This is the first time in history that ZIKV has been associated with the development of adverse birth outcomes and has been linked to perinatal transmission. Little is known regarding the natural history, epidemiological transmission patterns, and major risk factors associated with ZIKV. Data on the outcomes of pregnancies in ZIKV infected women as well as specific trimesters when pregnant women are at highest risk for developing an adverse birth outcome remains sparse. This presentation discusses the epidemiological background and history of Zika Virus, preventative methods, and risk factors. In addition, the presentation discusses a research proposal to evaluate potential risk factors associated with the development of adverse birth outcomes in pregnant women with a laboratory confirmed diagnosis of ZIKV versus those Zika Virus infected pregnant women that did not develop adverse birth outcomes in three low-income regions of Northeastern Brazil.
Advisor Live: Zika virus disease – What you need to knowPremier Inc.
Presented as part of Premier’s AdvisorLive® series and co-sponsored by the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC)
This webinar covers:
* Updates and late breaking information on Zika virus outbreak, lab diagnosis and travel,
* Issues for reproductive age and pregnant women, including evaluation, management, counseling, and congenital findings, and
* Implications and risks for healthcare personnel.
EXPERT PRESENTERS:
* Joanne Cono, MD, ScM, Director, Office of Science Quality, Office of the Director, Centers for Disease Control and Prevention (CDC)
* Jeanne S. Sheffield, MD, Director of Maternal-Fetal Medicine and Professor, Johns Hopkins Medicine
* Moderator: Gina Pugliese, RN, MS, Vice President, Premier Safety Institute
Three years ago, the Zika virus was nowhere to be found in the Western Hemisphere. But in 2015, Brazil suddenly found itself in the throes of an unprecedented Zika outbreak — with more than a million people infected by the mosquito-transmitted disease
This presentation summarizes what we know as of 10/27/16 about the connection between Zika virus and microcephaly, and what advice physicians could provide for their patients who are currently pregnant, or planning a pregnancy
Advisor Live: Zika virus disease – What you need to knowPremier Inc.
Presented as part of Premier’s AdvisorLive® series and co-sponsored by the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC)
This webinar covers:
* Updates and late breaking information on Zika virus outbreak, lab diagnosis and travel,
* Issues for reproductive age and pregnant women, including evaluation, management, counseling, and congenital findings, and
* Implications and risks for healthcare personnel.
EXPERT PRESENTERS:
* Joanne Cono, MD, ScM, Director, Office of Science Quality, Office of the Director, Centers for Disease Control and Prevention (CDC)
* Jeanne S. Sheffield, MD, Director of Maternal-Fetal Medicine and Professor, Johns Hopkins Medicine
* Moderator: Gina Pugliese, RN, MS, Vice President, Premier Safety Institute
Three years ago, the Zika virus was nowhere to be found in the Western Hemisphere. But in 2015, Brazil suddenly found itself in the throes of an unprecedented Zika outbreak — with more than a million people infected by the mosquito-transmitted disease
This presentation summarizes what we know as of 10/27/16 about the connection between Zika virus and microcephaly, and what advice physicians could provide for their patients who are currently pregnant, or planning a pregnancy
Shaping the Caribbean's response to Zika, UWI’s Zika Task Force (www.uwi.edu/zika) is gathering and providing expert advice to develop a strategic, scientific approach toward tackling the Zika virus.
What Insurers Can Learn From the Zika Outbreak Gen Re
In the weeks leading up to the 2016 Summer Olympic Games, a few athletes announced they would forgo the games for fear of contracting the Zika virus in Brazil. There’s a good chance athletes aren’t the only ones avoiding traveling to South America. While Zika presents with very minor symptoms that sometimes go unnoticed in adults, it can lead to microcephaly for infants born from mothers who have contracted it.
Read more here: http://www.genre.com/knowledge/blog/
Sujata Ambardar MD, FACP, of Travel Healthcare Services of Northern Virginia shares the latest updates on the Zika virus, including case counts in the US, symptoms, virus infection, travel guidance and prevention,
Neurological and Autoimmune Complications of Zika Virus infection - Slideset ...WAidid
The slideset by Professor Safadi analyses the case control study providing evidence for Zika virus infection causing Guillain-Barré syndrome.
In addition to Zika Virus association with Guillain-Barré syndrome, the slides show new data from endemic areas suggesting that ZIKV may be linked to other neurological outcomes.
Updated Lecture about Zika virus .
Currently I am working in Arar Central Hospital, Arar city
In Saudi Arabia
Please do not hesitate to contact us if you require any further information.
Alsultany@hotmail.com
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 )
Shaping the Caribbean's response to Zika, UWI’s Zika Task Force (www.uwi.edu/zika) is gathering and providing expert advice to develop a strategic, scientific approach toward tackling the Zika virus.
