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Zika virus
This document provides information about the Zika virus. It discusses that Zika is a mosquito-borne flavivirus transmitted by Aedes mosquitoes. While most cases are asymptomatic, symptomatic cases involve fever, rash, joint pain, and red eyes. There is no vaccine or treatment. The virus can be transmitted from mother to fetus during pregnancy and has been linked to microcephaly in newborns. Testing and guidelines are outlined for pregnant women, infants, and preventing transmission. An administrative order in Puerto Rico mandates screening and care for pregnant women due to Zika outbreaks on the island.
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Zika virus
- 1. ZIKA VIRUS Dr. HerminioOlivero ObGyn, FACOG
- 2. What is ZIKAvirus? Mosquito bourne flavivirus Transmitted by Aedes Aegyptus mosquito Found throughout the region of The Americas Dengue and Chikungunya both transmitted by these mosquitoes
- 3. Zika Virus Humansare primary host 80% asymptomatic Symptomatic disease mild compared to dengue and chikungunya Acute onset fever Macular rash Arthralgia Non-purulent conjunctivitis Symptoms last days-1 wk Hospitalization/fatalities rare
- 4. ZIKA Virus Novaccine No prophylaxis to travelers Mosquitoes bite mostly during daylight Long sleeve shirts/pants Repellants with DEET/IR 3535/picaridin safe during pregnancy Infected persons to avoid mosquito exposure during 1st week of illness to avoid human to human transmission
- 5. ZIKA Virus Notreatment Supportive Rest Fluid Analgesic/antipyretic Avoid aspirin, NSAID until Dengue ruled out
- 6. ZIKA Virus infection Intrauterine transmission Intrapartum transmission RNA detected in breast milk but no documented transmission
- 7. ZIKA outbreak inBrasil Zika virus identified in specimens of Brain tissue Placenta/amniotic fluid Infants with microcephaly
- 8. ZIKA virus testing No commercial testing available Diagnosis by molecular and serologic testing RT-PCR for viral RNA IG-Immunoglobulin MELISA for Zika activity PRNT-plasma reduction neutralization test-for Zika antibodies Testing performed at CDC
- 9. CDC guidelines forUS health care providers caring for pregnant women during ZIKA virus outbreak Serologic testing for asymptomatic pregnant women exposed Offered 2-12 weeks after return from travel Pregnant women who reside in areas with ongoing outbreak Testing at initiation of PNC and at mid-second trimester With negative Zika virus IGM testing Routine PNC US 18-20 wks gestation for fetal anatomy US later in pregnancy as follow up
- 10. Pregnant women withpositive or inconclusive ZIKA virus test results Monitor fetal anatomy Monitor fetal growth every 3-4 weeks Referral to maternal-fetal specialists Testing at time of delivery Testing of cord tissue for Zika virus RNA If fetal loss Zika virus RT-PCR of fetal tissue, umbilical cord and placenta
- 11. Preconceptive care forwomen in areas of active Zika virus transmission Plan pregnancy Personal decision Contraceptive methods Assessment of risk Signs and symptoms of Zika
- 12. Men and Womendiagnosed with ZIKA CDC recommends Women to wait 8 weeks before trying to get pregnant Men to wait at least 6 months after symtpons No reported cases of Zika virus transmission through assisted reproductive technology (ART) No evidence of increased risk for future pregnancies
- 13. Prenatal diagnosis ofmicrocephaly Ultrasound is safe during pregnancy Preventive fetal ultrasound at 18-20 weeks Ultrasound findings associated with Zika Microcephaly intracranial calcification Brain and eye anomalies
- 14. Ultrasound accuracy ofmicrocephaly Accuracy to detect microcephaly associated to Zika virus depends on many factors Severity of microcephaly Maternal obesity Gestational age Equipment Expertise Fetal MRI is last screening tool
- 15. Microcephaly Occipitofrontal circumferenceless than 3% If mother potentially infected infant should be tested Test infant serum for Zika virus RNA/Zika virus IgM and ab’s Initial sample from umbilical cord or directly from infant within 2 days after birth If CSF obtained for other studies-perform above testing Consider histopathologic evaluation of placenta and umbilical cord Test mother’s serum if not done during pregnancy
