**d. Zika**

Zika is an infectious disease caused by a flavivirus with a wide geographical distribution that is most often transmitted by the bite of an infected mosquito. The disease was first identified in the Americas in 2015 and was characterized by the occurrence of an abnormally high number of cases of congenital microcephaly in Brazil. It rapidly spread to the rest of the region and to the Caribbean including Haiti. Zika virus infection is associated with adverse fetal outcomes and rare neurological complications in adults [38]. The magnitude of the public health problems associated with Zika virus led the World Health Organization to declare the Zika virus epidemic a public health emergency of international concern on February 1, 2016 [38].

Because Zika was often an asymptomatic infection that did not necessarily require care, it was difficult to estimate the true incidence of Zika infection. However, during the period from October 12, 2015 to September 10, 2016, the Haitian Ministry of Public Health and Population (MSPP) had detected 3,036 suspected cases of infection in the general population, 22 suspected cases of Zika virus disease in pregnant women, 13 suspected cases of Guillain-Barré syndrome (GBS), and 29 suspected cases of Zika virus-associated congenital microcephaly. Nineteen patients with suspected Zika virus disease were detected, including 10 in the Western geographical department, 6 in Artibonite and 3 in the Central geographical department. These cases were confirmed by laboratory tests and included 2 pregnant women and 17 in the general population [39]. The surveillance program needs to be strengthened and supported by a functional laboratory in order to better monitor the evolution of the disease in Haiti.