What Insurers Can Learn From the Zika Outbreak Gen Re
In the weeks leading up to the 2016 Summer Olympic Games, a few athletes announced they would forgo the games for fear of contracting the Zika virus in Brazil. There’s a good chance athletes aren’t the only ones avoiding traveling to South America. While Zika presents with very minor symptoms that sometimes go unnoticed in adults, it can lead to microcephaly for infants born from mothers who have contracted it.
Read more here: http://www.genre.com/knowledge/blog/
Sujata Ambardar MD, FACP, of Travel Healthcare Services of Northern Virginia shares the latest updates on the Zika virus, including case counts in the US, symptoms, virus infection, travel guidance and prevention,
Neurological and Autoimmune Complications of Zika Virus infection - Slideset ...WAidid
The slideset by Professor Safadi analyses the case control study providing evidence for Zika virus infection causing Guillain-Barré syndrome.
In addition to Zika Virus association with Guillain-Barré syndrome, the slides show new data from endemic areas suggesting that ZIKV may be linked to other neurological outcomes.
Updated Lecture about Zika virus .
Currently I am working in Arar Central Hospital, Arar city
In Saudi Arabia
Please do not hesitate to contact us if you require any further information.
Alsultany@hotmail.com
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 )
When Ransomware Attacks: Emergency Measures to Save Your BusinessKaspersky Lab
Ransomware is a serious threat to businesses and it’s growing fast! If your computer becomes infected with this dangerous malware, don’t panic. Thankfully, there are still ways to protect your sensitive data and save your system. Follow this guide to protect yourself and your business from ransomware attacks.
https://www.kaspersky.com
Ransomware has troubled many individuals and companies and it has been called the greatest malware threat of 2016. Learn how it works and how to protect yourself.
Tackling the cyber security threat (2016 - v1.0)Rui Miguel Feio
Every day new businesses create their presence online. The internet can be the best way of marketing a product or service and generate new leads and income. But the risks are immense. Every day, hackers compromise websites and get hold of confidential data. When this happens, this can mean the end of your business. What can you do to prevent this from happening?
The New Threat on Campus: Ransomware Locks Down EducationCode42
Educational organizations are quickly becoming frequent victims of ransomware. Several factors make education a top target for cybercriminals. Find out why (and how to respond) in this SlideShare.
Zika Virus: Medical Countermeasure Development Challenges by Robert W. MaloneJan-Cedric Hansen
Reports of high rates of primary microcephaly and Guillain–Barré syndrome associated with Zika virus infection in French Polynesia and Brazil have raised concerns that the virus circulating in these regions is a rapidly developing neuropathic, teratogenic, emerging infec- tious public health threat. There are no licensed medical countermeasures (vaccines, thera- pies or preventive drugs) available for Zika virus infection and disease. The Pan American Health Organization (PAHO) predicts that Zika virus will continue to spread and eventually reach all countries and territories in the Americas with endemic Aedes mosquitoes. This paper reviews the status of the Zika virus outbreak, including medical countermeasure options, with a focus on how the epidemiology, insect vectors, neuropathology, virology and immunology inform options and strategies available for medical countermeasure develop- ment and deployment.
Stephen Rawlings, MD, PhD
Clinical Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Outbreak! Learning about Zika Transmission and TestingDanielle Snowflack
In this lesson, students will explore transmission and diagnosis of infectious diseases using the recent Zika outbreak as a model. First, students will use a simple model to simulate the spread of an infectious disease through a population. Next, they will use the Enzyme Linked Immunosorbent Assay (ELISA) to test patient samples for Zika. The results will be summarized in a laboratory report.
From Discovery to Delivery: Benchwork to Global Health: Shiu-Lok HuUWGlobalHealth
Explores relationships and discrepancies between important research-based medical advancements and subsequent real world implementation. Advancements in the management and potential elimination of infectious diseases such as HIV and TB will be addressed, as related to development and implementation of effective diagnostics, vaccines, or treatments.
Covid-19 Brief Review | A holistic review at pandemic Akhtar Hussain
Presentation holistically and briefly covers the technical aspects of global pandemic. To put things in perspective a comparison woth recent pandemics is also included.
I have tried to make the presentation as rational and unbiased. Though with the ever coming developments daily some things might become redundant even in 10 days only. would love to get suggestions for improvement.
From Discovery to Delivery: Benchwork to Global Health: Jerry CangelosiUWGlobalHealth
Explores relationships and discrepancies between important research-based medical advancements and subsequent real world implementation. Advancements in the management and potential elimination of infectious diseases such as HIV and TB will be addressed, as related to development and implementation of effective diagnostics, vaccines, or treatments.
