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Zika virus
- 1. Zika Virus Department of Medicine 2-9-2016
- 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).
- 14. Less Common Manifestations • Myalgia • Headache • Retro-orbital pain • Asthenia • Abdominal pain • Nausea • Diarrhea • Mucus membrane ulcerations • Pruritus
- 15. Complications • Congenital microcephaly and fetal losses among women infected during pregnancy • Guillain-Barré syndrome
- 16. Differential • Dengue (Back pain and high fever) • Chikungunya (Disabling arthritis) • Parvovirus (Symmetric arthritis) • Rubella (Coryza and descending rash) • Measles (Koplik spot, lymphadenpathy) • Malaria • Rickettsial Infections
- 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
- 22. Thanks for your time.