The document summarizes information about the Zika virus outbreak, including that it is spreading explosively in the Americas and Caribbean and has been declared a public health emergency. The virus is transmitted via mosquito bites and sexually and causes mild illness in most cases, but can lead to complications like microcephaly and Guillain-Barre syndrome. Pregnant women infected are at increased risk of fetal complications. While there is no vaccine or treatment, prevention efforts focus on personal protection against mosquitos and safe sexual practices.

1. ZIKA VIRUSZIKA VIRUS
A SYNOPSISA SYNOPSIS
Almataria Teaching Hospital, Nasser InstituteAlmataria Teaching Hospital, Nasser Institute
Cairo, EgyptCairo, Egypt
Dr. Mamdouh SabryDr. Mamdouh Sabry
MD. Ain Shams, Ph.D. FranceMD. Ain Shams, Ph.D. France
Consultant Ob. & Gyn.Consultant Ob. & Gyn.

2. INTRODUCTIONINTRODUCTION
o An ongoing Zika virus outbreak is evident inAn ongoing Zika virus outbreak is evident in
The Americans and Caribbean area.The Americans and Caribbean area.
o The WHO stated that, the virus is ( spreadingThe WHO stated that, the virus is ( spreading
explosively ) and declared Zika virus infectionexplosively ) and declared Zika virus infection
and its associated complications A Publicand its associated complications A Public
Health Emergency of International Concern.Health Emergency of International Concern.
o Outbreaks evidenced before in Africa,Outbreaks evidenced before in Africa,
Southeast Asia and the pacific islands, but wasSoutheast Asia and the pacific islands, but was
not that serious.not that serious.

3. o As of February 1, 2016, the virus was beingAs of February 1, 2016, the virus was being
reported in 28 countries and territories.reported in 28 countries and territories.
o WHO estimates that, there will be 3-4 millionWHO estimates that, there will be 3-4 million
cases of Zika infection (includingcases of Zika infection (including
asymptomatic cases) in the Americasasymptomatic cases) in the Americas
during next 12 months.during next 12 months.
o Sporadic cases reported in Europe.Sporadic cases reported in Europe.
o The high risk of this outbreak is due to:The high risk of this outbreak is due to:
Microcephaly, unusual in GBS, neonatalMicrocephaly, unusual in GBS, neonatal
death and the sporadic cases of mortality.death and the sporadic cases of mortality.

4. THE VIRUS
• Zika virus is an arbovirus of the flavivirus
(Flaviviridae) family which includes
dengue, west Nile, yellow fever and
Japanese encephalitis fever.
• This group contains a positive, single-
stranded genomic RNA encoding a
polyprotein.
• This virus is named after Uganda forest,
and first isolated in Rhesus monkey in
1947 in Uganda.

5. TRANSMISSION
o Via bite by Aedes aegyptus mosquito,
which lives in tropical regions and Aedes
albopictus which lives in temperate region,
they can also transmit dengue and
chikungunya viruses.
o Materno-fetal transmission intrauterine
results in congenital infection and also
intrapartum from infected mother.
o Sexual transmission from infected male,
virus stays more than 2 weeks in semen.

6. • Transmission via blood products and
blood transfusion.
• No evidence of breast milk transmission!!!
• Virus RNA has been detected in blood,
urine, semen, saliva, CSF, amniotic fluid
and breast milk.
• Protective measures is considered based
on viral transmission and excretion and
personal behavior.

7. Manifestations & Complications
• Acute onset of low-grade fever with maculopapular
rash, arthralgia ( small joints of hands and feet ) or
conjunctivitis( nonpurulent ), clinical diagnosis is
based on presence of 2 or more of symptoms.
• 2 – 12 days are the incubation period, with mild
illness that resolves in 2 – 7 days.
• 20 – 25% of cases show symptoms, infection
mostly followed by future immunity.
• Complications include congenital microcephaly,
brain calcification, fetal loss and Guillian-Barree
syndrome.
• First trimester infection increases microcephaly risk

8. o The unusual increase in the rate of GBS in
parallel with ongoing Zika virus infection is
not yet explained.
o No data available to suggest if pregnant
women are more susceptible to infection
or experience more severe form during
pregnancy.
o The rate of vertical transmission and fetal
complications are unknown.

9. Diagnosis & Management
• The disease is suspected in persons with
typical clinical manifestations and relevant
epidemiologic exposure ( residence in or
travel an area where Aedes mosquito is
present or where imported or local cases
reported or unprotected sexual contact
with a person who meets these criteria )
• Serum reverse-transcription polymerase
chain reaction (RT-PCR) testing or
serology are conclusive within first 7 days
following symptoms, both tests to be done.

10. o Pregnant women with viral exposure should
undergo lab. testing and sonography to
evaluate presence of microcephaly or
intracranial calcification.
o Evaluation of intrauterine infection with
positive or inconclusive diagnosis includes
serial sonography (every 3-4 weeks and
amniocentesis.
o Symptomatic infants born to infected women
and non-symptomatic infants born to
mothers with positive or inconclusive tests
are candidates for seriologic tests! Why?

11. CONCLUSION
• A new virus is added to the 27 STDs.
• No specific treatment and no vaccine are
available. Symptomatic treatment only.
• Plasmapheresis and immunoglobulins are
successful for treatment of GBS.
• Preventive measures are the corner-stone
for management, that includes personal
protection against bites and sexuality and
institutional measures against mosquitos.

12. • Pregnant women should apply mosquito
protective measures and avoid travelling
to endemic areas.
• Pregnancy is postponed and conclusive
contraception is used in endemic areas.
• Further studies and recommendations are
needed for sexual transmission
evaluation.
• More studies are needed to understand
role of the virus in congenital infection,
GBS and if there is another factor.

13. Thank You
Best Wishes

14. ANNOUNCEMENT
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