Zika virus disease is a mosquito-borne viral infection that primarily occurs in tropical and subtropical areas of the world. It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans Genre: Flavivirus Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours) Reservoir: mosquitoes (gut, blood, saliva ) human ( blood, prostate, semen and testes )

1.  DONE BY : MUSTAFA KHALIL IBRAHIM
 TBILISI STATE MEDICAL UNIVERSITY

3.  Introduction
 Epidemiology
 Transmission
 Signs and symptoms
 Complications
 Risk factors
 Diagnosis
 Treatments
 Prevention

4.  The World Health Organization has declared
the Zika virus an international public health
emergency, prompted by growing concern that it
could cause birth defects. As many as four million
people could be infected by the end of the year.
 Officials at the Centers for Disease Control and
Prevention have urged pregnant women against
travel to more than thirty countries, mostly in the
Caribbean and Latin America, where the outbreak
is growing. Some pregnant women who have been
to these regions should be tested for the infection,
the agency has said.

5.  Zika virus disease is a mosquito-borne viral infection that
primarily occurs in tropical and subtropical areas of the
world.
 It is related to other pathogenic vector borne flaviviruses
including dengue, West-Nile and Japanese encephalitis
viruses but produces a comparatively mild disease in
humans
 Genre: Flavivirus
 Vector: Aedes mosquitoes (which usually bite during the
morning and late afternoon/evening hours)
 Reservoir: mosquitoes (gut, blood, saliva )
human ( blood, prostate, semen and testes )
umknown (sliva, urine, milk …ect)

6.  1- Its viral infection .
 2- infect all kinds of people .
 3- rapid spread .
 The rapid spread of ZIKV will continue until it
reaches all countries of the region where the
Aedes mosquito is found.

8.  Zika virus is an emerging mosquito-borne
virus that was first identified in Uganda in
1947 in rhesus monkeys through a monitoring
network of sylvatic yellow fever. It was
subsequently identified in humans in 1952 in
Uganda and the United Republic of Tanzania.
Outbreaks of Zika virus disease have been
recorded in Africa, the Americas, Asia and the
Pacific.

11.  In 2007, a major epidemic was reported on the
island of Yap (Micronesia), where nearly 75% of the
population was infected.
 This was followed by an outbreak of the same strain
in French Polynesia in 2013; since then there have
been major outbreaks in other parts of the Pacific.
 On 3 March 2014, Chile notified PAHO/WHO of
autochthonous transmission of Zika virus on Easter
Island, where the virus continued to be detected
until June 2014.
 In May 2015, the public health authorities of Brazil
confirmed the transmission of Zika virus in the
country’s northeast. Since October 2015, other
countries and territories of the Americas have
reported the presence of the virus.

12.  As of 29 January 2016, 23 countries currently
experiencing active transmission are: Barbados,
Bolivia, Brazil, Cape
 Verde, Colombia, Dominican Republic,
Ecuador, El Salvador, French Guiana,
Guadeloupe, Guatemala, Guyana, Haiti,
Honduras, Martinique, Mexico, Nicaragua,
Panama, Paraguay, Puerto Rico, Saint Martin,
Samoa, Suriname, Thailand, Venezuela, US
Virgin Islands.

15.  1. The population in this part of the world had not
previously been exposed to ZIKV and so lacked
immunity.
 2. Aedes mosquitoes, the main vector for ZIKV
transmission, are present in all of these
regions/countries .
 ZIKV has not occurred naturally in the UK because
we do not have the vectors .
 imported cases have occurred in the UK in
travellers that have returned from South and
Central America (as well as one from the Cooks
Islands in 2014)

17.  Zika virus is transmitted to people through the bite of
an infected mosquito from the Aedes genus,
mainly Aedes aegypti in tropical regions.
 This is the same mosquito that transmits dengue,
chikungunya and yellow fever.
 There is no evidence of transmission Zika virus in
Europe to date
 Few people here have immune defenses against the
virus, so it is spreading rapidly.
 Only 2 known species out of 176 species of mosquitoes
spread Zika identified in the US.(cdc)
 Millions of people in tropical regions of the Americas
may now have been infected

18.  1- infected mosquito to human.
 2- infected human to mosquito then to human.
 3- from infected pregnant woman to fetus.
 4-blood transfusion .
 5- semen (sexual transmission) .
 sexual transmission of Zika virus has been
described in 10 cases, and the presence of the
Zika virus in semen in additional cases.
 umknown (sliva, urine, milk, air, …ect) under
reporting .

