Zika Virus Infection

1. Lelete Holson-Patterson
RN, RM, Cert. Admin, Dip. HRM, BSc, MSc,
Doctoral Candidate
2016

2. 1947- Zika Virus first isolated in the Zika Forest
(Uganda) in a Rhesus Monkey
1952- Zika Virus first isolated in humans in
Uganda, Tanzania
1968- Zika Virus detected in human samples
in Nigeria
2013- Outbreak of Zika Virus in French Polynesia
with 10,000 registered cases of which 70 were
severe cases including Guillian Barre’ syndrome,
meningoencephalitis, leukopenia
2007- First major outbreak of Zika Virus on
the island of Yap (Micronesia) with 185
suspected cases
2015- Zika Virus detected in New Caledonia
and in the Cook Islands

3. May, 2015- confirmed transmission of
Zika virus in Brazil
October, 2015, - Colombia health authorities
confirmed transmission of Zika virus
December 1, 2015- 9 member states in the
Americas confirmed circulation of Zika virus and
include Brazil, Chile, Colombia, El Salvador,
Guatemala, Mexico, Paraguay, Suriname and
Venezuala
January, 2016- 20 Member States of the
Americas including Haiti and Barbados

4.  In October 2015, Brazilian health authorities
reported an unusual increase in microcephaly
cases
 As of 30 November 2015, 1,248 cases of
microcephaly have been reported in 14 states
of Brazil.

5. 5.5/100,000 5.7/100,000
99.7/100,000
0
20
40
60
80
100
120
2000 2010 Nov. 2015

6.  On November 28, 2015, the Brazil Ministry of
Health notified 3 deaths associated with Zika
Virus infection.
 The fatal cases were 2 adults and 1 newborn

7.  The first case was a male adult with history of
lupus erythematosus, chronic use of
corticosteroid drugs, rheumatoid arthritis and
alcoholism who was admitted with suspected
dengue fever
 The second case was a 16 year old female
 The third case was a newborn

8.  This is a disease caused by the Zika virus
(ZIKAV).
 Very close phylogenetically to viruses such as
dengue, yellow fever, Japanese encephalitis,
or West Nile virus.

9.  Zika Virus (ZIKAV)
◦ An arbovirus the flavivirus genus (family
Flaviviridea)

10.  The Zika virus is transmitted by the Aedes
aegypti mosquitoes

11.  After an infected mosquito bite, the disease
symptoms usually appear following an
incubation period of 3-12 days

14.  Fever
 Non-purulent conjunctivitis
 Headache
 Myalgia
 Arthralgia
 Asthenia
 Maculopapular rash
 Oedema of the lower limbs

15.  Retro-orbital pain
 Anorexia
 Vomiting
 Diarrhoea
 Abdominal pain
 Mild Thrombocytopenia (laboratory findings)
 Mild Leucopenia (laboratory findings)

16.  Guillian Barre’
 Meningoencephalitis
 Thrombocytopenia purpura

18.  Patients with rash or elevated temperature (>
37.2°C) with one or more of the following
symptoms (not explained by other medical
conditions):
◦ Arthralgia or myalgia
◦ Non-purulent conjunctivitis or conjunctival hyperaemia
◦ Headache or malaise
In someone who resides in or has visited epidemic or
endemic areas within 2 weeks prior to the onset of
symptoms

19.  A suspected case with laboratory positive
result for the specific detection of Zika virus

20. Zika suspected cases (Regarding
the symptoms and epidemic
scenario)
Acute Phase
(1-5 days after
symptoms arise)
Onset of
symptoms vs
taking of samples
Positive
CHIK V
Confirmed
IgM
Dengue
IgM ChikV
Positive
Presumptive
ZIKA V
Positive
Presumptive
DENGV
RT-PCR/NS4
Dengue
Convalescent phase
(> 6 days after
symptom onset)
(Real Time)
PCR-CHIK
V
Positive
DENV
Confirmed
Negative
Consider
CHIK V
Negative
Consider
ZIkV
(Real time)
PCR-ZikV
Negative
Discard
Positive
Zik V Confirmed
Negative
Discarded
IgM
ZIKV
Positive
Presumptiv
e CHIK V
Negative
Consider ZIK V

21.  Zika Fever is a Class 1 Notifiable disease and
is notified on suspicion within 24 hours to
the Parish Health Department and the
National Epidemiology Unit, Ministry of
Health
 Cases (confirmed by laboratory testing)
should also be notified as a Class 1 Notifiable
disease to the Parish Health Department and
the Epidemiology Unit, Ministry of Health

22.  Samples for serology should be sent to the
National Public Health Laboratory along with
the completed CARPHA Laboratory form.
 The following are the requirements for the
sampling:
◦ Type of sample: Serum- 4-5 mls. Of blood in a
plain red top tube
 Acute phase: Until 8 days after symptom onset
 Convalescent phase: 10-15 days after symptom onset

23.  Keep refrigerated (2-8°C) if sample will be
processed within 48 hours at the NPHL.
 Keep frozen (-10 to -20°C) if sample will be
processed after the first 48 hours
 Maintain frozen (-70°C) if sample will be
processed after one week

24.  Samples should be transported on ice or with
ice packs to the National Public Health
Laboratory once the Notification is made to
the Parish Health Department

25.  Nucleic Acid detection of Zika viral RNA using
real time Reverse Transcriptase Polymerase
Chain Reaction (RT-PCR) performed on an
“acute sample” collected during the first five
(5) days of illness
 Serological detection of anti-Zika IgM and IgG
antibodies using Enzyme-Linked
Immunosorbent Assay (ELISA) and
immunofluorescence assays may be
performed on blood samples collected 6 days
after the onset of symptoms

26.  If the following is not included in the test
request form, the sample cannot be referred
and will be REJECTED:
◦ Name of patient
◦ Age of patient
◦ Date of symptom onset
◦ Date sample collected
◦ Clinical features- full description
◦ Clinical Tests Performed and Results
◦ Pertinent Travel History

27.  Dengue
 Chikungunya
 Malaria
 Leptospirosis
 Acute HIV infection
 Measles
 Rubella
 Rickettsial infections
 Epstein Barr Virus- Infectious mononucleosis

28.  There is no vaccine or specific treatment for
Zika Virus
 It is important to differentiate Zika virus from
other diseases
 Cases of co-infection, Zika and Dengue,
could occur
 Compared with dengue, fever associated with
Zika virus infection is more acute and shorter
in duration

29.  Symptomatic
 Rest
 Acetaminophen to relieve fever
 Antihistamines to control pruritus
 Using aspirin is not advised due to the risk of
bleeding and the developing of Reye’s
syndrome in children younger than 12 years
of age
 The use of NSAID is not advised as the clinical
symptoms may be Dengue or Chikungunya.

30.  Increased oral fluids
 Patient isolation especially during the first
week of illness
◦ Stay under mosquito net treated or without
insecticide
◦ Stay in places with intact windows, doors and
screens
◦ Staff who take care of these patients should protect
against mosquito bites using insect repellent (DEET,
IR3535 or Icaridin) and wearing long sleeves and
pants

31.  There is no evidence of any restriction of the
use of these repellents by pregnant women if
they are used in accordance with the
instructions on the product label

32.  EVERYONE’S RESPONSIBILITY
 Eliminate breeding sites of the mosquitoes
 Identify areas of high risk transmission
 Select appropriate insecticide

35.  There is no evidence of any restriction of the
use of these repellents by pregnant women if
they are used in accordance with the
instructions on the product label

36.  PAHO/WHO. (2016). Zika virus infection.