- 16. Guidelines for infantswith microcephaly Microcephaly or intracranial calcification prenatally Positive or inconclusive test for ZIKA Virus Report case Asses for possible long term sequelae Negative test for ZIKA Virus Evaluate and treat for other possible etiologies
- 17. Indications for testinginfants Infant with microcephaly or intracranial calcification born to women who travel or reside in area with active Zika virus transmission Infant born to mothers with positive or inconclusive tests for Zika virus
- 18. No microcephaly or intracranial calcification prenatalyor at birth Positive or inconclusive test for ZIKA virus prior to delivery Thorough physical exam and ZIKA virus testing in infant Positive test- additional labs and evaluation Negative test-routine care No ZIKA virus testing performed prior to delivery Test mother if illness consistent with ZIKA No testing if no clinical illness during pregnancy Positive test- thorough exam an labs Negative test-routine care Negative testing for ZIKA virus prior to delivery Routine care and follow up
- 19. Infants with possibleZika virus infection Comprehensive physical evaluation Head circumference, length and weight for gestational age Evaluate for neurologic abnormalities Dysmorphic features, splenomegaly, hepatosplenomegaly, rash or other skin lesions Cranial ultrasound Hearing – evoked optoacoustic emissions testing or ABR
- 20. Infants with possibleZika virus infection Ophtalmologic evaluation If microcephaly/intracranial calcifications Geneticist evaluation Pediatric neurologist Test for other congenital infections CBC, liver function, imaging studies If positive or inconclusive Zika virus testing-report case to state health department and assess for long term sequelae
- 21. Management and preventionof congenital Zika virus infection No antiviral treatment available Supportive Specific medical and neurodevelopmental needs Encourage breastfeeding To prevent congenital Zika – prevent maternal infection
- 22. Orden administrativa num345 2 de febrero 2016 Para ordenar a los proveedores medicos y aseguradoras sobre cernimiento y cuidado pre y post natal a toda embarazada Declaro estado de emergencia como resultado del Virus ZIKA en Puerto Rico, ordenando a todos los profesionales de la salud notificar todo caso sospechoso y/o confirmado de ZIKA Todo proveedor medico que evalue a una mujer embarazada que presente sintomas asociados al ZIKA se le ordenara realizarse la prueba de PCR-la aseguradora cubrira la toma de muestra
- 23. Orden administrativa num345 Toda mujer embarazada que no presente sintomas, tendra la opcion de hacerse pruebas serologicas para ZIKA y dengue en aquellas areas de alta densidad de transmission segun informes epidemiologicos semanales emitidos por el Departamento de Salud. Las pruebas seran enviadas al Departamento de Salud y la toma de muestra sera cubierta por la aseguradora. Si la prueba arroja un resultado negative se puede considerar repetir la prueba en el Segundo trimestre
- 24. Orden administrativa num345 Si resultado fuese positivo el cuidado prenatal comprende lo siguiente en adicion al cuidado prenatal preventivo Sonogramas cada 4 semanas Ofrecer amniocentesis despues de semana 15 pesando riesgo con su proveedor y muestra sera enviada al Dpt de Salud-cubierto por aseguradora Cuido post natal para madre y bebe con resultado positivo Si nace bebe con microcefalia se recomienda prueba de PCR a cordon umbilical y suero
- 25. ZIKA en PuertoRico Casos reportados en: San Juan, Carolina, Trujillo Alto, Carolina, Caguas, Gurabo, Juncos, Las Piedras, Luqillo, Naguabo, Humacao, Ceiba, Guanica
- 26. ZIKA en PuertoRico Perfil de casos- casos confirmados 19 Edad mediana 42yrs (rango de 10-80yrs) Varones = feminas Embarazadas -1 Hospitalizaciones 3 Guillain Barre 1 Co-infecciones con influenza 1 Pruebas Trioplex en Laboratorio de Salud Publica
- 27.