20.  There is no evidence
that ZIKV can be
transmitted to babies
through breast milk
and the advice to
mothers to
breastfeed remains
unchanged

21.  Wherever certain mosquitoes go.
 But the mosquito is common in the United States
only in Florida, along the Gulf Coast, and in Hawaii
– although it has been found as far north as
Washington, D.C., in hot weather.
 The Asian tiger mosquito, Aedes albopictus, is also
known to transmit the virus, but it is not clear how
efficiently. That mosquito ranges as far north as New
York and Chicago in summer.

22.  The virus moves from its gut to its salivary
glands.
 Only female mosquitoes bite people: they need
blood to lay eggs. They pick up the virus in the
blood. It travels from their gut through their
circulatory system to their salivary glands and
is injected into its next human victim. Mosquito
saliva contains proteins that keeps blood from
clotting. When a mosquito bites, it first injects
saliva so its prey’s blood does not clog its
strawlike proboscis.

23.  Yes.
 Experts believe that the vast majority of Zika infections are
transmitted by mosquitoes, not sex.
 As of early March/2016, however, more than a 10 cases of
transmission through sex have been reported in four
countries.
 In each case in which details were released, the virus was
transmitted by a man who had visited a region where the
infection circulates to a woman who had not.
 Live virus has been found in semen more than two months
after symptoms of infection disappeared. Scientists believe
the prostate or testes can serve as a reservoir, sheltering the
Zika virus from the immune system. In some cases, the
men with infections had blood in their semen.

24.  Health authorities now recommend that women who
are pregnant or trying to become pregnant avoid contact
with semen from men who have visited areas where the
Zika virus is transmitted. Women who are pregnant
should have sex only with partners using a condom
 There are still many unknowns.
 Can a woman pass the virus to a man through sex? Can
it be passed through anal, oral or other forms of sexual
contact?
 Does a man have to have blood in his semen to be
infectious? Is he infectious before the blood appears?
 If there is no blood, must he have had symptoms of Zika
infection, like fever and rash, to be contagious? How
long does a man remain infectious?

25.  Symptoms are similar to those of dengue or
chikungunya, arbovirus infections, which are
transmitted by the same type of mosquito.
 1 out of 4 infected people develops symptoms of
the disease .
 When symptoms do occur, they usually begin 2 to
12 days after being bitten by an infected mosquito.
 Most people recover fully, with symptoms
resolving in about a week.
 Signs and symptoms of Zika virus disease most
commonly include:

34. DengueChikungunyaZika
• higher fever
• more severe muscle pain
• bleeding
• higher fever
• more intense joint pain,
affecting the hands, feet,
knees, and back. It can
disable people, bending
them over so that they
cannot walk or perform
simple actions such as
opening a water bottle.
• Mild fever
• skin rashes
• conjunctivitis.

35.  Several reports now have shown
that ZIKV can cross the placental
barrier and enter the amniotic
fluid (the protective fluid that
surrounds a developing fetus
within the womb) and attack fetal
nerve cells, including some that
develop into
the brain.
 the virus has been detected in
blood and tissues of fetuses &
infants.

36.  Zika virus infections during pregnancy have
been linked to miscarriage and microcephaly,
a potentially fatal congenital brain condition.
 Zika virus also may cause other neurological
disorders such as Guillain-Barre syndrome.
 Neurological and autoimmune complications
are infrequent, but have been described in the
outbreaks in Polynesia and, more recently, in
Brazil..
 . In adults, the virus is linked to a form of
temporary paralysis.