Similar to Zika Virus: An Emerging Arboviral Threat of 2016 (20)
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Team 5: Ruchi Pancholy, Shelli Jensen, Stephanie Volpe, & Intoch Dieth
PHC 6006 Epidemiological Methods of Infectious Diseases
Final Disease Presentation
May 1, 2016
Zika Virus: An Emerging Arboviral
Threat of 2016
2. Background
Aedes aegypti
Aedes albopictus
What is Zika Virus (ZIKV)?: A Viral Mosquito Borne Disease Transmitted to Humans
Single Stranded
RNA Virus
In Utero & Sexually
Three Known Strains
3. ZIKV History
Figure 1. Reference: Peterson, Jamieson, Powers, Honein (2016). Zika Virus. Retrieved from:
http://www.nejm.org/doi/full/10.1056/NEJMra1602113 on April 28, 2016.
4. Disease Transmission
Primary Reservoir: Humans; Other Reservoirs: Monkey
Human Incubation Period: Although unknown; if similar to other arboviruses, average
of 2-7 days
Mosquito Incubation Period: Average of 7-10 days
Primary Mode of Transmission: Mosquito to Human to Mosquito Cycle
Other Modes of Transmission
-Intrabirth transmission, newborn of a viremic mother
- Sexual Transmission
- Transfusion of Infected Blood Products (3% of donated blood samples for ZIKV
Outbreak in French Polynesia)
To date, transmission via breast milk not documented.
6. Clinical Features
Asymptomatic 80%; 20% of exposed become ill.
Symptoms include:
Rash (90-95%), Fever (65-73%), Joint Pain (65-70%),
& Non-Purulent Conjunctivitis (55-63%)
ZIKV Associated Complications:
Congenital Microcephaly in ZIKV infected mothers
Guillain-Barre Syndrome (GBS)
Rarely fatal (Mortality<1%)
Treatment of ZIKV: Supportive therapy
7. ZIKV Complications
Figure 3. Microcephaly Figure 4. GBS
Reference: Connelly, D. & Macdonald, A. (2016). Origins of the Zika Outbreak and its potential threat. The Pharmaceutical Journal, 296 (7886).
Retrieved from: http://www.pharmaceutical-journal.com/news-and-analysis/features/origins-of-the-zika-outbreak-and-its-potential-
threat/20200765.article.
8. Diagnostic Testing
Diagnostic Assay Timing for Diagnostic
Assays/Days Post-Illness Onset
RT-PCR < 8 days
MAC-ELISA (IgM antibody Tests) < 4 days (Up to several months
after onset
Plaque Reduction Neutralization
Test
> 4 days
Where is testing performed?
CDC Arboviral Diseases Branch
Several State Health Departments
- Demonstrating four fold or
greater rise in antibody titer
- The antibody titer will
positive after 5th day of
illness only
9. Case Definitions for ZIKV
Suspect Case: Patient exhibiting rash, fever (> 37.2 C) and one or more
of the following symptoms: joint pain, conjunctivitis, headache, or
malaise (not explained by other medical conditions)
Probable Case: A suspected case with presence of IgM antibody
against ZIKV and an epidemiological link.
Confirmed Case: A suspected cases with a laboratory confirmed
diagnosis through one or more tests
10. ZIKV Affects Approximately 2 Million
Individuals Across the Globe
Figure 5: Countries and territories where Zika Virus cases have been reported (as of April 7, 2016), WHO
Reference: World Health Organization [WHO] (2016). Zika Situation report. Retrieved from: http://www.who.int/emergencies/zika-
virus/situation-report/7-april-2016/en/ on April 28, 2016
13. ZIKV in Brazil
Brazil: The leading country with greatest
incidence of ZIKV & Congenital Microcephaly
Cases
Population of 202 million residents and
country is divided into 5 regions.
The epicenter of our proposed research study
is: Region Nordeste.
In 2015: Approximately 440,000-1,300,000
laboratory confirmed ZIKV cases reported
So far in 2016: A total of 1,046 ZIKV cases
reported
14.
15. Distribution of Microcephaly in Brazil
Figure 10. Reference: Teixeira et al. (2014). The Epidemic of Zika Virus-Related Microcephaly in Brazil: Detection, Control, Etiology, and Future Scenarios.
American Journal of Public Health, 106(4), 1-15.
Brazil’s Northeast
Region, (N=3,003, 79%)
16. ZIKV Preventative Measures
To date, no vaccine is available.
However, several research groups are investigating potential vaccines
which are under the planning phases of development (Table 1).
