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Definition :-
• is the causative agent of
Zika Virus Disease, causing
a mild febrile illness to
maculopapular rash
• Enveloped icosahedral
Single stranded RNA Virus (+)ssRNA
• Family: Flaviviridae
• Genus: Flavivirus
• Reserviour: Aedes mosquito
Introduction
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•Two lineages: African and Asian
•Closely related to dengue, yellow fever, Japanese encephalitis and
West Nile viruses
So
What is the difference between Zika, dengue, and chikungunya?
Introduction
8. 8
•All of these viruses cause similar symptoms, but certain
symptoms suggest one disease or another.
•Most Zika patients have skin rashes .
•Most dengue patients have a higher fever and more severe
muscle pain .
•Most chikungunya patients have a higher fever and more
intense joint pain in the hands, feet, knees, and back .
Introduction
9.
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The virus was named after the region where it was
found in the of Uganda — in 1947
why it is called as Zika
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Isolated Fist in 1947 from rhesus macaque in the Zika Forest of
Uganda
1968 - isolated for the first time from humans in Nigeria
Since then, it has remained mainly in Africa, with small and sporadic
outbreaks in Asia. In 2007, a major epidemic was reported on the island
of Yap (Micronesia), where nearly 75% of the population was infected.
October 2013 -French Polynesia
May 2015 - Brazil
Since October 2015, other countries and territories of the Americas
have reported the presence of the virus
History
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• Since April 2015, a large, ongoing outbreak of Zika virus that began in Brazil
has spread to much of South and Central America, and the Caribbean .
• In January 2016, According to the CDC, Brazilian health authorities reported
more than 3,500 microcephaly cases between October 2015 and January
2016. Some of the affected infants have had a severe type of microcephaly
and some have died . In the worst affected region of Brazil, approximately 1
percent of newborns are suspected of being microcephalic.
Problem Statement
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• Major Mode of Transmission
Mosquito Bites
• Minor Mode of Transmission
From Mother to Baby
Blood transfusion & Sexual contact
How does it Spread? Mode of Transmission
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•Aedes aegypti : more efficient
vectors for humans
•Aedes albopictus : found in some
parts of NYS
Also transmit dengue and
chikungunya viruses
Major mode
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•A mother already infected with Zika virus near the time of
delivery can pass on the virus to her newborn around the
time of birth, but this is rare.
•In 2015, Zika virus RNA was detected in the amniotic fluid
of two fetuses, indicating that it had crossed the placenta
and could cause a mother-to-child infection
From Mother to Child:
Minor mode
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•It is possible that Zika virus could be passed from mother to fetus
during pregnancy. This mode of transmission is being
investigated.
•To date, there are no reports of infants getting Zika virus through
breastfeeding. Because of the benefits of breastfeeding, mothers
are encouraged to breastfeed even in areas where Zika virus is
found
From Mother to Child:
Minor mode
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•In 2009, it was proved that Zika virus can be sexually transmitted
between humans.
•Professor Brian Foy, a university biologist from the Colorado
State University is the first person known to have passed on an
insect-borne virus to another human by sexual contact.
Infected Blood or Sexual Contact:
(CNN)Zika has been sexually transmitted in Texas, the Centers
for Disease Control and Prevention said Tuesday (2nd Feb)
Minor mode
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•Infection rate: 73%(95%CI68–77)
•Symptomatic attack rate among infected:18%(95%Cl 10-27)
•All age groups affected
•Symptoms typically resolve in 5-7 days
•Mortality is rare
•Adults more likely to present for medical care
•No severe disease,hospitalizations,or
deaths only
ZikaVirus Incidence and Attack Rates
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The incubation period (the time from exposure to symptoms) for
Zika virus disease is not known, but is likely to be a few days to a
week.
• The illness is usually mild with symptoms lasting for several
days to a week.
• Zika virus usually remains in the blood of an infected person for
a few days but it can be found longer in some people.
Incubation period
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• It causes mild fever and rash. Other symptoms include muscle pain, joint
pain, headache, pain behind the eyes and conjunctivitis.
• Zika virus disease is usually mild, with symptoms lasting only a few days,
swelling observed occasionally (notably of the small joints of the hands and
feet).
• The disease has similar clinical signs to dengue, and may be misdiagnosed
in areas where dengue is common.
• According to recent epidemiological studies, only one in four of this virus
infected patients show symptoms, all rest suffer the asymptomatic disease
Signs and Symptoms:
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Neurological Complications
• Guillain-Barre Syndrome
is a rare disorder where a person’s own immune system damages
the nerve cells, causing muscle weakness and sometimes,
paralysis. These symptoms can last a few weeks or several
months. While most people fully recover from GBS, some people
have permanent damage and in rare cases, people have died.