37.  In addition to microcephaly, other problems have
been detected among fetuses and infants infected
with Zika virus before birth:
 1- Absent or poorly developed brain structures
 2- Defects of the eye
 3- Hearing deficits.
 4- Impaired growth.
 Although Zika virus has been linked with these
other problems in infants, there is more to learn.
Researchers are collecting data to better understand
the extent Zika virus’ impact on mothers and their
children. (cdc )

38.  An increase in Guillain-Barré syndrome (GBS) has been
observed in areas where a Zika virus epidemic has been
documented (e.gFrench Polynesia and Americas).
Recent studies have documented this association.
 GBS occurs when a person’s immune system attacks
itself, in particular affecting the cells of the nervous
system. This process can be initiated by infection with
various viruses or bacteria.
 The main symptoms include :
 1- Muscular weakness.
 2- Tingling (paresthesia) in the arms and legs.
 severe complications can occur if the respiratory
muscles are affected

40.  An usually small head, often accompanied by brain
damage.
 Babies with microcephaly have unusually small
heads. In roughly 15 percent of cases, a small head is
just a small head, and there is no effect on the infant,
according to Dr. Constantine Stratakis, a pediatric
geneticist and a scientific director at the National
Institute of Child Health and Human Development.
 But in the remainder of cases, the infant’s brain may
not have developed properly during pregnancy or may
have stopped growing in the first years of life. These
children may develop a range of problems, like
developmental delays, intellectual deficits or hearing
loss.

48.  Microcephaly can happen for many reasons. Some
babies have microcephaly because of
 1- Changes in their genes.
 2- Certain infections during pregnancy
ex: measles, toxoplasmosis, chickenpox and
cytomegalovirus.
 3- A woman being close to or touching toxins during
pregnancy
 4- Microcephaly may result if a pregnant woman
consumes alcohol, is severely malnourished or has
diabetes.
 There is no treatment for an unusually small head.
 “There is no way to fix the problem

51.  In October 2015, the Brazilian Ministry of Health
reported of increase in the number of babies born
with microcephaly 20-times more than normal.
 5.7:100,000 live births in 2010.
 300:100,000 live births in 2014 .
 As of 23 January 2016, 4,180 cases of suspected
microcephaly, including 68 deaths, had been
reported across 24 states in Brazil
 Normally microcephaly occurs in about 1 in 5,000
to 1 in 10,000 of all births. Scientists analyzing
that 1 in 100 of new borns are having microcephaly
.

54.  Officials in French Polynesia have suspicions
about an outbreak two years ago.
 In 2014-2015, 17 cases of fetal and neonatal
central nervous system malformations were
reported.
 Four of these women were tested and had
detectable IgG antibodies to flavivirus.

56.  Based on the available evidence, we think that
Zika virus infection in a woman who is not
pregnant would not pose a risk for birth defects
in future pregnancies after the virus has cleared
from her blood.
 From what we know about similar infections,
once a person has been infected with Zika
virus, he or she is likely to be protected from a
future Zika infection.(cdc)

57.  It may be that the virus had never struck such a large population
without immunity.
 Microcephaly is rare, and it has many other causes, including infection
of the fetus with rubella (German measles), cytomegalovirus or
toxoplasmosis; poisoning of the fetus by alcohol, mercury or radiation;
or severe maternal malnutrition and diabetes. It is also caused by
several gene mutations, including Down syndrome.
 Until recently, health officials paid little attention to the Zika virus. It
circulated in the same regions as dengue and chikungunya, and
compared with those two painful infections – nicknamed “break-bone
fever” and “bending-up fever” – Zika was usually mild.
 The virus is thought to have reached Asia from Africa at least 50 years
ago. While it may have caused spikes in microcephaly as it first spread,
there was no testing to pin down which of many possible causes was to
blame.
 By November 2015, when Brazil declared a health emergency,
Pernambuco had had 646 such births.