Table 1. Zika Virus Vaccine
Candidates
Bharat Biotech Recombinant
live
Inovio Pharmaceuticals DNA
Sanofi Pasteur DNA
National Institute of Health DNA
17. ZIKV Preventative Measures
Alternate Preventative Strategies Includes:
Targeted, Public Health Messaging to the Public including:
Avoiding mosquito bites
Wearing long sleeved clothing
Using mosquito bed nets when sleeping outside
Applying insect repellent containing DEET
Wearing clothing treated with permethrin
Using condoms during sexual intercourse
Avoiding travel to disease endemic countries
Using air conditioning versus window screens
Multiple Preventions Efforts Varying by Country: Mainly focus on reducing adult
mosquito population density & larviciding
18. Team 5: ZIKV Research Proposal
Project: Case control study to evaluate risk factors associated with the development of adverse birth
outcomes (microcephaly) in pregnant women with a laboratory confirmed diagnosis of ZIKV
Research Question: Do ZIKV infected pregnant women differ in their exposure status than those ZIKV
infected pregnant mothers who did not develop an adverse birth outcome upon delivery?
Pre-Existing Comorbidities Microcephaly
Diabetes, hypertension, dengue, chikungunya
Exposures Adverse Birth Outcome
Study Sample: Total of 411 Pregnant Laboratory Confirmed ZIKV patients admitted for delivery into
one of several maternal health facilities located in three Brazilian low-income regions:
Bahia, Rio de Grande Norte, and Rio de Janeiro.
Cases: 211 cases with adverse birth outcomes (microcephaly) upon delivery
Controls: 200 ZIKV infected pregnant women that did not develop an adverse birth outcome upon
delivery
Methods: Medical record abstraction of all study participants, initial telephone interviews to recruit
participants, and administration of telephone interviews by trained community health workers assessing
demographic data, clinical symptoms, timing of symptoms, and risk history.
19. Cultural Issues to Consider
Demographic Factors of Study Population:
58% percent of residents in Northeast Region reside in poverty
Overall high morbidity & mortality rates for chronic & infectious
diseases in this region
Low level of marital support: 40% of women residing in Natal,
capital of Rio de Grande Norte, Brazil headed a single-family
household (Edmond et al., 2011).
Low literacy and educational levels
Women are typically housewives while husband may be
unemployed or underemployed
Transportation barriers and poor access to a local health center
20. Future Directions
Table 2. Zika Virus What is Known & Unknown
Known Factors More Info Needed on:
1 Trimesters during which ZIKV infected
women are most likely to develop
microcephaly
Current evidence points to 1st and 2nd
trimesters; additional studies are
needed to confirm this
2 ZIKV clinical symptoms & duration of
symptoms
Immune response, pathophysiology,
demographic factors of pregnant
ZIKV infected women developing
adverse birth outcomes
3 Estimated attack rates from previous
arboviral outbreaks
Natural history of ZIKV
4 Modes of ZIKV disease transmission Understanding of non-mosquito
modes of transmission
21. Future Directions
Where are We Going?
ZIKV is likely to spread exponentially across the world, esp. the Americas due to increased air
travel, migration, global trade, and denser human and mosquito populations
Previously unexposed individuals will be at greater risk in future
Non-endemic regions will experience new cases (esp. due to climate change and global
warming)
What Needs to be Done?
A vaccine product protective of all possible ZIKV strains, post-exposure prophylaxis, and/or
drugs need to be tested & developed soon
Evaluate vector competence of mosquito populations to assess risk of future transmission &
spread
Development & Validation of Additional Laboratory and Rapid Point of Care Diagnostics
22. Reasons to Support Funding
The adverse birth outcomes observed in newborns can be prevented if more is known
concerning the risk of ZIKV infection
Classified by the World Health Organization as a Public Health Emergency of International
Concern (PHEIC)
Definition: serious, sudden, unusual or unexpected
Vector borne diseases are not contained to one geographical area, but is determined by the
habitat of the vector, A. aegypti, which is found on all continents, excluding Antarctica
The number of suspected cases is on the rise, as is the number of countries with confirmed
cases, meaning this is spreading globally
23. Selected References
Campos, G., et al. (2015). Zika virus outbreak, Bahia, Brazil. Emerging Infectious Diseases, 21(10). Retrieved from: http://wwwnc.cdc.gov/eid/article/21/10/15-
0847_article.
Centers for Disease Control and Prevention [CDC]. (2016). Zika virus disease in the United States. Retrieved from: http://www.cdc.gov/zika/geo/united-
states.html.
Central Intelligence Agency [CIA] (2015). Brazil Demographics Profile 2014. Retrieved from: http://www.indexmundi.com/brazil/demographics_profile.html..
Connelly, D. & Macdonald, A. (2016). Origins of the Zika Outbreak and its potential threat. The Pharmaceutical Journal, 296 (7886). Retrieved from:
http://www.pharmaceutical-journal.com/news-and-analysis/features/origins-of-the-zika-outbreak-and-its-potential-threat/20200765.article.