Complications
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WHO currently talking about a rate of 2.3 cases of Guillain-Barre for
every 1,000 patients with Zika
• During the Zika virus outbreak in French Polynesia with 8750 suspected
cases, 74 patients presented with neurological syndromes or autoimmune
syndromes following an illness with symptoms compatible with Zika virus
infection in previous days. Of these, 42 were diagnosed as Guillain –
Barrésyndrome
• In Brazil, 121 cases of neurological manifestations and Guillain–Barré
syndrome (GBS) were notified .
Guillain–Barre syndrome
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Pregnancy related Complications
• Those infected with Zika during pregnancy appear to be able to
transmit the virus to their fetuses. In some cases, this may lead
to microcephaly, a terrible congenital condition that's associated
with a small head and incomplete brain development. Babies
born with microcephaly have a limited life expectancy and poor
brain function.
Complications
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• There are no commercially available diagnostic tests for Zika
virus disease.
• Zika virus is diagnosed through PCR (polymerase chain
reaction) and virus isolation from blood samples.
• Diagnosis by serology can be difficult as the virus can cross-
react with other flaviviruses such as dengue, West Nile and
yellow fever.
Diagnosis
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Real-time PCR assay to detect viral RNA in serum and urine
collected ≤7 days after illness onset
Serological assays to detect either IgM or IgG in serum collected
≥4 days after illness onset. Detects both Zika-specific and cross-
reactive antibody
Plaque reduction neutralization test(PRNT)to detect a ≥4-fold rise in
Zika virus-specific neutralizing antibodies inpaired sera
Diagnostic Testing for ZikaVirus
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• Infants with microcephaly or intracranial calcifications born to
women who travelled to or resided in an area with Zika virus
transmission while pregnant; or
• infants born to mothers with positive or inconclusive test
results for Zika virus infection.
• For infants with laboratory evidence of a possible congenital
Zika virus infection, additional clinical evaluation and follow-up
is recommended.
• Health care providers should contact their state or territorial
health department to facilitate testing. As an arboviral disease,
Zika virus disease is a nationally notifiable condition.
Zika virus testing is recommended for
38. 3838
CDC recommends both molecular and serologic testing of
infants who are being evaluated for evidence of a
congenital Zika virus infection . No commercial tests for
Zika virus are available; Zika virus testing is performed at
CDC and some state and territorial health departments.
Health care providers should contact their state or
territorial health department to facilitate testing
CDC recommends
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• No vaccine or medications are available to prevent or treat Zika infections.
BUT
Treatment
• The NIH Vaccine Research Center began work towards developing a vaccine for
Zika per a January 2016 report.
• Bharat Biotech International, reported in early February 2016 that it was working
on vaccines for Zika
• using two approaches: "recombinant", involving genetic engineering, and
"inactivated", where the virus is incapable of reproducing itself but can still trigger
an immune response with animal trials of the inactivated version to commence in
late February.
• As of March 2016, 18 companies and institutions internationally were developing
vaccines against Zika, but none had yet reached clinical trials.
• Nikos Vasilakis of the Center for Biodefense and Emerging Infectious Diseases
predicted that it may take two years to develop a vaccine, but 10 to 12 years may
be needed before an effective Zika vaccine is approved by regulators for public
use.
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• Treat the symptoms:
• Get plenty of rest
• Drink fluids to prevent dehydration
• Take medicines, such as acetaminophen or paracetamol, to relieve fever
and pain
• If you have Zika, avoid mosquito bites for the first week of your illness.
• During the first week of infection, Zika virus can be found in the blood
and passed from an infected person to another mosquito through
mosquito bites.
Treatment
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Some Countries Are Employing Genetically Modified Mosquitoes to Fight the Virus
Sterile male Aedes mosquitoes could reduce the population, CNN reported. Some worry
that this could have an unknown effect on the environment
A genetically modified version can be
used to cut down the mosquito
population and reduce the Zika risk.
Prevention & Control
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The individual suspected to be infected by the virus may visit the nearest medical health Centre. To
eliminate and control the mosquito, it is recommended to:
• Avoid allowing standing water in outdoor containers (flower pots, bottles, and containers that collect
water) so that they do not become mosquito breeding sites.
• Cover domestic water tanks so that mosquitoes cannot get in.
• Avoid accumulating garbage: Put it in closed plastic bags and keep it in closed containers.
• Block drains that could accumulate standing water.
• Use screens and mosquito nets in windows and doors to reduce contact between mosquitoes and
people.
• During outbreaks, space spraying of insecticides may be carried out periodically to kill flying
mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also
be used as larvicides to treat relatively large water containers.
Prevention & Control
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• There is no commercially available vaccine to prevent
Zika virus (but several in clinical trials)
• Focus on prevention of mosquito exposure.