58.  Factors that put you at greater risk of developing
Zika virus disease include:
 1- Living or traveling in countries where there
have been outbreaks. Being in tropical and
subtropical areas increases your risk of exposure to
the virus that causes Zika virus disease. Especially
high-risk areas include several islands of the
Pacific region, a number of countries in Central,
South and North America, and islands near West
Africa. Because the mosquito that carries Zika
virus is found worldwide, it's likely that outbreaks
will continue to spread to new regions.

59.  2- Having unprotected sex. Isolated cases of
sexually transmitted Zika virus have been
reported. The CDC advises abstinence from
sexual activity during pregnancy or condom
use during all sexual contact for men with a
pregnant sex partner if the man has traveled to
an area of active Zika virus transmission.

60.  There is no commercial test available for the Zika
virus.
 Zika virus usually remains in the blood of an
infected person for about a week but it can be found
longer in some people.
 A pregnant woman with no symptoms of Zika virus
infection with a history of recent travel to an area
with active Zika virus transmission can be offered
testing two to 12 weeks after her return.
 Once the test shows that the virus is present the
confirmation of all cases is not necessary, and
laboratory testing will be adjusted to routine
virological surveillance of the disease.

61.  medical and travel history.
 Ask the patient about international trips in
detail and which countries heshe had visit.
 As well as any contact you may have had with
mosquitoes.
 The time and duration of the signs and
symptoms.
 sexual partner.

62.  1- The CDC has
blood tests to look
for Zika virus or
similar diseases such
as dengue or
chikungunya
viruses, which are
spread by the same
type of mosquitoes.

63.  2- Perform an ultrasound to detect microcephaly
or other abnormalities of the brain.

64.  3- Offer to take a sample of amniotic fluid using
a hollow needle inserted into the uterus
(amniocentesis) to screen for Zika virus.

65.  4- Virological Polymerase chain reaction PCR
tests are useful in the first 3-5 days after the
onset of symptoms.

66.  5- serological tests detect the presence of
antibodies but are useful only after five days.

67. 6- Urine 7- Saliva 8- Semen

68.  9- MRI may performed for adult people to lock for
guillain-barré syndrome and other disorders (the
pregnant women should not do this test ).

69.  Other birth defects may be linked to the virus.
 Federal health officials say that newborns should
be tested for infection with the Zika virus if their
mothers have visited or lived in any country
experiencing an outbreak and if the mothers’ own
tests are positive or inconclusive.
 The reason, officials said in interviews, is that
infection with the virus could be linked to defects
in vision and hearing, among other abnormalities,
even if the child does not suffer microcephaly. The
other defects may require further assessments and
testing.

71.  No specific antiviral treatment for Zika
virus disease exists.
 Treatment is aimed at relieving
symptoms with rest, fluids and
medications such as:
 Acetaminophen (Tylenol, others)
 Ibuprofen (Advil, Motrin IB, others) — to
relieve joint pain and fever.
 Drink fluids to prevent dehydration.

72.  There is no vaccine against the Zika virus and it might
take more than 10 years.
 The first vaccine candidate will be trialing is what's
known as a recombinant vaccine, which means it
contains Zika DNA, but not the virus itself.
 The second potential vaccine is 'inactivated', and
contains whole particles of Zika virus that have been
tweaked so that they can no longer replicate or cause
infection - but can still trigger an immune response.
 Testing these vaccine candidates on animals is expected
to take around five months, and after that they'll need to
be tested in humans.
“Source India’s Bharat Biotech company”

73.  Zika is a new virus for the Region of the
Americas. In the past, it had very limited
geographical and demographic
distribution and there was no evidence
that it caused death. However, in the
current outbreak, sporadic cases have been
reported of more serious manifestations
and complications that have sometimes
resulted in death.
 As of 23 January 2016, 4,180 cases of
suspected microcephaly, including 68 deaths,
had been reported across 24 states in Brazil

74.  1- Avoid mosquitoes bites if you are in that area.
 2 do not travel to that areas .
 3. The CDC recommends all pregnant women
avoid traveling to areas where there is an
outbreak of Zika virus.
 4- If she have a male partner who lives in or has
traveled to that areas ,the CDC recommends
protective sex (using condom).
 5- Zika virus transmitted through blood
transfusion (avoid it if possible).