Council of State & Territorial Epidemiologists [CSTE]. (2016). Zika Virus Disease and Congenital Zika Virus Infection Interim Case Definition and Addition to the
Nationally Notifiable Diseases List. Retrieved from: https://www.cste2.org/docs/Zika_Virus_Disease_and_Congenital_Zika_Virus_Infection_Interim.pdf.
Dupont-Rouzeyrol, M., et al. (2015). Co-Infection with Zika and Dengue Viruses in 2 Patients, New Caledonia, 2014. Emerging Infectious Diseases, 21 (2), 381-
2. Retrieved from: https://www.researchgate.net/publication/271600742_Co-infection_with_Zika_and_Dengue_Viruses_in_2_Patients_New_Caledonia_2014.
European Centre for Disease Prevention and Control (ECDC). (2015). Zika virus infection. Retrieved from:
http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/zika-outbreak/Pages/zika-outbreak.aspx.
Fauci, A., & Morens, D. (2016). Zika Virus in the Americas- Yet Another Arbovirus Threat. The New England Journal of Medicine, 1-3.
Florida Department of Health, Mosquito-Borne Diseases (2016). Florida Arbovirus Surveillance, Week 16: April 17-23, 2016. Retrieved from:
http://www.floridahealth.gov/diseases-and-conditions/mosquito-borne-diseases/_documents/2016/week16arbovirusreport-4-23-16.pdf.
Ioos, S., (2014). Current Zika virus epidemiology and recent epidemics. Med Mal Infec, 44(7).
Malone, R., Callahan, M., Glasspool-Malone, J., Damaidaran, L. (2016). Zika Virus: Medical Countermeasure Development Challenges. PLOS Neglected
Tropical Diseases. Retrieved from: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004530.
24. Selected References, cont’d
Teixeira, M., Oliveira, W., Rodriques, L., Costa, M., & Lavocat, M. (2016). The Epidemic of Zika Virus-Related Microcephaly in Brazil: Detection, Control,
Etiology, and Future Scenarios. American Journal of Public Health, 106 (4), 601-605. Retrieved from:
https://www.researchgate.net/publication/297722424_The_Epidemic_of_Zika_Virus-
Related_Microcephaly_in_Brazil_Detection_Control_Etiology_and_Future_Scenarios.
Wilson, M., & Schlagenhauf, M. (2016). Aedes and the triple threat of DENV, CHIKV, ZIKV-Arboviral risks and prevention at the 2016 Olympic Games. Travel
Medicine and Infectious Diseases, 14(1), 1-4. Retrieved from: https://www.clinicalkey.com/#!/content/1-s2.0-S1477893916000120?transactionId=.
Yakob, L. & Walker, T. (2016). Zika virus outbreak in the Americas: the need for novel mosquito control methods.Lancet, e148-e149. Retrieved from:
http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(16)00048-6.pdf.
World Health Organization [WHO]. (2016). Zika virus disease. Retrieved from: http://who.int/csr/disease/zika/case-definition/en/.
World Health Organization [WHO]. (2016). Zika Situation Report. Retrieved from: http://www.who.int/emergencies/zika-virus/situation-report/7-april-2016/en/.
Maurice, K. (2016). WHO reveals its shopping list for weapons against Zika. Lancet. Retrieved from : http://www.ncbi.nlm.nih.gov/pubmed/26913304.
Musso, D. et al. (2015). Potential Sexual Transmission of Zika Virus. Emerging Infectious Diseases, 21(2), 359-360. Retrieved from:
https://www.researchgate.net/publication/271830017_Potential_sexual_transmission_of_Zika_virus.
Pan American Health Organization [PAHO]. (2016). Zika Virus Infection. Retrieved from:
http://www.paho.org/hq/index.php?option=com_topics&view=article&id=427&Itemid=41484&%3Ehttp://www.paho.org/hq.
Peterson, L., Jamieson, D., Powers, A., Honein, M. (2016). Zika Virus. The New England Journal pf Medicine, 374, 1552-1563. Retrieved from:
http://www.nejm.org/doi/full/10.1056/NEJMra1602113.
Soares de Arujo, J., Regis, C., Gomes, G., Tavares, T., Rocha de Santos, C, Assuncao, P, et al. (2016). Microcephaly in northeastern Brazil: a review of 16,208
births between 2012 and 2015. Bull World Health Organization. Retrieved from: http://www.who.int/bulletin/online_first/16-170639.pdf?ua=1.
Hello everyone. Our presentation is on Zika Virus, an Emerging Arboviral Threat of 2016.
BACKGROUND
ZIKV is a viral mosquito borne disease transmitted to humans, which was initially identified in the blood of a rhesus monkey in the Zika Forest of Uganda in 1947. It is a single-stranded RNA virus, of which there are 3 known, distinct lineages (Nigerian Cluster, MR766 Cluster, and the Asian Genotype).