• Consider advising people at risk for severe disease to
avoid travel to areas with ongoing outbreaks
• Those with active infection should be advised to avoid
exposure to mosquitos to avoid further spread
Prevention & Control
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Avoid being bitten (mostly daytime feeder)
• Use repellent on skin (sunscreen first, then repellent)
• Wear long-sleeved shirt and long pants
• Spray permethrin or DEET repellents on clothing (DEET >20%)
• Stay in places with screens or air conditioning
• Use of mosquito nets.
Avoid sexual contact with patients with acute symptoms for about
7 days:
Condom use
Abstinence
Abstain to donate blood while acute sickness
Prevention & Control
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A worker uses a forklift to store abandoned tires, to remove potential breeding
spots for mosquitoes transmitting Zika and other mosquito-borne diseases, at
a temporary collection center in San Juan, Puerto Rico, on January 27, 2016.
Prevention & Control
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Department of Health drives fumigating a neighborhood to prevent the
spread of Zika virus in San Juan, Puerto Rico, on January 27, 2016.
Prevention & Control
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A health worker stands in the Sambadrome as he sprays
insecticide in Rio de Janeiro, Brazil, on January 26, 2016.
Prevention & Control
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• When traveling to countries where Zika virus or other viruses spread
by mosquitoes are found, take the following steps:
• Wear long-sleeved shirts and long pants.
• Stay in places with air conditioning or that use window and door
screens to keep mosquitoes outside.
• Sleep under a mosquito bed net if you are overseas or outside and are
not able to protect yourself from mosquito bites
• It is also important to empty, clean or cover containers that can hold
water such as buckets, flower pots or tyres, so that places where
mosquitoes can breed are removed.
CDC recommendations
Prevention & Control
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• Between November 2015 and January 2016, local transmission of the virus
was detected in 14 new countries and territories .
• we know so little about this virus.
• 60-80% of Zika infections are asymptomatic.
• Potentially, all areas of the world where Aedes mosquito is endemic are at
risk.
• in the past year, a 3,800% increase in microencephaly—brain shrinkage—in
newborns of mothers infected .
• We don’t know yet how long after a woman is infected with the virus it is
safe for her to get pregnant.
Why is everyone so worried of ZIKA?
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• WHO warned last week that the mosquito-borne virus was
"spreading explosively" in the Americas, and said the region
could see up to four million Zika cases this year alone.
• Olympics affected
Rio 2016 Olympics & Paralympics
Why is everyone so worried of ZIKA?
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CDC recommends the following special
precautions:
• Women who are pregnant (in any trimester):
Postpone travel to any area where Zika virus transmission is ongoing.
If you must travel to one of these areas, talk to your doctor first and
strictly follow steps to prevent mosquito bites during your trip.
Zika in pregnancy
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CDC recommends the following special precautions:
• Men who live in or have traveled to an area of active Zika virus transmission
who have a pregnant partner should not have sexual activity, or should use
condoms consistently and correctly during sex—vaginal intercourse, anal
intercourse, and fellatio (oral sex) for the duration of the pregnancy. Men who live
in or have traveled to an area of active Zika virus transmission who are concerned
about sexual transmission of Zika virus to a non-pregnant partner might consider
abstaining from sexual activity or using condoms consistently and correctly during
sex.
• Women who are trying to become pregnant:
Before you travel, talk to your doctor about your plans to become pregnant and
the risk of Zika virus infection.
Strictly follow steps to prevent mosquito bites during your trip.
Zika in pregnancy
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• Obtain recent travel history from pregnant women
• NYSDOH recommends and will provide testing for
symptomatic, pregnant women who traveled to an area with
ongoing Zika virus transmission during pregnancy
• Provide information to pregnant women and their provider to
help inform clinical management and decision making
Evaluation of Pregnant Women
Zika in pregnancy
Mosquito avoidance is the best way to prevent dengue when traveling to dengue-affected areas.
Physicians can advise patients during to:
Avoid being bitten (a few hours after dawn until an hour or so after sunset)
Use repellent containing:
DEET including (but not limited to these products): Off!, Cutter, Sawyer, and Ultrathon.
Picaridin including:Cutter Advanced, Skin So Soft Bug Guard Plus
Oil of lemon eucalyptus* or PMD including Repel
IR3535 including Skin so Soft Bug Guard Plus Expedition
Wear long-sleeved shirt and long pants when on patio
Spray permethrin or DEET repellents on clothing
Use screens in house
Prevent mosquitoes from breeding in your home and patio
Get rid of water in flower vases, uncovered barrels, buckets, and discarded tires on weekly basis
Fix septic tanks and seal toilets that are not used often