76.  When in areas with Zika and other diseases
spread by mosquitoes, take the following steps:

77. 1- Wear protective clothing (long-sleeved
shirts and long pants) .

78. 2- Stay in places with air conditioning or
that use window and door screens to keep
mosquitoes outside.

79.  3- Sleep under a mosquito bed net if you are overseas
or outside and are not able to protect yourself from
mosquito bites.

80.  4- Use Environmental Protection
Agency (EPA)-registered insect
repellents. When used as
directed, EPA-registered insect
repellents are proven safe and
effective, even for pregnant and
breast-feeding women.
 Always follow the product label
instructions.
 Reapply insect repellent as
directed.
 Do not spray repellent on the skin
under clothing.
 If you are also using sunscreen,
apply sunscreen before applying
insect repellent.

81.  If you have a baby or child:
 Do not use insect repellent on babies younger than 2
months of age.
 Dress your child in clothing that covers arms and
legs
 Do not apply insect repellent onto a child’s hands,
eyes, mouth, and cut or irritated skin.
 Adults: Spray insect repellent onto your hands and
then apply to a child’s face.

82.  Treat clothing and gear with permethrin or
purchase permethrin-treated items.
 Treated clothing remains protective after multiple
washings. See product information to learn how
long the protection will last.
 If treating items yourself, follow the product
instructions carefully.
 Do NOT use permethrin products directly on skin.
They are intended to treat clothing.

83.  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. An
infected mosquito can then spread the virus to other
people.
 Avoid mosqitoes bite .
 Zika virus can be spread during sex by a man infected
with Zika to his sex partners.
 We do not know how long the virus is present in the semen of
men who have had Zika.
 We do know that the virus can stay in semen longer than in
blood.
 To help prevent spreading Zika from sex, you can use
condoms the right way every time you have sex

84.  Zika virus transmitted through blood transfusion
 A blood donor screening test for Zika virus is not currently
available. To reduce the risk of transmitting Zika virus through
blood transfusion in areas where there are no active Zika virus
outbreaks, the Food and Drug Administration recommends not
donating blood for four weeks if you:
 1- Have a history of Zika virus infection
 2- Traveled or lived in an area with active Zika virus transmission
 3- Have symptoms that are suggestive of Zika virus infection
within two weeks of travel from an area with Zika virus
 4- Have had sexual contact with a male partner who has been
diagnosed with Zika virus infection
 5- Have had sexual contact with a male partner who has traveled
or lived in an area with active Zika virus transmission in the past
three months

86.  Health officials in five countries — Brazil, Colombia,
Ecuador, El Salvador and Haiti — and Puerto Rico have
suggested that women delay pregnancy temporarily.
 Once infected residents have recovered and have become
immune, these officials argue, the epidemic will fade and
women can safely become pregnant again. Also, many
companies are working on Zika vaccines, and delaying
pregnancy will buy time for them to arrive.
 The Centers for Disease Control and Prevention recently
recommended that women who have had symptoms of the
virus or tested positive for it should wait at least eight weeks
after their symptoms first appeared before trying to get
pregnant.
 Officials recommended that men who had symptoms should
wait six months before having unprotected sex. The virus has
been known to live longer in semen. Symptoms can
include rashes and sore joints.

87.  Women should be advised to avoid becoming
pregnant while travelling in an area with active
ZIKV transmission. On returning to the UK,
 they should avoid becoming pregnant for a
further 28 days; this allows for a maximum two
week incubation period and possible two-week
viraemia.
 Women whose partner has been to an area with
ZIKV transmission
 for 6 months following recovery if he did
experience ZIKV symptoms during that period

88.  Even if they do not feel sick, travelers returning to
the United States from an area with Zika should
take steps to prevent mosquito bites for 3 weeks so
they do not spread Zika to uninfected mosquitoes.

89.  http://www.cdc.gov/zika/prevention/index.html
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