It is primarily Transmitted by the bite of the Aedes Aegypti and Albopictus mosquitoes which are aggressive daytime biters. Other possible transmission routes are: mother to child (in utero), sexual transmission. Mosquito to human, and infected human to non-infected mosquito.
Approximately 80% of individuals are asymptomatic and 20% will experience: a mild fever similar to dengue fever, rash, joint pain, and conjunctivitis lasting several days to a week.
To date, there is no treatment or vaccine for ZIKV. Treatment only focuses on relieving pain and symptoms associated with the disease. Supportive therapy including rest, getting plenty of fluids, applying cold compresses to inflamed joined, and use of NSAIDS is recommended. However, aspirin use is discouraged due to risk of hemorrhage and Reye’s Syndrome.
A yellow fever study in 1947 led to the isolation of the virus from the blood of a macaque in the Zika forest of Uganda.
Human infection was suggested because serosurveys indicated the presence of Zika antibodies in some African and Asian population
The first human illnesses occurred in Nigeria during 1953.
Zika virus remained silent for almost 70 years until a 2007 outbreak on several Pacific islands including the Federated States of Micronesia resulted in approximately 5, 000 infections among the total population of 6,700.
Outbreaks continued in French Polynesia from 2012-2014 which involved 32,000 individuals and cases of Guillain–Barré syndrome were observed during that time.
ZIKV was initially identified in the Americas in Brazil in March 2015, where an ongoing outbreak is occurring. By March 2016, the virus subsequently spread to at least 33 countries and territories in the Americas as depicted in Figure 1.
By September 2015, investigators in Brazil also noted an increase in the number of infants born with microcephaly in the same areas in which Zika virus was first reported,38 and by mid-February 2016, more than 4300 cases of microcephaly had been recorded.
Later, in French Polynesian investigators retrospectively identified an increased number of fetal abnormalities, including microcephaly, after the Zika virus outbreak occurred in that country.
The primary reservoir are humans and other reservoirs in Africa includes non-human primates.
Although the human incubation period for ZIKV is unknown, if it is similar to other arboviruses, it has an average incubation of: 2-7 days following the bite of an infected mosquito.
The Mosquito Incubation Period ranges from: an average of 7-10 days between intake of an infected blood meal to when mosquitos can transmit the virus to humans
The primary mode of transmission is through a mosquito to human to mosquito transmission cycle.
Other reported modes of transmission includes: intrabirth transmission (mother to fetus), sexual transmission, and transfusion of infected blood products occurring in 3% of donated samples were infected with ZIKV during a 2013 outbreak occurring in French Polynesia.
Sexual transmission has been reported in males travelling abroad to disease endemic countries and returning back to non-endemic areas. In one instance, sexual intercourse and transmission of ZIKV occurred only before the onset of symptoms, whereas in other cases sexual intercourse occurred during the development of symptoms.
To date, transmission via breast milk is not documented. Although, breast milk of a symptomatic woman with ZIKV on day of delivery consisted of infective ZIIKV particles in high titer.
Please note that the duration of symptoms after sexual transmission and other modes of transmission are not documented in the literature yet.
This image to the left depicts the life cycle of ZIKV virus in Africa showing the connection b/t the sylvatic cycle on the left and the urban cycle on the right.
In Africa, ZIKV circulates in a sylvatic cycle among forest-dwelling Aedes mosquitoes and monkeys. In this setting, sporadic infections could occur.
In urban settings including the Americas, ZIKV is primarily transmitted by Ae. aegypti through a mosquito to human to mosquito transmission cycle.
In this cycle, mosquitoes bite an infected person, infected mosquitos bite healthy individuals, and then healthy individuals become sick/infectious-cycle continues.
Aedes aegypti mosquitoes can infect multiple humans (approximately 4-5 people) within a single blood meal and they reside in close proximity to human populations.
80% of individuals infected with ZIKV are asymptomatic while 20% of those exposed will develop flu-like symptoms including: rash being the most common symptom seen in 90 to 95% of all symptomatic cases, a mild fever, joint pain, and conjunctivitis.
However, in some cases Congenital Microcephaly in ZIKV infected mothers during the first two trimesters of pregnancy and Guillian-Barre Syndrome has been observed.
Substantial evidence now indicates that Zika virus can be transmitted from the mother to the fetus during pregnancy and result in adverse birth defects including: microcephaly. Microcephaly is ……
The timing of the Zika virus and microcephaly epidemics in Brazil and French Polynesia indicate that the greatest risk of microcephaly is in the first trimester.
In addition, a number of cases in past outbreaks as well as recently infected cases have reported: Guillian-Barre Syndrome.
Clinically, the disease is very similar to dengue. Misdiagnosis is not unusual. Therefore differential diagnosis of illness includes: dengue fever, WNV, and Chikungunya viruses.
