2. Flavus=Yellow
• West Nile virus
• dengue virus
• tick-borne encephalitis virus
• yellow fever virus
• Zika virus
3. Flaviviruses
• 40–65 nm
• Symmetry
• Single-stranded RNA
• 10,000–11,000 bases
• Most classified as arboviruses (tick or
mosquito)
4. History
• Zika means "overgrown" in the Luganda
language
• In 1947, the Zika virus was isolated from a
Rhesus monkey stationed at Zika
5. Epidemiology
• 1950s : Narrow belt
between Asia and Africa.
• 2007: Yap/Micronesia
• 2014: the virus spread
eastward across the Pacific
Ocean to French Polynesia,
then to Easter Island
• 5/2015: Brazil
• 2015: South America
(pandemic levels).
• 2/4/16: Pregnancy case in
Spain
6. Indigenous Circulation
• Barbados
• Bolivia
• Brazil
• Cape Verde
• Colombia
• Costa Rica
• Curaçao
• Dominican Republic
• Ecuador
• Nicaragua
• Panama
• Paraguay
• Saint Martin
• Samoa
• Suriname
• Venezuela
El Salvador
• French Guiana
• Guadeloupe
• Guatemala
• Guyana
• Haiti
• Honduras
• Jamaica
• Martinique
• Mexico
7. WHO
• February 1st 2016
• 18 experts looked at the strong association, in
time and place, between infection with the Zika
virus and a rise in detected cases of congenital
malformations and neurological complications
• Zika infection during pregnancy and microcephaly
is strongly suspected, though not yet scientifically
proven.
• Advised countries not to accept blood donations
from people who had travelled to Zika-affected
regions
8. CDC
• In January 2016, the U.S. Centers for Disease
Control and Prevention issued travel guidance
on affected countries, including the use of
enhanced precautions, and guidelines for
pregnant women including considering
postponing travel.
9. CDC
• Interim Guidelines for Pregnant Women During a Zika Virus Outbreak - United States, 2016. AU
Petersen EE, Staples JE, Meaney-Delman D, Fischer M, Ellington SR, Callaghan WM, Jamieson DJ
SOMMWR Morb Mortal Wkly Rep. 2016;65(2):30.
• Recommendations for pregnant women considering travel to an area with Zika virus transmission
and recommendations for screening, testing, and management of pregnant returning travelers.
Updates on areas with ongoing Zika virus transmission are available online
(http://wwwnc.cdc.gov/travel/notices/).
• Health care providers should ask all pregnant women about recent travel. Pregnant women with a
history of travel to an area with Zika virus transmission and who report two or more symptoms
consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or
conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal
microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation
with their state or local health department. In pregnant women with laboratory evidence of Zika
virus infection, serial ultrasound examination should be considered to monitor fetal growth and
anatomy and referral to a maternal-fetal medicine or infectious disease specialist with expertise in
pregnancy management is recommended.
10. South America
Colombia, the Dominican Republic, Ecuador, El
Salvador, and Jamaica advised women to
postpone getting pregnant until more is known
about the risks
11. Transmission in US
• On February 2, 2016, Dallas County Health
and Human Services confirmed the first case
of transmission in the United States
12. Incubation and Course
• 2 to 12 days after the mosquito vector bite.
• The illness is usually mild
• Symptoms resolve within two to seven days.
• Asymptomatic infection is common
• Symptoms develop in 20 to 25 percent
• Once infected, protected from future infections.
• Severe disease requiring hospitalization is
uncommon
• Case-fatality rates are low
13. Clinical Manifestations
• 20 percent of patients.
• Acute onset of low-grade fever
• Maculopapular rash
• Arthralgia (notably small joints of hands and
feet)
• Conjunctivitis (nonpurulent).
17. What We Should Be Doing
(Area of No Mosquito Transmission)
Ask pregnant women about relevant
epidemiologic exposure (residence in or travel
to an area where mosquito-borne transmission
of Zika virus infection has been reported, or
unprotected sexual contact with a person who
meets these criteria).
18. Diagnosis
• Low-grade fever (37.8 to 38.5°C)
• Maculopapular rash
• Arthralgia (notably the small joints of hands and feet)
• Conjunctivitis (nonpurulent)
• Reverse-transcription polymerase chain reaction (RT-
PCR) for Zika viral RNA or Zika virus serology
• Serologies post 4 days of symptom onset
• Communication should be initiated with the CDC (1-
970-221-6400) prior to shipment of specimens.
19. Diagnosis and Pregnancy
• Serologies= flavivirus cross-reactivity.
• Do not test pregnant women with no ZV exposure
• Pregnant women with positive/inconclusive ZV
laboratory testing should undergo further
evaluation for presence of intrauterine infection
• Pregnant women with negative ZV laboratory
testing and no ultrasound findings should have
routine prenatal care.
20. Intrauterine Infection
• Microcephaly as an isolated finding is difficult
to diagnose before the third trimester.
• Intracranial calcifications are sometimes
evident in the second trimester.
• Tools for prenatal fetal evaluation for Zika
virus infection include serial ultrasound
examinations and amniocentesis
