

leukopenia Leukopenia () is a decrease in the number of white blood cells (leukocytes). It places individuals at increased risk of infection as white blood cells are the body's primary defense against infections. Signs and symptoms Symptoms may include: * s ...

(decreased levels of

white blood cell White blood cells (scientific name leukocytes), also called immune cells or immunocytes, are cells of the immune system that are involved in protecting the body against both infectious disease and foreign entities. White blood cells are genera ...

s) and moderate

thrombocytopenia In hematology, thrombocytopenia is a condition characterized by abnormally low levels of platelets (also known as thrombocytes) in the blood. Low levels of platelets in turn may lead to prolonged or excessive bleeding. It is the most common coag ...

(decreased levels of

platelet Platelets or thrombocytes () are a part of blood whose function (along with the coagulation#Coagulation factors, coagulation factors) is to react to bleeding from blood vessel injury by clumping to form a thrombus, blood clot. Platelets have no ...

s).

Aftermath

Brazilian researchers have suggested that a traveler infected with the Zika virus arrived in

Brazil Brazil, officially the Federative Republic of Brazil, is the largest country in South America. It is the world's List of countries and dependencies by area, fifth-largest country by area and the List of countries and dependencies by population ...

from French Polynesia, leading to the ongoing Zika virus outbreak that began in 2015. This may have occurred during the

2014 FIFA World Cup The 2014 FIFA World Cup was the 20th FIFA World Cup, the quadrennial world championship for list of men's national association football teams, men's national Association football, football teams organised by FIFA. It took place in Brazil fr ...

tournament, or shortly after, based on

phylogenetic In biology, phylogenetics () is the study of the evolutionary history of life using observable characteristics of organisms (or genes), which is known as phylogenetic inference. It infers the relationship among organisms based on empirical dat ...

DNA analysis of the virus. French researchers have speculated that the virus arrived in August 2014, when canoeing teams from French Polynesia, New Caledonia, the Cook Islands and Easter Island attended the

Va'a Vaʻa is a word in Samoan language, Samoan, Hawaiian language, Hawaiian and Tahitian language, Tahitian which means 'boat', 'canoe' or 'ship'. It is cognate with other Polynesian words such as ''vaka (sailing), vaka'' or the Māori language, Māo ...

World Sprint Championships in

Rio de Janeiro Rio de Janeiro, or simply Rio, is the capital of the Rio de Janeiro (state), state of Rio de Janeiro. It is the List of cities in Brazil by population, second-most-populous city in Brazil (after São Paulo) and the Largest cities in the America ...

. Between 1 January and 20 May 2015, a further 82 confirmed cases of Zika were reported in New Caledonia, including ten imported cases. In early 2015, two cases of Zika virus infection were reported in travelers returning to

Italy Italy, officially the Italian Republic, is a country in Southern Europe, Southern and Western Europe, Western Europe. It consists of Italian Peninsula, a peninsula that extends into the Mediterranean Sea, with the Alps on its northern land b ...

from French Polynesia. In February 2015, an outbreak of Zika began in the

Solomon Islands Solomon Islands, also known simply as the Solomons,John Prados, ''Islands of Destiny'', Dutton Caliber, 2012, p,20 and passim is an island country consisting of six major islands and over 1000 smaller islands in Melanesia, part of Oceania, t ...

. The Ministry of Health and Medical Services reported the first laboratory confirmation of Zika virus infection on 12 March 2015, and by 3 May 302 cases of Zika had been reported, with the number of new cases steadily decreasing. On 27 April 2015, the Ministry of Health of

Vanuatu Vanuatu ( or ; ), officially the Republic of Vanuatu (; ), is an island country in Melanesia located in the South Pacific Ocean. The archipelago, which is of volcanic origin, is east of northern Australia, northeast of New Caledonia, east o ...

announced that blood samples collected prior to

Cyclone Pam Severe Tropical Cyclone Pam was the second List of the most intense tropical cyclones, most intense tropical cyclone of the South Pacific Ocean in terms of sustained winds and is regarded as one of the worst natural disasters in the history of ...

in March were confirmed to contain the Zika virus. The Ministry of Health advised people to consult medical aid if they experienced a high fever with no obvious cause, and recommended communities clean up places where mosquitoes could lay eggs. The introduction of the Zika virus was thought to be linked to frequent travel between New Caledonia and Vanuatu. Local transmission of the Zika virus by mosquitoes has been reported in the

Polynesia Polynesia ( , ) is a subregion of Oceania, made up of more than 1,000 islands scattered over the central and southern Pacific Ocean. The indigenous people who inhabit the islands of Polynesia are called Polynesians. They have many things in ...

n islands of

American Samoa American Samoa is an Territories of the United States, unincorporated and unorganized territory of the United States located in the Polynesia region of the Pacific Ocean, South Pacific Ocean. Centered on , it is southeast of the island count ...

Samoa Samoa, officially the Independent State of Samoa and known until 1997 as Western Samoa, is an island country in Polynesia, part of Oceania, in the South Pacific Ocean. It consists of two main islands (Savai'i and Upolu), two smaller, inhabited ...

, and

Tonga Tonga, officially the Kingdom of Tonga, is an island country in Polynesia, part of Oceania. The country has 171 islands, of which 45 are inhabited. Its total surface area is about , scattered over in the southern Pacific Ocean. accordin ...

since November 2015. Cases of Zika virus infection have subsequently been confirmed in American Samoa, Samoa, Tonga, and the

Marshall Islands The Marshall Islands, officially the Republic of the Marshall Islands, is an island country west of the International Date Line and north of the equator in the Micronesia region of the Northwestern Pacific Ocean. The territory consists of 29 c ...

References

External links

Eurosurveillance case report of a French Polynesian woman with a Zika virus infection and Guillain–Barré syndrome
{{DEFAULTSORT:Zika virus outbreaks in Oceania Zika virus 2013 disease outbreaks 2014 disease outbreaks 2013 in French Polynesia 2014 in French Polynesia 2013 in New Caledonia 2014 in New Caledonia 2013 in the Cook Islands 2014 in the Cook Islands Health disasters in Oceania Disasters in the Cook Islands Disasters in French Polynesia Disease outbreaks in New Caledonia 2013 in Oceania 2014 in Oceania 2013 disasters in Oceania 2014 disasters in Oceania