The virus can be detected via RT-PCR testing within the first week of clinical illness up to day 8 from initial onset of symptoms. The diagnosis can also be confirmed by a four-fold or greater rise in antibody titres to ZIKV virus antigen in paired serum samples. Also, presence of ZIKV IgM antibody, which is usually detectable in serum collected from day 5 after onset, provides a presumptive diagnosis.
The considerable cross-reactivity of flavivirus antibodies presents major challenges for the interpretation
of serologic test results. For example, Zika virus infection may also evoke a positive ELISA result for dengue. The plaque reduction neutralization test (PRNT), is the most specific test used to differentiate antibodies
of closely related viruses, and can be used to help verify the ELISA results.
Testing is performed at CDC Arboviral Diseases Branch and several reference labs located in state health departments throughout the country.
In 2016, ZIKV become a nationally notifiable disease in the US and the Council of State and Territorial Epidemiologists (CSTE) developed the following case definition for a suspected case: “a patient with rash or elevated body temperature (> 37.2 C) with one or more of the following symptoms (not explained by other medical conditions): joint pain, conjunctivitis, headache or malaise” in someone who resides in or has visited epidemic or endemic areas within two weeks prior to the onset of symptoms (PAHO).
A probable ZIKV case is defined as a “suspected case with presence of IgM antibody against ZIKV and an epidemiological link” (WHO, 2016).
A confirmed case of ZIKV infection is defined as: “a suspected case with a laboratory confirmed diagnosis of ZIKV, which includes the presence of ZIKV RNA or antigen in serum or other samples (e.g. urine, saliva, tissues, whole blood) or IgM antibody against ZIKV and exclusion of other flaviviruses identified through one or more tests” (PAHO, 2016).
Surveillance also includes:
Informing and evaluating women who traveled to areas with ZIKV transmission while they are pregnant.
Evaluating fetuses of women infected during pregnancy for microcephaly.
ZIKV currently affects approximately 2 million residents in 62 countries and territories since the beginning of 2016.
To date, local transmission has been identified in 43 countries or regions throughout the Americas (including Puerto Rico, Caribbean Islands, Central and South American countries & the Pacific Islands.
Zika virus has been found in total of 62 countries, including countries where only sexual transmission has taken place.
Zika is now found in North and South America, Asia, Africa and the Pacific Islands.
ZIKV associated Microcephaly has been reported in Brazil, the United States, Cabo Verde, Colombia, French Polynesia, and Panama.
As of April 20, 2016, a total of 426 laboratory confirmed Zika virus disease cases have been reported from 50 U.S. states between 2015-2016. To date, no locally acquired cases have been reported in the continental US. All of the cases were travel-associated to disease endemic countries.
Of the 426 cases, 33 (9%) were reported in pregnant women, 8 (2%) were sexually transmitted, and one resulted in Guillian Barre Syndrome.
The State of Florida reported the largest number of cases (N=84, 20%) followed by New York State with 60 cases.
In US territories including: Puerto Rico, US Virgin Islands, and the American Samoa, a total of 500 lab confirmed locally acquired Zika cases were identified and a total of 3 travel associated cases were reported.
Zika virus became a notifiable disease in 2016 and establish case definitions were established by CSTE.
To date, Florida reports largest number of travel associated ZIKV cases in the Continental United States (N=94), (January-April 27, 2016).
The top three counties reporting the largest number of reported cases were: Miami-Dade (N=39), Broward (N=15), & Palm Beach (N=5).
Brazil leads the world with the greatest incidence of ZIKV, as nearly 440,000-1,300,000 cases occurred in 2015, and to date a total of 1,046 cases were reported in 2016 (
Brazil has a total population of: 202 million residents and the country is divided up into 5 regions as depicted on the image at the top right. The Nordeste or Northeast region has reported the highest number of ZIKV & Microcephaly cases and this is the epicenter of our proposed research study.
In 2015, approximately 440,000-1,300,000 laboratory confirmed ZIKV cases were reported in Brazil.
To date in 2016, a total of 1,046 ZIKV cases were reported.
Brazil has reported the first Zika outbreak in the Americas in 2015 and the first and largest number of Zika virus associated microcephaly cases.
Based on the epidemiological curve in this slide, the Brazil Ministry of Health has identified a total of 3,050 microcephaly cases in the country in 2015 and during the first two weeks of January 2016, a total of 728 cases were reported.
Of the 3,778 cases reported in 2015 and early 2016, a total of 3,003 (79%) cases were identified within the Northeast Region of Brazil, one of the nation’s poorest areas that has overall poverty rate of 58%.
The second highest number of cases during this time period were reported in the Southeast region of Brazil with a total of 483, making up 13% of all cases. The southeast region is another area marked by poverty as compared to the northern and Midwest regions of the country.
To date, no vaccine is available but several research groups are investigating potential vaccines which are under the planning phases of development as depicted in Table 1.
An effective ZIKV response strategy involves policy change, federal funding, aggressive testing of potentially infected ZIKV cases, proactive vector control measures, and targeted public health messaging towards high risk groups.
Targeted public health messages includes issuing travel advisories encouraging women of reproductive age not to travel to disease endemic countries, avoiding mosquito bites by: wearing long sleeved clothing, remaining indoors, applying deet, and using air conditioning versus window screens.
Multiple prevention efforts vary by country and the majority are focusing on: reduction of mosquito breeding sites and reducing adult mosquito population density. The strategies employed by Brazil are depicted in the bottom images.
Statement of Problem: This is the first time in history that ZIKV has been associated with the development of adverse birth outcomes and has been linked to perinatal transmission. Little is known regarding the exposures that may be associated with development in adverse birth outcomes in some ZIKV infected pregnant mothers versus those that do not develop any outcomes.
We are proposing a case control study to evaluate risk factors and exposures associated with the development of adverse birth outcomes (microcephaly) in pregnant women with a laboratory confirmed diagnosis of ZIKV and gain insight into the development of future vaccination recommendation, screening guidelines, and interventions for women of childbearing age. The risk factors include:
Multiple exposures will be measured to explore associations among the risk of developing adverse birth outcomes among infected pregnant women including: a previous arboviral infection with dengue and/or chikungunya, co-infections with one or more illnesses including: chronic hypertension, diabetes, sexually transmitted diseases (gonorrhea, HIV, syphilis) and/or arboviral diseases (dengue and chikungunya), travel within the past 14 days of illness onset, age at pregnancy, smoking, alcohol and/or drug use during any stage of pregnancy etc., and socioeconomic variables (e.g., type of employment, household income, marital status, etc.). The primary outcome measure for this study is the development of adverse pregnancy outcomes among women infected with Zika virus.
We will attempt to answer the research question: Do ZIKV pregnant infected women different in their exposure status (e.g., have concurrent infection with one or more chronic, sexual, arboviral infections or have a lower socioeconomic status) than those ZIKV infected pregnant mothers who did not develop an adverse birth outcome upon delivery?
An example of one exposure we will look at is: presence of a pre-existing comorbidity such as diabetes or dengue with ZIKV in a pregnant mother and the development of an adverse birth outcome.
The study sample consists of a total of 411 Pregnant Laboratory Confirmed ZIKV patients admitted for delivery into one of several maternal health facilities located in three Brazilian low-income regions:
Bahia, Rio de Grande Norte, and Rio de Janeiro. Cases will include 211 ZIKV infected pregnant mothers that developed an adverse birth outcome upon delivery. Controls includes 200 ZIKV infected pregnant women that did not develop an adverse birth outcome upon delivery.
Medical record abstraction and brief telephone interviews will be conducted to recruit participants. Telephone interviews will be conducted by culturally competent, trained community health workers. The training of field staff will encompass a week long work shop covering topics in cultural competence, safety, and ethics in conducting research with women of reproductive age, and resources to redirect the women to access counseling and support services.
The individuals in our study population experience a vulnerable socioeconomic situation that can further exacerbate their overall health.
Some of the cultural factors to consider are the demographics of our study population.
58% of residents in Northeast Region reside in poverty and they are of the most socially disadvantaged groups residing in the nation. There are overall high morbidity and mortality rates for all diseases in this region.
The women typically receive very little marital support in raising a child as the majority of households consist of women heading a single-parent family (40%).
Women were typically housewives while their husbands remained unemployed (32%), educational levels, and literacy rates are low.
The majority of women residing in these regions do not own public transportation and their closest health center is typically located within a 20-mile radius
Inequality and discrimination against women is significant as the incidence of poor maternal health outcomes remains high, and many women do not have adequate resources or support to raise a healthy child further exacerbating the cycle of poor health and poverty in low-income regions of Brazil.
A thorough understanding of these factors are important as they will inform our research team on whether inequalities and barriers are resulting in a significant disproportion of poor, minority women facing the greatest maternal health challenges and placing them at an increased risk for developing ZIKV associated microcephaly.
This program deserves to be funded for a number of reasons. Not only is ZIKV considered a public health emergency of international concern by the World Health Organization, but these adverse birth effects that have been associated with the virus can possibly be prevented. It is also evident that the disease can continue to spread to other parts of the world, as seen by the increasing number of cases. Infectious diseases are preventable and that means that no one should have to suffer when something is avoidable. It is important to fund this program not only to prevent the effects seen in newborns, but also to help their families. No one should have to suffer from a preventable disease, which is why this study should be funded.
-Here are a list of references we used to compile our presentation and we encourage you to peruse them for further information.